Can Mental Illness Prevent Me From Sustaining Full-Time Work Even If I Can Do Some Activities?

Can Mental Illness Prevent Me From Sustaining Full-Time Work Even If I Can Do Some Activities?

Why Attendance, Reliability, Off-Task Time, and the Ability to Function Throughout a Workweek Matter in a Social Security Disability Claim

You can make yourself a sandwich.  People make sandwiches for a job sandwich shops everyday.

You can make your bed.  Hotels hire people to make up beds.

You can drive some.  Taxi companies and Uber hire folks to do the same thing.

You may watch television, use your telephone, pay a few bills, or attend church.

On a good day, you may even accomplish quite a bit.  Does that mean you can work full-time?

Not necessarily.

One of the most important distinctions in a Social Security Disability claim is the difference between being able to perform an activity and being able to sustain competitive employment.

A job generally requires more than the ability to do something once.  An employer expects you to:

Show up when scheduled.

Arrive on time.

Remain at work throughout the day.

Understand and remember what you are supposed to do.

Stay focused.

Maintain an acceptable pace.

Interact appropriately with supervisors and coworkers.

Handle ordinary changes and workplace stress.

And then come back the next day and do it again.

For someone suffering from severe depression, anxiety, PTSD, bipolar disorder, or another mental-health condition, that ability to function regularly, reliably, and consistently may be the real problem.

The important question is not simply: “Can you do something?”  It is: “Can you do what an employer requires, throughout a normal workday and workweek, on a regular and continuing basis?”

That question brings together everything we have discussed throughout this series.

Recommended Reading: Social Security Is Not Asking Are You Disabled-They Are Asking Whether You Can Maintain Steady Employment

A Job Is More Than a Collection of Individual Tasks

Suppose someone asks:  “Can you fold towels?”  Yes.

“Can you put something into a box?”  Yes.

“Can you warm up some soup?”  Yes.

Does that prove you can maintain full-time employment?  No.

A real job is not a five-minute demonstration of individual abilities.  An employee may have to perform tasks repeatedly throughout the day.

The employee must maintain attendance.

Work at an acceptable pace.

Respond to supervisors.

Deal with interruptions.

Adjust when something changes.

The ability to perform one isolated task therefore does not necessarily establish the ability to sustain the combined demands of competitive employment day in and day out.

The Four Mental Abilities We Have Discussed Work Together

Throughout this series, we have looked at four broad areas Social Security specifically considers when evaluating adult mental impairments:

1. Understanding, remembering, or applying information;
2. Interacting with others;
3. Concentrating, persisting, or maintaining pace; and
4. Adapting or managing oneself.

These categories are useful.

Real life, however, rarely fits neatly into four separate boxes.  Imagine a supervisor gives you a new assignment.

First, you must understand and remember the instructions.

Then you have to concentrate and persist long enough to complete the assignment.

You may have to interact appropriately with the supervisor and coworkers.

If something changes or goes wrong, you must adapt.

And you must do all of those things often enough and reliably enough to remain employed.  That is why the final question in this series is so important:

Can you sustain all of these abilities together throughout a normal workweek?

Attendance May Be the Problem Even If You Can Do the Job

Consider someone who can perform relatively simple work when present, but severe depression causes that person to remain in bed several days each month.

Or PTSD symptoms periodically become so severe that leaving home is impossible.

Perhaps anxiety produces unpredictable panic attacks.

Bipolar symptoms cause periods of significantly impaired functioning.

The problem may not be whether the person knows how to perform the job.  The problem may be: Can the person show up often enough to keep it?

Competitive employment ordinarily requires regular attendance, and if medically determinable impairments would cause excessive absences, that can become a significant vocational issue.

There Is No Universal Social Security Rule Allowing a Certain Number of Absences

This is worth emphasizing.  You may hear statements such as:

“Social Security allows two absences per month,” or “If you miss three days a month, you’re automatically disabled.”

That is too simplistic.  There is no universal regulation establishing one magic number of absences that automatically determines disability in every case.

At a disability hearing, a vocational expert may testify concerning the attendance tolerance of employers for the jobs being considered, and that testimony can become extremely important-but the specific vocational evidence matters.

The question is whether the limitations established by the evidence are compatible with the requirements of competitive employment.

Recommended Reading:  What is the Vocational Expert?

Coming to Work Is Only Part of Attendance

Attendance is not limited to whole days missed.  Someone may:

Arrive late.

Leave early.

Need to leave unexpectedly because of panic symptoms.

Miss part of the day for treatment.

Be unable to return after becoming overwhelmed.

Need frequent breaks away from the workstation.

Those problems can affect reliability even when the employee technically appears for work most days.  So, the better question is not merely “How many days would you miss?”  It may also be “Can you reliably remain at work for the entire scheduled workday?”

What If I Am at Work but Cannot Stay on Task?

