How Do Problems With Concentration, Persistence, and Pace Affect a Social Security Disability Claim?

How Do Problems With Concentration, Persistence, and Pace Affect a Social Security Disability Claim?

Why Being Able to Start a Task Is Not the Same as Being Able to Stay Focused and Finish It

You understand what you are supposed to do.  You know how to do it.  You may even be able to start the task without any difficulty.

But then your mind wanders.

You lose track of where you are.  You make mistakes.  You have to start over.

Maybe anxiety becomes overwhelming and you have to stop.  Perhaps chronic pain makes it impossible to concentrate for very long.

Medication makes you sleepy or slows your thinking.

Or depression makes a task that once took thirty minutes take two hours.

You may wonder: “Can problems staying focused or completing tasks help qualify me for Social Security Disability?”

Yes.

Social Security specifically considers your ability to concentrate, persist, or maintain pace when evaluating how a mental impairment affects your ability to function.

But the question is not simply whether you can concentrate at all.  Most people with significant medical conditions can concentrate on something for at least a short period of time.  The more important question is:

Can you stay focused, continue performing a task, and maintain an acceptable pace well enough to work on a regular and continuing basis?

That can be an entirely different question.

Recommended Reading: Can Problems With Memory and Following Instructions Help Me Qualify for Social Security Disability? Understanding and remembering what you are supposed to do is one issue. Being able to remain focused and actually complete the work is another.

What Does “Concentrating, Persisting, or Maintaining Pace” Mean?

This is Social Security’s terminology.  Most people would describe the problem more simply:

“Can I stay on task long enough to get my work done?”

Social Security describes this area of mental functioning as the ability to focus attention on work activities and stay on task at a sustained rate.  That can involve abilities such as:

• Initiating and performing a task;
• Working at an appropriate and consistent pace;
• Completing tasks in a timely manner;
• Ignoring or avoiding distractions;
• Changing activities or work settings without becoming disruptive;
• Working near or with others without being distracted;
• Sustaining an ordinary work routine and regular attendance; and
• Working a full day without needing more than the expected number or length of rest periods.

These are not abstract psychological concepts.  They are basic requirements of competitive employment.

Concentration, Persistence, and Pace Are Related—but They Are Not Exactly the Same Thing

Social Security-under 20 C.F.R. § 404.1545(c), looks at

• Concentration,
• Persistence, and
• Pace:

Concentration

Can you focus your attention on what you are doing?  Suppose you are entering information into a computer.  Can you remain focused, or does your attention repeatedly drift away from the task?

Persistence

Once you begin the task, can you keep going?  Perhaps you can concentrate for ten minutes but then become overwhelmed, distracted, fatigued, or unable to continue.

Pace

Even if you eventually complete the task, can you do it quickly enough?  If a task normally takes thirty minutes but consistently takes you two hours because you lose focus, make mistakes, take breaks, and start over, the fact that you eventually completed it does not tell the entire story.

A competitive workplace ordinarily requires all three.

You generally must be able to focus on the work, continue doing it, and complete it at an acceptable rate.

“But I Can Do the Task.”

That may not answer the disability question.

Imagine two employees who are given the same assignment.  The first completes it accurately in forty-five minutes.  The second understands the assignment and eventually completes it correctly—but needs three hours, several breaks, repeated redirection, and has to correct multiple mistakes.

Can both employees technically perform the task?  Perhaps.

Can both employees perform it under the ordinary expectations of competitive employment?  That is a very different question.

Social Security Disability is not simply about whether you are capable of doing something eventually.  The ability to perform work includes the ability to sustain work-related activities on a regular and continuing basis.

Starting Something Is Not the Same as Finishing It

This is a common problem with depression, anxiety, PTSD, and other mental-health conditions.

You may start cleaning the kitchen.  Twenty minutes later, half of the dishes are done, something has been taken out of a cabinet, the trash is sitting by the door, and you have moved on to something else.

You may begin reading a book but realize several pages later that you have no idea what you just read.

You may start paying bills but become overwhelmed and leave the paperwork unfinished.

You may begin a television program but repeatedly lose track of the story.

Those examples can help explain a problem with concentration or persistence, but Social Security will generally want to understand the broader picture: How often does this happen, how serious is it, and what would happen if you were expected to perform work tasks throughout an eight-hour workday?

