Evaluation of Posttraumatic Stress Disorder

Evaluation of Posttraumatic Stress Disorder


Background


Posttraumatic Stress Disorder (PTSD) is an important impairment to consider in the Social Security disability program, but not always easily identified. Consequently, we are preparing guidance to assist reviewers. We believe you and other members of our stakeholder community, such as individuals with PTSD, their advocates, private industry and state representatives, federal partners, health care providers, members of the academic and research community, and others, have insight that could help to inform our efforts.


We are specifically requesting input in the following areas, but welcome all insight. We want to hear from you!


1. How should we consider evidence about a claimant’s behavior and functioning from non-professional sources, such as parents or friends?

2. What lesser-known symptoms of PTSD might be helpful for adjudicators to know about, and what professional sources support this information?

3. What indicators can be used to rule out PTSD as an impairment, and what professional sources support this information?


This initiative coincides with our release of a final rule, Revised Medical Criteria for Evaluating Mental Disorders, which became effective January 17, 2017. The revised criteria now include new listings for trauma- and stressor-related disorders for both adults (listing 12.15) and children age 3 to attainment of age 18 (listing 112.15). You can review the final rule HERE.


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Campaign: Evaluation of Posttraumatic Stress Disorder

Opinions

Though parents and friends opinion should not be the sole means of evaluating a claimant’s behavior, however it should be taken into great consideration due to the daily interaction they experience.

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Linda Landry

Dear Social Security Administration: Thank you for this opportunity to comment on evaluations of trauma related disorders. I agree with the comments submitted by Kevin Liebkemann, Legal Services of New Jersey, Emilia Sicilia, Urban Justice, and Jen Burdick, Community Legal Services. I will not repeat their comments. I want to stress that the failure of decision-makers to consider whether a person with a trauma related ...more »

Submitted by (@llandry)

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Response submitted on behalf of Community Legal Services

Dear Social Security Administration: Thank you for the opportunity to provide comments on the following three questions about evaluating Post-traumatic Stress Disorder and other trauma and stressor disorders. CLS agrees with the comments offered by Kevin Liebkemann and Emilia Sicilia. 1. How should we consider evidence about a claimant’s behavior and functioning from non-professional sources, such as parents or friends? ...more »

Submitted by (@jburdick)

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Children with ODD

Following up on comments offered by Kevin Liebkemann and Emilia Sicilia, many children diagnosed with Oppositional Defiant Order have underlying trauma. Since ODD has been removed from the new Children Mental Impairment Listings at 112.08, it is very important that adjudicators not write off children with ODD diagnoses but explore for trauma issues. Guidance similar to that in SSR 09-2p, which requires adjudicators to ...more »

Submitted by (@kcallery)

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Friend/Family Evidence Should Be Fully Considered

1. How should we consider evidence about a claimant’s behavior and functioning from non-professional sources, such as parents or friends? Answer: Evidence from non-professional sources is highly valuable in cases involving trauma. For many of the reasons documented in other comments, PTSD and other trauma-related disorders are underdiagnosed. (See submission from Kevin Liebkemann noting intermittent nature of symptoms, ...more »

Submitted by (@esicilia)

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More on Lesser Known Symptoms

What lesser-known symptoms of PTSD might be helpful for adjudicators to know about, and what professional sources support this information? a. Chronic sleep deprivation Chronic partial sleep deprivation is a known symptom of trauma or stressor related disorders. In our experience adjudicators often misunderstand its effects perhaps due to not fully understanding the impact it can have on function. When we mention chronic ...more »

Submitted by (@kliebkemann)

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Family and Friend Input

Many of the symptoms of post-traumatic conditions that produce functional limitations and behaviors are severe but intermittent. For that reason it is critical for adjudicators to consider evidence from non-professional sources in conjunction with evidence from professional sources. It is consistent with the nature of the post-traumatic impairments that particular symptoms might not be consistently present and observable ...more »

Submitted by (@kliebkemann)

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Family and Friend input

I think it is important to consider what friends and family have to say about PTSD symptoms for two reasons. 1. The family and friends see the patient and may be aware of symptoms that the patient cannot/will not admit they have or are unaware of. 2. The medical records for some are not as descriptive, they may not be complete and/or the patient may not want to admit the full scale of issues they are experiencing because ...more »

Submitted by (@julieengland)

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What lesser-known symptoms of PTSD important for adjudicators?

Some of the (lesser known?) symptoms might include irritability, social anxiety (not wanting to go out in public, avoiding crowded places), self-medicating with alcohol / drugs, emotional withdrawal from friends/family, depression, etc. The symptoms of PTSD are quite similar to those of depression, and also nearly identical to those of POST-CONCUSSION SYNDROME / MILD TRAUMATIC BRAIN INJURY. For example, many of our returning ...more »

Submitted by (@patti.goodall)

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Gathering information re: PTSD claimant’s behavior, functioning.

Very important to identify and use external sources to establish further corroborating evidence of a claimant's behavior and functioning, particularly in the area of PTSD. The symptoms / results of PTSD are often not readily seen in an office examination or via telephone interview, but can be triggered when a person is under stress or in certain situations (e.g., being in crowds, loud noises, kids screaming). Therefore, ...more »

Submitted by (@patti.goodall)

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