Opinion ID: 487727
Heading Depth: 2
Heading Rank: 3

Heading: Treatment of Mental Illness

Text: 24 The Secretary's treatment of mental disabilities has long been criticized. Indeed, in 1984, Congress specifically amended the Social Security Act to require the Secretary to revise the criteria for assessing mental disorders to realistically evaluate the ability of a mentally impaired individual to engage in substantial gainful activity in a competitive workplace environment. 90 The Secretary, in promulgating the mandated revisions, noted: 25 One of the major changes is in listing 12.03 where language has been added to ensure that the chronic schizophrenic individual who may have his or her symptoms attenuated by treatment but who still cannot work because of more subtle manifestations of his or her disorder will now meet the severity of the revised listing. This had been the major area of criticism and a principal area of deficiency in the former regulations. 91 26 Two areas where these revised regulations are especially pertinent to this case involve the evidentiary requisites to a finding of disability 92 and the fact that one characteristic of mental illness is the presence of occasional symptom-free periods. Like the unique evidence appropriate for proving psychiatric disability, the normal course of mental illness distinguishes it from broken bones. The administrative law judge attached great--indeed, decisive--importance to appellant's ability to work in 1969, after the onset of his schizophrenia. 93 However, sporadic ability to work is typical of the disease, not inconsistent with disability: 27 While the mere existence of symptom-free periods may negate a finding of disability when a physical ailment is alleged, symptom-free intervals do not necessarily compel such a finding when a mental disorder is the basis of the claim. Unlike a physical impairment, it is extremely difficult to predict the course of mental illness. Symptom-free intervals, though sometimes indicative of a remission in the mental disorder, are generally of uncertain duration and marked by an impending possibility of relapse. Realistically, a person with a mental impairment may be unable to engage in competitive employment, as his ability to work may be sporadically interrupted by unforeseeable mental setbacks. 94 28 The Secretary, in the revised listings, has explicitly acknowledged that total disability is not incompatible with this pattern of alternating active and residual phases. In the preamble to the rules, he observed that [i]ndividuals who have a medically documented history of one or more episodes of acute symptoms ... may have a remission either induced by treatment or by living in a supportive environment, but emphasized that [m]any such individuals remain disabled because they experience a return of symptoms and signs when they encounter stressful circumstances or when they leave the supportive environment. 95 The revised regulations specifically note that [s]ome individuals may have attempted to work or may actually have worked during the period of time pertinent to the determination of disability. 96 Thus, mere ability to attempt employment during some symptom-free intervals does not negate disability, 97 at least for periods of inability to work. 98 In particular, the Secretary appropriately should consider both the length of time on the job and the reasons for leaving, 99 as well as the likelihood, frequency, and severity of relapses in [appellant's] mental illness. 100 29 The administrative law judge failed altogether to consider whether appellant's ability to work for a time in 1969, rather than being dispositive of his claim for disability benefits, in fact constituted only a period of temporary remission not incompatible with a finding of total disability. Both medical evidence 101 and lay testimony 102 support this possibility and bear on the relevant factors here established. 103 On remand, the Secretary should reconsider the effect of appellant's 1969 employment in light of this evidence and his recognition that schizophrenia's basic pattern of alternating episodes of acute and less acute symptoms means that occasional amelioration of symptoms does not preclude a finding of total disability. 104