Recommended Reading: Why Does Social Security Care About My Activities of Daily Living?

What Does It Mean to Be “Off Task”?

“Off task” is not a diagnosis.  It is a practical way of describing time during the workday when an employee is not productively performing the assigned work.

Someone may be off task because of:

• Poor concentration;
• Panic symptoms;
• Intrusive thoughts;
• PTSD symptoms;
• Depression;
• Pain;
• Fatigue;
• Medication side effects;
• The need to lie down;
• Excessive bathroom use from a medical condition;
• Difficulty redirecting attention; or
• Other symptoms caused by medically determinable impairments.

A person might physically remain at the workstation and still not be productively working.  For example, someone may sit in front of a computer for eight hours but repeatedly lose concentration, stare at the screen, reread the same information, make mistakes, and need to start over.

Simply being present at work is not necessarily the same as being productive at work.

Why Can Off-Task Time Matter So Much?

Employers generally expect employees to spend most of the workday performing their assigned duties, other than ordinary breaks and normal interruptions.  If a person’s medical conditions cause substantial additional periods of lost productivity, that may affect whether competitive employment can realistically be sustained.

At a Social Security hearing, a vocational expert may be asked hypothetical questions concerning how particular limitations would affect available work.  For example, the Administrative Law Judge may ask the vocational expert to assume an individual would be off task for a certain percentage of the workday.  Being “off task” 10-15% of a work day could mean that you are unable to maintain steady employment.

The vocational expert’s answer can become extremely important.

Recommended Reading: Social Security Is Not Asking Whether You Can Work-They Are Asking Whether You Can Maintain Steady Employment and What is a Vocational Expert?

What About Needing Extra Breaks?

This is closely related to persistence and pace.  Most jobs provide ordinary breaks; typically a 15 minute morning break, lunch break and a 15 minute afternoon break.

The problem arises when a medical condition causes someone to need additional unscheduled breaks beyond those normally permitted.  For example:

A person with severe anxiety may need to leave the work area when a panic attack begins.

Someone with PTSD may need time to recover after being triggered.

A person suffering from severe depression may become overwhelmed and need to withdraw.

Chronic pain may require someone to stop working, change position, or rest.

Medication may cause significant fatigue.

The important questions include:

How often would you need an additional break?

How long would it last?

Could you control when it occurred?

Could you return to the task and resume an acceptable pace afterward?

Those facts may matter far more than simply saying “I need breaks.”

What If I Work Slowly?

Working slowly can be important when the reduced pace results from a medically determinable impairment.  Suppose you once completed a particular task in thirty minutes; now it takes ninety minutes.

Why?

Do you lose concentration?

Do you have to reread instructions?

Do you repeatedly check your work because of anxiety or OCD symptoms?

Do you make mistakes and have to start over?

Does pain interrupt your concentration?

Are medications slowing your thinking?

Do you become overwhelmed and stop?

Those details can help explain why your reduced pace is related to your medical conditions rather than simply a personal preference for working slowly.

What If I Make a Lot of Mistakes?

Accuracy can be another part of the picture.  Imagine an employee who works quickly enough but repeatedly makes errors because concentration drifts.  A job may require not only an acceptable quantity of work, but also an acceptable quality of work.

Repeated mistakes and the need for excessive supervision can therefore be important evidence of impaired work functioning.

What If I Can Concentrate on Television?

This is one of those facts that needs context.  Someone may say “You told Social Security you cannot concentrate, but you watch television.”

The two activities are not necessarily equivalent.

When watching television at home, you may:

Pause the program.

Rewind it.

Get up.

Change programs.

Fall asleep.

Miss part of the program.

Watch something familiar that requires little concentration.

Or simply stop watching when you cannot focus.

An employer generally does not allow you to pause the workday whenever your concentration fails.  So, the relevant question is not merely:

“Do you watch television?”

It is:

“How do you actually watch television, and what does that activity tell us about your ability to sustain concentration in a workplace?”

In completing your disability application, or when answering questions about what you do during the day, it is vitally important to be as detailed as possible when detailing what you do during a normal day.

Recommended Reading: Can Social Security Use My Activities of Daily Living Against Me?

What If I Can Use My Phone or Social Media?