Physical presence is not the same as productive work.  Imagine an employee who arrives every morning and remains at the workstation for eight hours, but throughout the day:

The employee loses concentration.

Needs repeated redirection.

Experiences intrusive thoughts.

Takes unscheduled breaks.

Makes mistakes and has to redo work.

Works much more slowly than expected.

The employee is physically present-but is the employee maintaining competitive productivity?

That is a different question.

Recommended Reading: How Do Problems With Concentration, Persistence, and Pace Affect a Social Security Disability Claim? That article explains why being capable of performing a task is different from being able to stay focused and complete it at an acceptable pace.

Off-Task Time Can Be Extremely Important

“Off task” generally refers to periods when an employee is supposed to be working but is not productively performing the assigned duties.  Mental-health symptoms may cause off-task behavior in many ways.

Severe anxiety may consume attention.  PTSD may cause intrusive thoughts or hypervigilance.

Depression may substantially slow functioning.  Panic attacks may interrupt the workday.

Medication may cause sedation.  Chronic pain may interfere with concentration.

Again, the more pertinent questions are: How frequently does this occur?  How long does it last?

Again, there is no universal regulatory percentage of off-task time that automatically establishes disability, and vocational testimony concerning employer tolerance can become particularly important on this issue.

Recommended Reading: Can the Side Effects of My Medication Help My Disability Claim?

What If I Need More Breaks Than Other Employees?

Most jobs allow ordinary breaks.  The problem arises when your medical conditions require additional unscheduled breaks.

Suppose anxiety causes you to leave your workstation several times a day; or panic attacks require twenty or thirty minutes before you can regain control.

Perhaps depression causes periods when you simply cannot continue.  Maybe medication causes severe fatigue.

The relevant questions are the practical ones:

How many additional breaks do you need?

How long are the unscheduled breaks?

Can you control when they occur?

Can you return to work afterward?

Would an employer tolerate these additional breaks?

A person who can perform a task for thirty minutes at a time may still have difficulty sustaining an eight-hour workday if substantial recovery periods are required between those episodes.

“But I Have Good Days.” 

Most people with chronic medical conditions do.  The existence of good days does not necessarily establish an ability to work; likewise, having bad days does not automatically establish disability.

The important issue is the pattern over time.

Suppose you function relatively well three days each week, but two days each week your symptoms are severe enough that you accomplish very little.  At home, you may simply postpone things.  The laundry can wait.  The grass can wait.  The grocery shopping can wait.

Competitive employment is different.

Your employer usually cannot reorganize the workplace every time you have a bad day.  That is why frequency matters.

How many bad days occur?

How severe are they?

How long do they last?

Could you still meet an employer’s attendance and productivity requirements?

Social Security Should Not Judge Your Ability to Work by Your Best Day

Mental-health conditions frequently fluctuate.  Someone with bipolar disorder may experience periods of substantial improvement followed by significant deterioration.

PTSD symptoms may intensify after particular triggers.

Depression may vary in severity.

Anxiety may be manageable at times and overwhelming at others.

Looking at one good office visit—or even a period of temporary improvement—may not describe how the person functions over time.  Social Security’s regulations require evaluation of mental functioning on a sustained basis, and the longitudinal medical record can be particularly important for episodic conditions.

Daily Activities Need Context Too

A disability claimant’s daily activities are relevant evidence, but broad descriptions can be misleading.  Consider: “She cooks.”

Does that mean she prepares complex meals every evening?  Or microwaves frozen food?

“He shops.”

Does he spend two hours alone in a crowded store?  Or use grocery pickup because anxiety prevents him from entering?

“She cleans.”

Does she clean the entire house in one afternoon?  Or wash dishes for ten minutes, stop, and finish them the next day?

“He watches television.”

Does he follow complicated programs for hours?  Or repeatedly lose track of what is happening?

The fact that someone performs an activity does not tell us:

How well?

How often?

For how long?

With what assistance?

At what pace?

With what breaks?

Those details can be critical.

 

You Usually Control Your Activities at Home

There is another major difference between daily activities and work.  At home, you often control the environment.  You decide when to start.

You can stop.

You can lie down.

You can postpone something.

You can avoid people.

You can work slowly.

You can try again tomorrow.

You may have family members helping you.

At work, your employer usually controls much more of the environment.  The employer determines:

When you arrive.

When you leave.

When breaks occur.

What task you perform.

How quickly it must be completed.

What changes occur.

What level of productivity is acceptable.

That difference can be enormous for someone with a serious mental-health condition.

Mental Limitations Often Compound One Another

This may be the most important lesson from the entire series.  Suppose a claimant has:

A moderate problem remembering complicated instructions; difficulty concentrating for extended periods; experiences significant anxiety around strangers; has difficulty accepting criticism or has substantial problems dealing with unexpected change.

