NOSSCR recently obtained through a Freedom of Information Act (FOIA) request and shared with its members the Social Security Administration (SSA’s) Administrative Message AM-17049 on the subject of Post-Traumatic Stress Disorder (PTSD). AM-17049 was originally issued by SSA on August 22, 2017, but the agency made available to the public only a one-page summary. The full content is available at: https://empirejustice.org/wp-content/uploads/2020/07/AM-17049-PTSD.pdf
Advocates had previously urged the agency to issue a ruling on the topic of trauma. SSA staff informed advocates that it would issue only a desk guide. This AM followed but was not published.
The AM is in fact quite helpful and addresses many of the challenges confronted in developing a case involving trauma. There are a number of important aspects that could be useful to cite in our advocacy, for example:
- PTSD can have disparate impacts, with great variation in onset, duration and severity of symptoms.
- Symptoms may improve or re-occur, or exacerbate in response to a triggering event.
- A characteristic of trauma that can complicate adjudication are the “feelings of anxiousness, shame, fear, or guilt” that make it difficult to discuss the trauma “let alone seek treatment.”
- There are high rates of comorbidity with other disorders, most commonly depressive, bipolar, anxiety and substance use disorders. In young children, common comorbidities are oppositional defiant and separation anxiety disorders.
- The subjective nature of the trauma is emphasized, and the AM notes that it is not the event that is disabling, but how the person experiences it.
- PTSD can involve multiple traumatic events.
There is a discussion of steps to take to evaluate a claim when treatment is scant or sporadic. Adjudicators are instructed to remember:
- PTSD could be present despite an absence of evidence;
- Allegations must not be discounted based on treatment or symptoms that are delayed after the traumatic event;
- With medical documentation, “inconsistency is common, given that people with PTSD may not report the traumatic event to every provider, or each provider may not provide an identical account of the claimant’s statements”…[t]he fact that a claimant discloses symptoms of PTSD to one provider and not to another does not necessarily reflect an inconsistency with the claimant’s self-report”;
- SSA will resolve an inconsistency “when it is material to the disability”;
- The claimant’s medical source is “generally the preferred CE provider…[t]his policy is especially important in claims involving trauma or stress-related disorders, as people with these disorders may be particularly reluctant to discuss the traumatic event…with an unfamiliar CE provider.”
The importance and value of lay evidence is emphasized. Since it is common for a person to be reluctant to discuss trauma, non-medical sources are sometimes in a better position to observe the claimant and provide information about their functioning.
One of the most notable instructions concerns Drug Addiction and Alcoholism (DAA), a frequent complication in cases involving trauma. DAA is noted as co-occurring often. The AM urges “caution when evaluating the effects of DAA in relation to PTSD.” It mentions the evaluation of schizophrenia, for which SSA previously issued a separate AM with similar language. See AM 12048. The PTSD AM 17-049 addresses specifically the dilemma faced in cases where there the symptoms of DAA and the disorder are intermingled: “When it is not possible to separate the mental restrictions of DAA from the mental restrictions of PTSD, a finding of “not material” is appropriate.” The AM cross-references Social Security Ruling (SSR) 13-2p and POMS DI 90070.041 on evaluating materiality in DAA claims.
The retention date of this AM is September 22, 2020. Since it is not public, it may not be readily known if the date is extended. We will keep you posted of any developments. In the meantime, please let us know if you have the opportunity to cite this AM in your advocacy.