The same reasoning applies.  Scrolling through a phone for short periods does not necessarily require the same concentration, persistence, accuracy, or pace as competitive employment.

But the details matter.

Someone who spends hours writing complicated online material, managing transactions, communicating extensively with others, or performing sustained complex activities on a computer may present different evidence from someone who occasionally looks at photographs or scrolls through short videos.

Social Security should consider what the activity actually requires rather than treating all “phone use” as equivalent.

What If My Concentration Problems Are Caused by Pain?

This is an important point because concentration limitations are not limited to psychiatric conditions.  Imagine trying to complete detailed paperwork while experiencing severe back pain.

Or trying to concentrate while suffering from a migraine.

Or working through significant neuropathic pain.

Pain itself may interfere with concentration, persistence, and pace.

The same may be true of fatigue, sleep disturbance, or other symptoms resulting from physical conditions.

So even in a disability claim based primarily on physical problems, the mental effects of those symptoms may matter.

Recommended Reading: Understanding Pain in Alabama Workers Compensation and Social Security Disability Claims

Medication Side Effects Can Matter Too

Medication may help one problem while creating another.

Some medications may cause:

• Drowsiness;
• Fatigue;
• Slowed thinking;
• Dizziness;
• Difficulty concentrating; or
• Other side effects.

If medication necessary to treat your medical conditions causes significant functional limitations, those effects may be relevant to the disability analysis.

But simply listing a possible side effect from a medication is not the same as establishing that you actually experience it.

The evidence should describe what happens to you.

Recommended Reading: Can the Side Effects of My Prescribed Medication Help Prove My Social Security Disability Claim?

Anxiety Can Affect Concentration Even When You Appear Calm

A person can look perfectly calm during a brief conversation while experiencing significant internal anxiety.  Perhaps your mind is constantly focused on:

“What if something goes wrong?”  “What if I make a mistake?”  “What if I have a panic attack?”  “What are those people thinking about me?”  “Is something bad about to happen?”

If a substantial part of your attention is consumed by anxiety, intrusive thoughts, hypervigilance, or fear, less attention may be available for the work task, and that can affect concentration and pace even though an outside observer does not see obvious distress.

PTSD Can Create Its Own Concentration Problems

PTSD may involve symptoms such as intrusive memories, flashbacks, hypervigilance, sleep disturbance, and heightened reactions to reminders of trauma.

Imagine trying to maintain production while your attention is repeatedly drawn away from the work by intrusive thoughts or by constantly monitoring the surroundings for danger.

Again, the issue is not merely the diagnosis of PTSD.

It is what the PTSD symptoms actually do to your ability to function.

Recommended Reading: PTSD and Social Security Disability

Depression May Affect More Than Your Mood

People often think of depression only as sadness, but significant depression may also affect:

• Concentration;
• Energy;
• Motivation;
• Processing speed;
• Persistence;
• Decision-making;
• Sleep; and
• The ability to initiate and complete activities.

A person may understand perfectly well what needs to be done and still struggle to begin the task, continue it, or complete it within a reasonable period.  That is why a disability evaluation based on depression should not be reduced to “Were you sad today?”

The functional consequences matter.

What About Good Days and Bad Days?

Many medical and psychological conditions fluctuate.  On a good day, you may be able to concentrate fairly well.

On a bad day, you may accomplish almost nothing.

The question is not whether you can perform adequately on your best day, nor should the analysis necessarily be based only upon your worst day.  The issue is your ability to function on a sustained basis over time.

How frequently do the bad days occur?

How long do they last?

What happens to your concentration when symptoms increase?

Can you predict when they will occur?

Would they interfere with attendance or productivity?

A person who functions well three days a week but cannot reliably function the other two may have a serious problem sustaining full-time competitive employment.

A Short Doctor’s Appointment Is Not a Full Workday

Medical records sometimes say things like: “Concentration intact.”  “Attention normal.”  “Able to follow conversation.”

Those observations are relevant, but context matters.

Someone may be able to concentrate during a fifteen-minute conversation with a doctor in a quiet room.  That does not necessarily establish the ability to Stay focused for an eight-hour workday; perform repetitive tasks without drifting off task; meet production requirements; Ignore coworkers and workplace distractions; Recover from interruptions; Maintain accuracy; Work at an acceptable pace.

Do it again tomorrow.

