State Hearing Decision - Hearing Decisions and Administrative ...

STATE HEARING DECISION CONTINUATION
addition is in early full remission, and the substance-induced mood and psychotic
disorders were also in remission. DDA compared the conditions to social security listing
12.08 (personality disorders) and 12.09 (substance addiction disorders). DDA found he
did not meet the criteria for either listing, then determined his residual functional
capacity. It found that with his mental health issues he could still do some light work in
the national economy such as janitorial work after hours.
4. The Mental Functional Capacity Assessment completed on 7-14-10 indicated he had no
marked or extremely marked limitations. The mental status exam found no obvious
indications of perceptual disturbances, and reasoning abilities and other cognitive
processes did not seem overtly compromised.
5. The Appellant has a history as laborer at Value City Distribution from 1999 to 2004.
6. He does not have a high school diploma or GED.
7. The Appellant is several medications for his high blood pressure, medication for his
depression and schizophrenia and insomnia. He currently has prescriptions for 10
different medications.
CONCLUSIONS OF POLICY
In order to be eligible for Medicaid for the Disabled (MA-D) the individual must have a physical
or mental impairment that limits her ability to work as determined by the Disability
Determination Unit. The impairment must result from anatomical, physiological, or
psychological abnormalities which can be shown by medically acceptable clinical and laboratory
diagnostic techniques. A physical or mental impairment must be established by medical evidence
consisting of signs, symptoms, and laboratory findings, not only by a statement of symptoms. 20
CFR 416.908 (1991).
The determination of disability by DDA is based upon the SSI requirements specified in 20 Code
of Federal Regulations § 416.901 to 416.998. The regulations define “disability” as the inability
to do any substantial gainful activity by reason of any medically determinable physical or mental
impairment which can be expected to result in death or which has lasted or can be expected to
last for a continuous period of not less than 12 months. If the individual’s severe impairment
does not meet or medically equal a listing in appendix 1 to subpart P of part 404 of this chapter,
the individual’s residual functional capacity is assessed to see if past relevant work or other work
in the national economy can be done. In other words, the individual must have a severe
impairment that makes her unable to do her past relevant work or any other substantial gainful
work that exists in the national economy. 20 CFR § 416.905 (2003). Work may be substantial
even if it is done on a part-time basis or if the individual does less, is paid less, or has less
responsibility than when he or she worked before.
Listing 12.04 (Schizophrenic Disorders) is characterized by the onset of psychotic features with
deterioration from a previous level of functioning.
The required level of severity for these disorders is met when the requirements in both A and B
are satisfied, or when the requirements in C are satisfied.
A. Medically documented persistence, either continuous or intermittent, of one or more
of the following:
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