Building a Successful
Schizophrenia Case

Administrative Law Judges and disability examiners may find that a claimant suffers from schizophrenia to such an extent so as to be unable to secure and hold a job.  As such, these claimants may be entitled to a social security disability award if certain requirements are met.  The mental disorder schizophrenia is defined in the DSM IV, published by the American Psychiatric Association, and this definition has been adopted by the Administration for its listing of this medical condition.

Traditionally, a person suffers from schizophrenia if he experiences delusions, disorganized behavior, hallucinations, incoherent thinking, and a simple abnormal perception of reality.  The disorder is quite complex and often difficult to prove without concrete medical evidence.  Some examples of schizophrenic behavior include hallucinations, paranoia, disorganized speech and thinking, emotional withdrawal, and the inability to manage basic needs such as hygiene.  A claimant suffering from schizophrenia may present two different arguments to support his claim: falling under the Administration’s listing and arguing reduced functional capacity.

The First Winning Strategy

Satisfying the 12.03 Listing Requirement

The Social Security Administration has developed descriptions of medical or mental health problems, known as “listings.”  Claimants meeting these descriptions suffer from problems so severe that the Administration automatically recognizes them as disabled.  Although these listings help to reward claimants quickly, it is difficult to prove the requirements necessary to meet a listing.  Many listing cases are approved at the initial application stage; however, some are not as apparent and must be argued in front of an administrative law judge.

Claimants suffering from schizophrenia should argue that the condition is so severe, thereby meeting the Social Security Administration’s listing at 12.03.  To be considered under this listing requires concrete and thorough evidence.  Of utmost importance is documentation from a claimant’s treating psychiatrist, which identifies the specific elements of the abnormal behavior described in the listing.  Medical records should be detailed, updated, and complete, so that a judge may accurately examine the case.

In addition to proving the actual mental disorder schizophrenia, the listing also requires evidence that the claimant has activity limitations that would impact his capacity to work.  A claimant’s doctor can aid in describing these limitations.  He/she can review the 12.03 listing and then create a narrative report or checklist, which details exactly how the claimant meets the listing and work limitations. These documents are very persuasive in a hearing and allow the judge to rely on a medical expert’s advice to make a determination of benefits.

A social security listing is difficult to prove and requires complex medical evidence.  Because a claimant may be immediately awarded benefits based on a listing, they are designed to be difficult to meet.  The disability examiners and Administrative Law Judges look for specific records and medical language, required for listing approval. Although it is a difficult argument to win, with the right records, preparation, and testimony, a claimant suffering from schizophrenia can be successful in a disability award.

The Second Winning Strategy:

Residual Functional Capacity

The functional capacity argument is often more successful and easier to prove than a listing argument.  This strategy revolves around the idea that a claimant’s capacity to perform standard, simple job related activities is so diminished by schizophrenia that the claimant is unable to obtain and hold an unskilled job for a standard work week.  Many claimants use this functional capacity argument when their schizophrenia symptoms are severe, yet do not meet the requirements under the 12.03 listing.

The functional capacity strategy requires evidence of the specific limitations that would impact a claimant’s ability to function in a simple, unskilled, low stress job.  A judge usually evaluates the case in reference to whether the claimant could work in a position that requires little to no training, involves primarily sitting, with the ability to change his position, and involves little to no interaction with others. Some examples of these types of jobs include:

• small parts assembler
• ticket taker at a move theater
• surveillance system monitor
• hand packer

In order to evaluate a claimant’s capacity in relation to these types of jobs, a judge will ask a vocational expert to testify.  This expert will testify about the claimant’s prior working conditions, as well as minimally demanding jobs that currently exist.  The judge will then take this testimony, as well as the medical professional’s testimony into account when making his decision.

A functional capacity argument is most successful when specific work limitations are specified in relation to the claimant’s condition or medications.  Further, when these limitations are so severe that they prevent a claimant from completing a work day, the argument becomes more solid.  Some examples of these limitations include the following:

• the need to take frequent unscheduled breaks
• the likelihood of missing numerous days of work
• the likelihood of suffering an emotional breakdown at work
• problems with social interaction
• inability to follow simple instructions
• difficulty concentrating and focusing
• experiencing audio or visual hallucinations
• experiencing feelings of paranoia or delusions

This is not an exhaustive list and a claimant may suffer from symptoms not listed, yet is equally important in his evaluation.

Conclusion – A Doctor’s Opinion is Vital

The Social Security Administration recognizes schizophrenia as a disability because a claimant’s symptoms may be so severe that he is completely unable to perform basic job functions.  A medical professional can aid a claimant to this end by detailing the claimant’s condition and how it may impact work.  Additionally, using the 12.03 listing as a guide, a doctor may be able to better word his documentation to reflect the specifics that the Administration looks for in these types of cases.  Finally, it is always best in these complex and difficult cases to seek the advice of an attorney who can help prepare the case and the vital medical testimony.