GAF Scores: Help or Hindrance?

March 1, 2009

Author: Catherine M. Callery (Kate)| Louise M. Tarantino

Ann Biddle, Esq., Paul M. Ryther, Esq.

How many of us have cited low GAF (Global Assessment of Functioning) scores as indicators of disability in our mental impairment cases? We see a lot of hands out there. Now, how many times have Administrative Law Judges (ALJs) cited moderate to high GAF scores as an indication that a claimant can function and is therefore not disabled? Yes, lots of hands again.  So, are both advocates and ALJs right in citing GAF scores to further their position? Read on.

According to the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), a two-digit GAF score may be particularly useful in tracking the clinical progress of individuals in global terms, using a single measure.  The GAF scale is to be rated with respect only to psychological, social, and occupational functioning.  The instructions specify, “Do not include impairment in functioning due to physical (or environmental) limitations.  . . .”

Although potentially useful in the clinical setting, it is not clear how useful GAF scores really are in the context of determining ability to work.  It is well known, for example, that some mental disabilities can be totally disabling but nonetheless result in very high GAF scores in some individuals.  Examples would be certain Panic Disorders and individuals with certain personality disorders.  [E.g., Guides to the Evaluation of Permanent Impairment (5th Edition, AMA Press); See, examples of how to assess impairment for individuals with psychiatric impairments at 357-372].  GAF scores such as 60 or even 70 are possible for some individuals who could not regularly and consistently perform full time employment. 

Some advocates believe that it is the better practice not to rely on GAF scores at all – high or low.  Others prescribe to the theory that, especially in the face of high GAF scores, it is better to address the “problem” up-front. At the very least, a thoughtful response to high GAF score requires inquiry of the treating psychiatrist who has treated the patient over time in her medical specialty.  Preemptively, an advocate can contact the physician for further explanation; likewise, if troubled by the GAF score, the ALJ is required to follow up with the physician pursuant to 20 C.F.R. §§404.1527, 416.927.

It seems that new ALJs are being given only the GAF scales as part of their orientation and training, but are not informed of the limitations on the use of GAF scores as set out in other parts of the DSM.  In one case, an ALJ requested that the advocate get clarification from a claimant’s treating doctor on the significance of the GAF scores.  The response provides some interesting arguments to counteract an ALJ’s knee jerk reliance on the two-digit GAF code despite what other medical evidence may be in the record.  A sample doctor’s letter, legal arguments to the ALJ, a relevant chapter on mental impairments from the AMA’s Guides to the Evaluation of Permanent Impairment, and an example of the DSM’s GAF chart are all part of DAP #516 available on the Online Resource Center.

Let us know what you are seeing from ALJs on the use of GAF scores to deny - or approve - claims.