Psychiatric Disability

Question 1

Rate of Malingering in Disability Evals

Answer 1

20-30%

Question 2

Significant Point About Disability Defs

Answer 2

Vary - need to know def being used

Question 3

AMA Impairment

Answer 3

“significant deviation, loss, or loss of use of any body structure of function”

Question 4

AMA Disability

Answer 4

Activity limitations and/or participation restrictions

Question 5

Impairment Rating

Answer 5

% est loss of activity and limitations of ADLs

Question 6

Maximum Medical Improvement

Answer 6

Status were person to get “as good as he gets” from available tx, and date from which further recovery/deterioration no longer anticipated

Question 7

AMA Guides 4 Essential Questions of both Provider and Rater

Answer 7

1. What is the clinical problem/dx?
2. What difficulty does the pt report (sx, functional loss)?
3. What are the exam findings?
4. What are the results of clinical studies?

Question 8

Physical D/o w/ Mental D/o

Answer 8

Mental d/o included in physical impairment rating, so MH chapter not used

Question 9

AMA Guides 3 Types of D/o Allowed

Answer 9

Mood, Anxiety, and Psychotic D/os (so pain-related, somatization, PDs, dissociative, substance-related, etc not allowed)

Question 10

AMA Guides Psych Limitation

Answer 10

50% of whole person

Question 11

SSDI vs SSI

Answer 11

SSDI - pays benefits to workers who have become disabled
SSI - social welfare proram to provide income support for people who have become disabled regardless whether they have ever worked

Question 12

SSI Eligibility

Answer 12

Means-tested: dependent on meeting needs test against income, not work hx or contribution to fund / provides minimum income for indigent disabled

Question 13

SS Disability Gen Def + 3 Reqs

Answer 13

“Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment
- can’t do work they did before
- can’t adjust to other work bc of condition
- expected to result or death or last > 12 months

Question 14

SS Medically Determinable Impairment (Gen def (2) and add’l req)

Answer 14

• results from anatomical, physiological, or psychological abn
• can be shown by medically acceptable clinical and laboratory diagnostic techniques
• Must be established by medical evidence other than self-report

Question 15

SSA 11 Qualifying Categories of Mental D/o

Answer 15

1. NCDs
2. Schiz-spectrum/psychotic
3. Depressive, BP, and related d/o
4. ID
5. Anxiety and OCDs
6. Somatic sx and related d/o
7. Personality and impulse-ctrl d/o
8. ASD
9. Neurodevelopmental d/o
10. ED
11. Trauma- and stressor-related d/os

Question 16

SSA Add’l Qualifying D/o Category for Children

Answer 16

Developmental d/o in infants and toddlers

Question 17

SS SUDs

Answer 17

• Don’t qualify, but independent d/os caused by substance use do

Question 18

SSA Paragraphs

Answer 18

Combo of “paragraphs” established for each dx to meet their guidelines

Question 19

SS Paragraph A

Answer 19

• Objective medical evidence to establish d/o (might be med recs, testing, collateral)

Question 20

SS Paragraph B

Answer 20

Functional criteria, w/ rating scale, to evaluate how d/o limits functioning

Question 21

SS Paragraph B 4 Areas of Mental Functioning

Answer 21

1. Understand, remember, or apply information
2. Interact w/ others
3. Concentrate, persist, or maintain pace
4. Adapt or manage oneself

Question 22

SS Paragraph C

Answer 22

• D/o must be “serious & persist”

Question 23

SS Paragraph C Duration and 2 Subcriterion

Answer 23

Must have medically documented period > 2 years
C1: Individual relies (ongoing) on medical tx, MH therapy, psychosocial supports, or highly structured setting
C2: Despite diminished sx/signs, have achieved on marginal adjustmentS

Question 24

SS Residual Function Capacity

Answer 24

• If doesn’t meet all listing criteria, can consider all impairment-related physical/mental limitations, such as sfx to medications

Question 25

Private Disability Purpose & Consideration

Answer 25

Provide benefits purchased by insured in addition to Workers' Comp or SSA - Need to know their def of disability and extent of context affected (same job, any occupation, etc)

Question 26

Rehabilitation Act 1973 Historical Significance

Answer 26

First act in world to prevent employer discrimination against disabled

Question 27

Rehab Act 1973 Jurisdiction

Answer 27

Only certain elements of fed, Postal Service, and Fed contractors/subcontractors

Question 28

Rehab Act 1973 "Handicapped Individual Def" (3)

Answer 28

1. Has physical/mental impairment which substantially limits 1+ major life activities OR 2. Has a record of such impairment OR 3. Is regarded as having such impairment by employer

Question 29

School Board of Nassau County FL v. Arline (SCOTUS 1987) (FOTC, Issue)

Answer 29

Arline fired from teaching job after TB relapse Issue: Is contagious ds "physical impairment" thereby qualifying her for protection under Rehab Act 1973?

