The National Eating Disorders Association has declared February 24-March 2, 2013 as National Eating Disorders Awareness Week. Both men and women can be affected – women are more likely to suffer with anorexia nervosa and/or bulimia nervosa, whereas men are more likely to use unhealthy weight control methods (nutritionally deficient diets) or engage in binge eating.
During the past year I have represented several clients who have been diagnosed with eating disorders, although I can report that even when those cases were approved, it seemed as if the judges were intent on focusing on associated medical or psychological conditions as opposed to the eating disorder per se.
As I have discussed extensively on this web site, there are basically three theories of disability that apply in every SSDI or SSI case:
- do you meet a listing?
- has your functional capacity been so eroded by your symptoms that you would not be a reliable employee?
- do you meet a grid rule?
Claimants with eating disorders, could, in theory, be found disabled under any of these theories, although in my experience, the most likely approach will be the functional capacity argument.
Do the Listings Apply in an Eating Disorder Case?
The only place that eating disorders are directly mentioned by Social Security in its blue book is at Listing 12.00 (Mental Disorders). SSA writes as follows:
In cases involving anorexia nervosa and other eating disorders, the primary manifestations may be mental or physical, depending upon the nature and extent of the disorder. When the primary functional limitation is physical; e.g., when severe weight loss and associated clinical findings are the chief cause of inability to work, we may evaluate the impairment under the appropriate physical body system listing. Of course, we must also consider any mental aspects of the impairment, unless we can make a fully favorable determination or decision based on the physical impairment(s) alone.
As you can see, SSA recognizes the mental health aspect of eating disorders but prefers to find a listing level impairment based on physical health problems. In my previous cases, the physical issues have included such things as:
- esophageal dysfunction and pain
- permanent or semi-permanent kidney disease
- cardiac arrhythmias and congestive heart failure
- dysfunction of colon and large intestine
- diabetic ketoacidosis (see listing 9.0 reference to the an eating disorder as a mental impairment)
Often these types of physical organ damage or chronic pain associated with damage to these body systems rises to a listing level for that particular body system.
There is no listing for anorexia, bulimia or other eating disorder specifically, and, again, my experience has been that the judges I have appeared before have not been willing to award benefits based on an eating disorder as a mental health condition. Interestingly professionals who research and treat eating disorders generally find a significant mental health component to these problems.
Can the Grid Rules Apply?
The grid rules only apply in cases where a claimant’s medical condition results in physical limitation. Further, the grid rules almost always apply to claimants over the age of 50 who have a high school or less education. For more information about the grid rules, please click here.
In my experience, I have not pursued any grid rule arguments on behalf of female clients with eating disorders because all of the clients I have represented have been younger than age 50 and have had more than a high school education. I have represented men in this demographic who are significantly overweight and who have lost physical capacity due to limited mobility and associated health problems, although these cases are difficult to win as many judges see binge eating as a lifestyle choice rather than as a mental health issue.
I have been successful representing morbidly obese claimants with heart or other organ damage, but these cases tend to be approved based on the listings rather than the grid rules. So, while the grid rules could apply, as a practical matter, this theory of disability has not been a fruitful one for me.
Impaired Functional Capacity and Eating Disorders
In my experience, the most productive argument I have used on behalf of clients with eating disorders has been the functional capacity argument. Click here to read more about functional capacity arguments. Basically this argument allows me to identify both mental and physical limitations and to argue that when taken as a whole, my client would not be a reliable employee. The issues that I focus on include:
- excessive absences from work
- excessive bathroom breaks (often due to chronic constipation, or in the case of a client with active bulimia – vomiting)
- fatigue
- emotional instability
- physical weakness including inability to lift 5 lbs. frequently, limited capacity to walk and stand
Judges have been receptive to functional capacity arguments, especially when I have a supporting functional capacity form from a treating psychiatrist or psychologist, and when my client has made a sincere effort to comply with treatment regimens. Interestingly at the hearing level, judges seem more receptive to the mental health component of eating disorders than does SSA in its written materials.
In sum, I have found that eating disorders can support a finding of disability but we must be able to identify associated issues (preferably physical in nature) and we must have long standing treatment records, a history of compliance with treatment and support from a treating specialist in the form of a functional capacity evaluation.