- She has nightmares
- He is struggling with significant symptoms of depression and anxiety
- The claimant made several errors on a “Serial Sevens” task
Symptoms of depression and anxiety are common manifestations of a variety of mental disorders. But, symptoms of depression and anxiety can also be expressed by individuals with mild mental disorders and by those with no mental disorder at all. In reviewing records in a disability claim, I often read psychotherapy progress notes indicating that the claimant was observed to be anxious or that he exhibited symptoms of depression. The psychotherapist may then conclude that the claimant is disabled and cannot work at all at his usual occupation or any occupation. Yet, the report did not provide examples of behaviors exhibited by the claimant demonstrating that the symptoms interfere with usual functioning in such areas as daily activities or social relationships, or that the symptoms precluded work.
In order to identify mental processing problems, some mental health professionals utilize a task in which the claimant is asked to subtract numbers from another number or spell certain words backwards. On the basis of errors on such tasks, a claimant was described as totally disabled for all work because of impairments of attention, concentration and memory. Yet, this claimant’s cognitive functioning was normal, except for the problems noted, and was not precluded from working as a result of cognitive impairments. Clearly, a problem in counting backwards or spelling a word backwards does not prevent an individual from working in all occupations.
CONCLUSIONS: I often note that medical documents purportedly demonstrating disability do not include objective findings that substantiate mental impairments that preclude work. It is not enough to describe the claimant’s subjective report of psychological symptoms or to state that a claimant is anxious or depressed. In order to prove that a claimant cannot work in any occupation, treating or examining doctors must provide up-to-date clinical findings, backed-up by behavioral observations or psychological test data that document mental impairments that result in significant loss of capacity to function.
Dr. Clayman practices forensic and clinical psychology in Boston, MA, USA. He can be reached at 617 782-8355. More information about Dr. Clayman's areas of expertise can be found at his website by clicking on the Articles button.