Question 30

School Board of Nassau County FL v. Arline (SCOTUS 1987) H & R

Answer 30

H: Yes, protected. Remanded to determine actual threat. R: School argued was to protect others rather than inability, SCOTUS wrote society's myths/fears about disability/ds are as handicapping as the actual physical limitations

Question 31

School Board of Nassau County FL v. Arline (SCOTUS 1987) Historical Sig

Answer 31

Laid foundations for protections of HIV+

Question 32

ADA Gen

Answer 32

Enacted 1990 to prohibit discrimination against persons w/ disabilities in all aspects of employment (hiring, training, comp, benefits, etc)

Question 33

ADA Employer Req (& 2 caveats)

Answer 33

Reasonable accommodation to perform essential job functions - Unless would cause undue hardship or if employee is a direct threat

Question 34

ADA "Disability" (3)

Answer 34

Same as Rehab Act 1. Physical/mental impairment that substantially limits 1+ major life activities of such individual 2. "Record of impairment" 3. "Regarded as" having impairment

Question 35

"Regarded as" having impairment

Answer 35

Doesn't actually have to have, just show that they were regarded as to have one and discriminated against as such

Question 36

ADA (EEOC) Physical or Mental Impairment Def

Answer 36

1) An physiological d/o or condition, cosmetic disfigurement, or anatomical loss affecting 1+ body systems, such as ... 2) Any mental or psychotical d/o, such as ID, organic brain syndrome, emotional or mentail illness, and specific learning disabilities (Specifically mentions all the big ones)

Question 37

ADA Excluded Dx (6)

Answer 37

- Transvestism/transgender/GID - Pedophilia/exhibition/voyeurism/other sexual behavior d/os - Compulsive gambling - Kleptomania - Pyromania - Current psychoactive susbtance abuse d/os related to illegal drug use

Question 38

ADA Other Code Listings Not Included (2)

Answer 38

Phase of life problems or parent-child problems

Question 39

ADA Drugs (2)

Answer 39

- Not protected. Denies coverage of any employee/applicant currently (recently enough that reasonable belief ongoing problem) engaging in illegal use of drugs - Protected only if in tx/completed program + not currently using

Question 40

ADA ETOH

Answer 40

ETOH dependence protected by ADA

Question 41

ADA Drugs/ETOH Additional Exclusion

Answer 41

If condition poses direct threat of harm to others or (arguably) selves

Question 42

ADA PDs

Answer 42

Do count. Personality traits don't

Question 43

ADA Corrected Disabilities

Answer 43

Do qualify

Question 44

ADA Amendments Act of 2008

Answer 44

Says that impairments must be examined in unmitigated state w/ only exception of ordinary eyeglasses or contact lenses

Question 45

ADA "Substantially Limits" Considerations (5)

Answer 45

- Construed broadly in favor of expansive coverage - Limits MLA compared to gen pop - Don't consider mitigating effects - Episodic/remission count, if limits when active - < 6mo can count

Question 46

ADA Major Life Activities Gen Def

Answer 46

- Basic activities that the average person in gen pop can perform with limited or no difficulty2

Question 47

2 Gen Categories of ADA MLAs

Answer 47

1. General activities 2. Major bodily functions

Question 48

ADA Reasonable Accommodation Def

Answer 48

A modification or adjustment of the "way things are customarily done"

Question 49

PA DOC v. Yeskey (SCOTUS 1999) Summ + Main Point

Answer 49

- Excluded from prison boot camp option instead of sentence bc PMH HTN. Sued under ADA T II. - H: Prisoners covered entities, ADA applies to inmates in state prisons and can sue if excluded from programs due to disability (except dirt threat)