Young Adult SSR Issued

September 30, 2011

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

On September 12, 2011, the Social Security Administration (SSA) published another significant Social Security Ruling: SSR 11-2p, entitled “Documenting and Evaluating Disability in Young Adults.”  76 Fed. Reg. 56263-56271, available at www.gpo.gov.  The purpose of this SSR, according to SSA, is to consolidate information from the regulations on documenting and evaluating disability in young adults, and to provide guidance as to how SSA’s policies are to be used in determining disability under the rules.

In one of the many footnotes in this SSR (56 in all), SSA further points out that “[f]or simplicity, we refer in this SSR only to initial claims for benefits.  However, the policy interpretations in this SSR also apply, with some exceptions, to age-18 redeterminations under section 1614(a)(3)(H)(iii) of the Act and 20 CFR 416.987 and to CDRs under sections 223(f) and 1614(a)(4) of the Act and 20 CFR 404.1594 and 416.994.  When there is a difference in how the policy applies to age-18 redeterminations or to CDRs, we explain how the policy differs.”  See note 6.

On the whole, SSR 11-2p appears to be a helpful consolidation of the rules for determining disability in adults, serving as a reminder to adjudicators of many things they are wont to ignore. It should be particularly useful in those confounding age-18 reviews that result in discontinuance of SSI benefits for individuals who previously had “listing-level” disability under the childhood standard. Per the SSR, “[t]he abilities, skills, and behaviors that young adults use to do basic work activities are essentially the same as those that older adolescents use for age appropriate activities.” It goes on to point out that although the domain analysis that applies in children’s claims does not apply to young adults, the domains “describe aspects of functioning that are relevant to our evaluation of a young adult’s work-related limitations.”  By way of example, the SSR states:

…absent medical improvement or new evidence demonstrating that the prior finding was in error, a young adult who had an extreme limitation in the ability to interact and relate with others as a child will probably have extreme limitation in social functioning as an adult. Similarly, unless the impairment(s) has improved or there is new evidence indicating that the prior finding was in error, a finding of marked limitation in the ability to attend and complete tasks as a child is likely to translate to a marked limitation in the ability to concentrate, persist, or maintain pace in work-related task completion as an adult.

The SSR also contains what should be useful nuggets pertaining to the use of school and special education records in young adult claims.  It refers back to the helpful guidance in the 2009 Childhood SSRs, in particular SSR 09-2p, which “applies equally to people age 18-22 that are still in special education.” SSR 11-2p emphasizes the importance of school information related to “transition services.” And again, as in SSR 09-2p, it reminds adjudicators that IEP (Individualized Education Programs) transition goals may be set so low that achievement of the goals does not necessarily reflect a lack of limitations.

SSR 11-2p also reminds adjudicators that evidence about a young adult’s functioning from school programs may indicate how well a young adult can use his or her physical or mental abilities to perform work activities. For example, school reported difficulties in understanding, remembering and carrying out simple instructions might indicate difficulties with work activities.  Similarly, difficulties in communicating appropriately and spontaneously, maintaining attention for extended periods in the classroom, or relating to authority figures and responding appropriately to correction or criticism during school could translate into work difficulties.

Per the SSR, evidence of community experiences and job placements, whether or not substantial gainful activity, is relevant to the evaluation of young adult claims.  Of note, evidence that a young adult has had multiple job placements as part of a transition plan might indicate unsatisfactory performance. Information about how much support the young adult may have needed is also relevant.  And there is a wealth of guidance about evaluating work activity and participation in vocational programs (Section 301). 

The SSR also reiterates that “working involves many factors and demands that may be stressful,” and “one person’s reaction to the stress associated with the demands of work may be different from another’s, even among people with the same impairments”; sources familiar with the young adult might be able to provide insight.  The SSR refers adjudicators to SSR 85-15 for further discussion of mental disorders and stress, reaffirming that it remains a viable tool for advocates.

In determining “medically determinable impairments” (MDIs), adjudicators are reminded that young adults often have the same kinds of impairments as children, such as ADHD or language and learning disorders.   And the SSR provides guidance on the application of the Medical-Vocational Guidelines (the grids), noting that the guidelines might not be applicable in many young adult cases. For example, if a young adult has a substantial loss of one or more of the basic mental demands of competitive unskilled work (as set forth in SSRs 85-15 & 96-9p), “the occupational base will be significantly eroded, despite vocational factors that we would ordinarily consider favorable.”

The SSR acknowledges that young adults are more likely to have recent educational experiences that might provide for direct entry into skilled work and would need only basic communication skills for unskilled work. But impairments that affect communication must still be taken into account. For example, a young adult would be found not disabled even if illiterate under the grid rules.  Illiteracy or limited reading ability, however, could be an indication of an underlying impairment (MDI) such as borderline intellectual functioning (BIF) that could affect residual functional capacity (RFC).

These are just a few of the highlights in the new SSR, which went into effect on September 12, 2011.  Remember that there are also examples of ways in which the same types of evidence could indicate that a young adult is not disabled, which are just as likely to be cited by adjudicators as the ones noted above.  Even if you don't have a young adult's claim that is active right now, it would be a great idea to read this SSR soon and often.  And keep us informed of your successes with it, or your concerns about how it is - or is not - being applied.