u/Rdh88jags

Over the last few weeks I have seen a few comments on posts about needing two years of mental health records for mental health claims. DDS is going to request the same records date range regardless, but lets take a look at where this "two year" messaging comes from and where it has become distorted.

DDS will request one year prior to your protected filing date or your potential onset date. In concurrent T2 and T16 cases, it will be the earlier date. Depending on a few narrow circumstances, they may request something earlier, but this is usually for some targeted test or specific exam.

With the mental listings, there are three component paragraphs: A and B on all listings, and C criteria. The "A" criteria is symptoms or requisite criteria that is specific to the impairment. The "B" paragraph is the functional criteria that is divided up into four components: 1. Concentration, persistence, and pace. 2. Understand and remember. 3. Social function. 4. Adapt. To outright meet a listing, you need to have two "marked" or one "extreme" limitation in these areas. (The ratings are non, mild, moderate, marked, and extreme.)

The final paragraph is not applicable to every listing. The "C" criteria is for disorders that are serious and persistent. The gist of the paragraph is that when someone has been engaged in very intense levels of treatment for two years but have a limited response to treatment and remain in a somewhat fragile state, they can still meet the listing without marked limitations. The paragraph has two parts, needing both "Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder" AND "Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life."

The C criteria is commonly applied to schizophrenia/ delusional/ psychotic disorders and bipolar disorder. The people meeting this criteria are usually institutionalized or have some type of supportive housing because it has been well demonstrated that they cannot function alone. Having shorter mental health holds is NOT equivalent to this criteria. Also, many people who do meet this are not applying themselves and are doing so with the aide of the agency giving them care.

Alleging an earlier onset date will not change the dates of records requested. If you are worried about applying because you do not have two years of records, you do not need them. If you are waiting to apply because you read that on here, you are doing yourself a disservice.

This is meant to serve as a quick understanding of how SSA/DDS evaluates medical source opinions. Meaning, when you have a doctor fill out something that states what your limitations are, how does DDS weigh that information while assessing your RFC/MRFC.

There are 5 factors, but two are a bit more meaningful than the others.

The first is SUPPORTABILITY. This means "how does the opinion stack up with exam information provided by the source?" If the opinion says Mr. Smith can only stand 2 hours in a day and they conduct an exam that shows an ataxic gait, limited motor function, and +romberg, this would likely be a reasonable opinion.

The second is CONSISTENCY. This is stacking the opinion against the majority of the other exams in file. So if one provider says you are very limited in function, but you have multiple others that have normal exams, the opinion may not be consistent with the other evidence in file.

Those are the two big ones.

The third is RELATIONSHIP WITH THE CLAIMANT. This is divided into subcategories like length of treatment relationship, frequency of exams, and purpose of the relationship. You will note that a CE examiner's opinion takes a hit on this because they are providing a one time opinion off one exam.

The fourth is SPECIALIZATION. Obviously, if the opinion comes from a specialist in the area of the impairment the limitations are based on, it carries more weight. (You would be surprised the amount of psychiatrists who will say pain limits the claimant's ability to work!)

The fifth is OTHER factors. This is a bit broad, but it mostly is going to refer to programmatic knowledge and case knowledge. When DDS orders a CE, a little bit of information is selected to be sent over to give the consultative examiner to have some background info. This is usually under 30 pages of information, so naturally their opinion would be limited from someone who is going to have an opinion based off all of the medical records in file (like the MC/PC).

Also of note: many people order their case file and may see an CE report that says something like "marked limitations" as being recommended, but DDS did not choose to accept that opinion. One thing to keep in mind, is your examiner sees reports from that CE provider many times per year. They know some CE providers may have a tendency to over or under rate limitations. Combined with the fact that it is a one time exam and from a source that does not have your entire case file at hand, it is normal for DDS to not find these opinions persuasive.

This information is sourced from DI 24503.025. If you are thinking about having a treatment source submit an opinion, thinking about these factors may help guide you to think about which of your sources would provide the most valuable information.