Viewed separately, each limitation may sound manageable, but jobs do not require those abilities separately.  The worker has to use them together, and the combined effect may be much greater than any single limitation viewed in isolation.

Physical and Mental Conditions Can Compound Each Other Too

The same principle applies when someone has both physical and mental impairments.

Suppose a claimant has severe back pain and depression. The back condition limits lifting, standing, and walking.  Pain interferes with concentration and poor sleep leads to fatigue.  Depression affects motivation and pace.  Prescribed medication causes drowsiness and nausea.  Individually, each separate ailment may not provide significant limitations, but Social Security does not necessarily evaluate each impairment as though the others disappear.  Under 20 C.F.R. §§ 404.1523 and 416.923, the combined effect of medically determinable impairments must be considered.

Recommended Reading: What Is Residual Functional Capacity and Why Does It Matter in My Social Security Disability Claim? RFC should reflect the combined functional effects of the limitations established by the evidence.

 

What Does “Regular and Continuing Basis” Mean?

When Social Security determines Residual Functional Capacity, it evaluates the most a person can do despite limitations on a regular and continuing basis.

SSR 96-8p explains that a regular and continuing basis generally means 8 hours a day, 5 days a week, or an equivalent work schedule.

That concept is critical.  The question is not “Could you do this for an hour?”  It is not “Could you do it once?”  And it is not “Could you do it during your best week of the year?”

The RFC analysis asks what you can sustain with the frequency and consistency normally required for work.

 

What Happens at the Disability Hearing?

This is where the vocational evidence can bring all of these limitations together.

An Administrative Law Judge may ask a vocational expert to assume a person with a particular RFC.  The hypothetical may include limitations involving:

• Simple instructions;
• Social interaction;
• Workplace changes;
• Production pace;
• Additional breaks;
• Off-task time;
• Absences; or
• Other restrictions supported by the evidence.

The vocational expert may then testify about what jobs, if any, could be performed, and their testimony may change dramatically as limitations are added.

That is why vocational evidence can become so important in mental-health disability claims.

 

 

The Law

Under 20 C.F.R. §§ 404.1520a and 416.920a, Social Security evaluates adult mental impairments by considering four broad areas of mental functioning:

1. Understanding, remembering, or applying information;
2. Interacting with others;
3. Concentrating, persisting, or maintaining pace; and
4. Adapting or managing oneself.

Section 12.00 of the Adult Listing of Impairments explains these functional areas and directs Social Security to evaluate whether a claimant can function independently, appropriately, effectively, and on a sustained basis.  If the impairment does not meet or medically equal a Listing, Social Security generally proceeds to determine the claimant’s Residual Functional Capacity.

Under SSR 96-8p, RFC concerns the ability to perform sustained work-related activities on a regular and continuing basis, generally meaning eight hours a day, five days a week, or an equivalent work schedule.

The RFC assessment is more detailed than simply assigning paragraph B ratings. It should reflect the work-related mental and physical limitations supported by the complete record.

At the later stages of the sequential evaluation process, Social Security considers whether the claimant can perform past relevant work or adjust to other work considering that RFC and the applicable vocational factors.

The Bottom Line

A mental-health disability claim should not be reduced to: “Can you do this activity?”  The better question is: “Can you sustain the demands of competitive employment?”

The central question is whether your medically determinable impairments allow you to function regularly, reliably, productively, and consistently enough to sustain competitive work.

That is where all of the individual mental limitations we have discussed in this series ultimately come together.

Experience With Social Security Disability Claims

At Powell & Denny, P.C., we have extensive experience representing individuals whose physical conditions, mental-health conditions, or combination of impairments prevent them from sustaining employment. Mental-health disability claims frequently require looking beyond the diagnosis—and beyond isolated examples of things a person can occasionally do—to determine whether the individual can meet the attendance, concentration, productivity, interaction, adaptation, and reliability requirements of competitive employment.

A diagnosis tells Social Security what condition you have.

The four areas of mental functioning help explain how the condition affects you.

The Residual Functional Capacity analysis asks the ultimate vocational question: What can you still do, regularly and reliably, despite all of your limitations?

An experienced Social Security Disability attorney can evaluate your medical evidence together with your vocational factors to determine how the law applies to your specific situation.  At Powell & Denny, we have represented injured and disabled workers throughout Alabama for more than 30 years. We understand that serious claims are rarely decided by a diagnosis alone. They are decided by how the injury affects the person’s ability to function, work, and earn a living.

If you have questions about an Alabama Workers’ Compensation claim, or a claim for Social Security Disability benefits, don’t hesitate to contact the experienced attorneys at Powell and Denny today a free consultation; remember. Virtual appointments are available through Zoom so you can meet with one of the attorneys of Powell and Denny from wherever you live, and remember-there is no fee unless you win.

Powell & Denny: We Work When You Can’t.

Offices in Birmingham, Alabama and Huntsville, AL