By Martha A. Churchill

A.  Who needs to prove an additional work related impairment?
B.  How do you prove it?

For someone with a developmental disability, the Social Security office has three ways of deciding if the person is disabled.

The rule, called a "Listing," says that you need to prove an I.Q. of 70 or below.  Usually, the psychological test provides three IQ scores: verbal, performance, and full-scale. For Social Security purposes, look at the lowest of the three numbers. If it is 59 or less, no additional work-related impairment need be shown. If the lowest number is in the 60-70 range, the additional impairment must be proven

If the IQ is below 60, that is sufficient all by itself; there is no need to prove an additional work-related impairment or anything else.

If the lowest IQ score for the person is in the 60-70 range, though, it is necessary to prove the presence of an additional work related impairment. Every judge has his or her own idea how serious the additional impairment needs to be.  Some judges will allow any additional impairment, no matter how slight.  Others require a really debilitating condition before granting benefits.

How do you prove it?

It all boils down to one thing:  Convincing the Social Security judge that a particular individual is unable to work, full-time, in the competitive job market, due to the mental impairment.  For those in the 60-70 IQ range, a little something extra is required, an additional impairment that affects the person's ability to work.

Additional impairments are easy to miss.  Family members have a blind spot when it comes to identifying the person's other disabilities.  There are enough problems to go around.  We family members want to look at the person’s good qualities rather than dwelling on the negative.  

I remember watching the movie "Rain Man" and realizing, for the first time, that my brother was affected by autism.  Where my brother is concerned, I can't be objective.  I just want to see the good in him.  But for purposes of Social Security, and proving a disability, someone has to take a close look at the person and identify their true difficulties.

Even teachers and other professionals may overlook the additional problems faced by an individual with a developmental disability, or fail to mention such things in reports, because everyone is trying to think positive.

I am in favor of positive thinking. But for Social Security purposes, it is important to be realistic.

Here are some of the additional work-related impairments which should be looked for. This is not a complete list. These items are simply intended to start you thinking along the lines of what could be considered an "impairment."

• Arthritis, or any other orthopedic disability.  Even mild joint pain.
• Auditory impairment. The person may not be not deaf, but a hearing impairment could affect his or her ability to work. (Note: hearing impairments are not considered a problem if the person can hear okay with a hearing aid.)
• Autism or autistic features. This may be present, even though not formally diagnosed in the psychological report. Does this individual rock back and forth? Stay to himself? Engage in pedantic monologue? Doesn’t get jokes and figures of speech? See if a psychologist will evaluate for either autistic features, or possibly Asperger Syndrome, a mild form of autism. Bring those symptoms to the attention of the judge even if it is not formally diagnosed.
• Back pain. Although the pain might not be debilitating, by itself, it can impair job performance. The same goes for knee pain, etc.
• Clumsy, awkward. Klutz. Tends to break things. Tends to fall down frequently. Poor coordination.
• Depression. Even mild forms of depression or dysthemia, if chronic, can qualify as a work impairment.
• Diabetes. Mild numbness or tingling in arms or legs is an impairment; so is occasional difficulty with eyesight.
• Dermatological. It is hard to work effectively with painful itchy skin or rashes.
• Facial disfigurement. Scars, birthmarks, or other deformities can make an individual less "marketable" to employers. Also, look for involuntary muscle movements or tics.
• Financial difficulties. Does this person have enough judgment to pay the rent and budget for groceries? What about counting change, making purchases? If the individual doesn’t know how much change to expect when buying a candy bar with a five dollar bill, bring that to the judge’s attention. Do not hesitate to ask for a representative payee if necessary; it will enhance your chances of success in proving the underlying disability.
• Heart problems. If the person lacks stamina, or can't do overhead work, that may reduce the number of jobs that might be available, so it is a work-related impairment.
• Imaginary pain. Hypochondriacs are less productive, and that is a job impairment! The pain may be "all-in-your head," but it still hurts. If it’s bad enough, "imaginary" pain may qualify the person for benefits pursuant to Listing 12.07, Somatoform Disorder.
• Infantile mannerisms. Uses baby-talk. Walks up to strangers and hugs them. Excessively dependent. Any of these characteristics would impede employability.
• Instant gratification. Unable to focus on a paycheck two weeks hence; needs to be rewarded for his or her work immediately. That shows a lack of sound judgment. A person like that is less employable.
• Learns slowly; needs to be given extra instructions, or repeated instructions, to learn a new task. Must be given demonstrations and taught in small stages. This is a bad sign for employment. The boss wants workers who catch on quick.
• Manual dexterity is impaired. Clumsy with hands; cannot use fingers effectively to manipulate small objects.
• Medication side-effects, such as sleepiness, frequent urination, or stomach pain. (Frequent urination is a work impairment!)
• Obesity. Being overweight is a definite hindrance in the workplace. So is being too thin. Any appetite disturbance affects one’s work performance. Obesity is often a sign of other physical problems, such as difficulty breathing, or joint pain.
• Obsessive-compulsive behavior. The person cannot complete tasks in the workplace if he or she is constantly arranging and rearranging objects in the work area, washing hands, collecting old rags, or counting flowers in the wallpaper.  See OCD.
• Personality disorder. This is very often overlooked. Some psychologists don’t even bother giving a diagnosis for this, because there is no treatment. Even so, it is an extremely effective argument for disability.  See Personality.
• Respiratory problems. Asthma, allergies, or any other difficulties breathing, may not prevent the person from working-- but these problems sure don’t help! Any physical problem which affects the available job base, is a "work related impairment."
• Seizures. Even petit mal seizures, which do not occur frequently, may affect employability.  See seizures.
• Sleep disorders. Inability to sleep regular hours is a serious impediment to staying alert and productive on the job.
• Slow. Needs extra time to complete tasks. Moves like he/she is swimming in molasses. The Social Security rules provide that in order to be employable, the person must be able to complete tasks in a timely manner. The boss wants the job done now, not later.
• Speech impairment. Slow speech, difficulty communicating, unwillingness to speak, etc. Nearly every job, including factory assembly work, requires the ability to communicate effectively with boss and coworkers.  See speech
• Supportive environment. Family or friends "help" this individual with cooking, shopping, socializing, or transportation.
• Unable to take instructions. You try to show him a faster, more efficient way to do a task, and he says "No! I’ll do it my way," and proceeds to perform the task very slowly and inefficiently. Inability to take instructions is a serious job limitation. Get a report from the vocational counselor or other appropriate professional.
• Urinary incontinence. Having to go to the bathroom frequently, or change an undergarment during working hours, may affect employability.
• Visual impairments. If the person can wear glasses, and see with average vision, fine. But what if the person has visual problems, even with glasses, and is not totally blind? What if wearing glasses helps some, but does not solve the problem? Any visual problems can contribute to a reduction in the available job base, and qualify as an additional work-related impairment. How can you work when you can’t see clearly?

You may be wondering if these annoying problems are not serious enough to mention to the Social Security office, since there are a few employers out there who offer job accommodations. Forget about the "nice" boss.  

Do not overlook evidence of disabilities just because there are a few "good" bosses out there who will hire the disabled. The standard for Social Security is the commercial job market, not the extra-special employer who bends over backwards and helps those in need.