The document discusses how medical documentation often fails to properly support claims of psychological disability. Specifically, it notes that simply reporting symptoms of depression, anxiety, or poor performance on basic cognitive tests is not enough to demonstrate an inability to work. To prove disability, clinical findings and observations are needed to show how documented mental impairments significantly impact daily functioning and preclude employment. In many cases, further details reveal that claimed symptoms do not prevent normal activities or that cognitive issues only cause minor problems and do not preclude work. Proper documentation of disabling conditions is needed to substantiate mental impairment claims.

1. When Documentation Fails to Support Psychological Disability
April 1, 2007
Stuart J. Clayman, Ph.D.
Licensed Psychologist
75 Potter Pond
Lexington, MA 02421
Tel.: (781) 862-4292
Fax: (781) 861-1993
jay@braindoctor.org
I often review medical records as a part of my evaluation of an individual claiming
mental impairment in workers compensation and disability cases. Often, these cases
involve mental disorders such as Panic Disorder, Posttraumatic Stress Disorder and
Major Depressive Disorder . The purpose of this article is to discuss one type of error,
made by doctors who examine or treat workers compensation and disability claimants,
that can lead to incorrect conclusions. This error involves an assumption that if an
individual reports psychological symptoms, that individual is disabled and cannot work,
even in the absence of corroborating evidence of the symptoms and lack of impairment in
daily functioning.
It is, unfortunately, quite common for me to review reports that will contain statements
like the following as sole corroboration of a mentally disabling condition:
• She has nightmares
• He is struggling with significant symptoms of depression and anxiety
• The claimant made several errors on a “Serial Sevens” task
Having nightmares does not necessarily preclude an individual from working. When I
met with an individual claiming nightmares, I learned that the nightmares had been
occurring only occasionally and that the claimant last had a nightmare six months before
I met with her. I also learned that the nightmares did not prevent the claimant from
sleeping 8 hours per night.
Symptoms of depression and anxiety are common manifestations of a variety of mental
disorders. But, symptoms of depression and anxiety can also be expressed by individuals
with mild mental disorders and by those with no mental disorder at all. In reviewing
records in a workers compensation or disability claim, I often read psychotherapy
progress notes indicating that the claimant was observed to be anxious or that he
exhibited symptoms of depression. The psychotherapist may then conclude that the
claimant is disabled and cannot work at all at his usual occupation or any occupation.
Yet, the report did not provide examples of behaviors exhibited by the claimant
demonstrating that the symptoms interfere with usual functioning in such areas as daily
activities or social relationships, or that the symptoms precluded work.

2. When Documentation Fails to Support Psychological Disability, Page 2
Stuart J. Clayman, Ph.D.
In order to identify mental processing problems, some mental health professionals utilize
a task in which the claimant is asked to subtract numbers from another number or spell
certain words backwards. On the basis of errors on such tasks, a claimant was described
as totally disabled for all work because of impairments of attention, concentration and
memory. Yet, this claimant’s cognitive functioning was normal, except for the problems
noted, and was not precluded from working as a result of cognitive impairments. Clearly,
a problem in counting backwards or spelling a word backwards does not prevent an
individual from working in all occupations.
CONCLUSIONS: I often note that medical documents purportedly demonstrating
disability do not include objective findings substantiating mental impairments that
preclude work. It is not enough to describe the claimant’s subjective report of
psychological symptoms or to state that a claimant is anxious or depressed. In order to
prove that a claimant cannot work in any occupation, treating or examining doctors must
provide up-to-date clinical findings, backed-up by behavioral observations or
psychological test data that document mental impairments that result in significant loss of
capacity to function.