Neurocognitive disorders are those involving thinking difficulties caused by abnormalities of the brain. These disorders are usually permanent and often progressive, though there are some that are short-term because the person has an early and treatable infection. There are many things that can damage the brain, most commonly infections, traumatic brain injuries, strokes, dementias like Alzheimer's disease, vascular disease, toxins, genetic and congenital brain malformations, immune disorders, alcohol or other substance abuse, and fetal alcohol exposure.
When determining whether someone is disabled, Social Security is not so much concerned with the specific type of neurocognitive disorder as it is with the loss in a person's ability to function in a work-related way. Neurocognitive disorders (also referred to as organic brain syndrome) can be mild or advanced at the time of application for disability benefits; in advanced cases, another person is needed to help with the disability application—usually a spouse or other family member.
Neurocognitive disorders are usually diagnosed by mental status examinations done by mental health professionals. During a mental status examination, a doctor tries to identity the underlying cause of the disorder and treatment to the extent possible. When there is not enough medical information in an applicant's medical records to determine the severity of the neurocognitive disorder, Social Security will ask for evaluation by a psychiatrist or psychologist at no cost to the applicant.
People with the diagnosis of a neurocognitive disorder usually have brain imaging studies (MRI or CT scans) in their medical records, but Social Security does not require imaging in determining disability. In rare instances in which severity cannot otherwise be determined, Social Security may ask the person to undergo some type of neuropsychological test.
Note that, because intellectual impairment is not considered a neurocognitive disorder, a low IQ does not mean a neurocognitive disorder exists. However, a decrease in IQ between two IQ tests is strong evidence that a neurocognitive disorder is present. Social Security will take such information into account when deciding disability, but the most weight is given to medical and psychological observations by professionals.
People with significant neurocognitive impairments may need family or other caregivers to attend medical appointments to make sure problems observed in the applicant's everyday life are mentioned to the treating doctor so that they can be entered into the applicant's medical records.
Social Security may also seek information from family members or others who know the applicant, to find out more about what kind of problems he or she is having, such as difficulty remembering things.
The listing for neurocognitive disorders was previously called "organic mental disorders," and it was updated significantly in 2017 (the criteria were fairly different in the old listing). To meet Social Security's new listing for neurocognitive disorders, an applicant must have one or more of the following problems that has become significantly worse than before:
Once a diagnosis of a neurocognitive disorder is made by a psychologist or psychiatrist under the above criteria, Social Security then determines if the disorder qualifies for benefits because it affects the applicant's functioning, by either of the two methods below.
In the first method, there must be an extreme limitation in at least one of the following areas, or a "marked" limitation in at least two of the following areas:
Note that Social Security defines "marked" as less than extreme, but worse than moderate. Marked and extreme are matters of professional judgment to be made by a Social Security psychiatrist or psychologist reviewing the medical evidence.
In the second method, the neurocognitive disorder must be medically documented as serious and persistent over a period of at least two years. The applicant must be receiving medical treatment, mental health therapy, psychosocial support, or be living in a highly structured setting that diminishes the symptoms and signs of the mental disorder. The person must have minimal capacity to adapt to changes in their environment or to handle demands that are not already part of their daily life.
This second method recognizes that there are some people who don't satisfy the listing because they live in highly supportive and supervised situations, which makes their functional abilities appear better than would be the case in real-life situations where the stress and demands on them would be greater.
If an adult's neurocognitive disorder is not severe enough to satisfy the listing, Social Security will consider the individual's mental limitations in combination with any vocational factors (age, education, work experience) that can affect the ability of the person to do their prior job or any other job that is available in reasonable numbers.
At this step of the disability determination process, doctors working for Social Security evaluate the applicant's mental impairments and note limitations on a document known as a mental residual functional capacity form (RFC). Disability examiners or specialists known as vocational analysts then evaluate the non-medical parts of the application, in combination with the mental RFC. If Social Security cannot find a job that a person with a neurocognitive impairment can do, disability benefits can still be allowed even though the impairment is not severe enough to satisfy the listing. Getting approved this way is called a medical-vocational allowance; the more severe the mental limitations, the more likely the person will qualify. Many claims are allowed on a medical-vocational basis.