And the next day.

Social Security evaluates functioning on a sustained basis, not simply during a brief examination.

What If I Can Concentrate Better When I Am Alone?

That can be important too.  Perhaps you can complete something at home if:

The room is quiet.

No one interrupts you.

There is no deadline.

You can take breaks whenever you want.

You can work at your own pace.

You can stop when symptoms become worse.

Those conditions may be very different from a workplace.  Competitive employment may involve coworkers, supervisors, telephones, machinery, customers, production expectations, deadlines, interruptions, and changes in routine.

A person’s ability to function in a carefully controlled environment should be considered in that context.

What If I Need Someone to Keep Me on Task?

Suppose a family member repeatedly says:

“Finish what you were doing.”

“You forgot the laundry.”

“You still haven’t paid that bill.”

“You need to go back and finish the kitchen.”

That assistance may be relevant.

In a workplace, a supervisor ordinarily expects an employee to perform assigned duties without constant redirection.  A person who can complete tasks only when another person repeatedly prompts or redirects them may function very differently from someone who works independently.

Social Security considers the amount of help and support a person requires when evaluating mental functioning.

Concentration Problems Can Affect Safety

Not every consequence involves productivity.  Some jobs require sustained attention for safety.

Consider someone operating machinery.

Driving a commercial vehicle.

Working at heights.

Handling dangerous equipment.

Administering medication.

Monitoring patients.

Working around electrical systems.

A brief lapse in concentration may have consequences far beyond completing a task slowly.

Limitations affecting sustained attention can therefore affect both the type and amount of work a person can safely perform.

How Does Social Security Rate This Limitation?

When evaluating adult mental impairments, Social Security considers four broad areas of functioning:

1. Understanding, remembering, or applying information;
2. Interacting with others;
3. Concentrating, persisting, or maintaining pace; and
4. Adapting or managing oneself.

Social Security rates limitations in these four areas using five levels: see 20 C.F.R. Part 404, Subpart P, Appendix 1, § 12.00F(2):

• None: You are able to function in the area independently, appropriately, effectively, and on a sustained basis.
• Mild: Your ability to function that way is slightly limited.
• Moderate: Your ability to function that way is fair.
• Marked: Your ability to function that way is seriously limited.
• Extreme: You are not able to function in that area independently, appropriately, effectively, and on a sustained basis.

But those ratings are only one part of the disability analysis.

I Don’t Meet a Mental Health Listing—Do My Concentration Problems Still Matter?

Absolutely.

This is one of the most important points in this series.  For the paragraph B criteria used by many adult mental-health Listings, a claimant generally needs an extreme limitation in one of the four broad areas or marked limitations in two.

But failing to meet a Listing does not necessarily mean you are not disabled.

If your severe impairment does not meet or medically equal a Listing, Social Security generally proceeds to determine your Residual Functional Capacity, or RFC.  That requires a more detailed assessment of the work-related mental abilities affected by your conditions.

Recommended Reading: What Is Residual Functional Capacity and Why Does It Matter in My Social Security Disability Claim?

“Simple Work” Does Not Necessarily Solve Every Concentration Problem

This deserves its own section because it can be misunderstood.  Suppose someone has difficulty performing complicated tasks.  Limiting that person to simple work may address some of the problem.

But what if the person’s primary difficulty is not understanding the task?

What if the person understands a simple task perfectly well but cannot stay focused on it long enough to complete it at an acceptable pace?  Those are different limitations.

Consider:

“Put these parts into boxes.”

The instruction is simple.

But the employee still has to remain on task, maintain an acceptable pace, avoid excessive breaks, and continue doing the work throughout the day.

Reducing the complexity of the instruction does not necessarily eliminate a separate problem with concentration, persistence, or pace.  That distinction can be important when Social Security determines a claimant’s mental RFC.

What Happens at a Social Security Disability Hearing?

At a disability hearing, the Administrative Law Judge may obtain testimony from a vocational expert.  The ALJ may ask the vocational expert to assume a hypothetical person with certain physical and mental limitations.

For example, the hypothetical might include limitations involving:

• Simple tasks;
• Reduced interaction with other people;
• Certain workplace changes;
• Additional breaks;
• Off-task behavior; or
• Absences.

The vocational expert may then testify about whether jobs exist for a person with those limitations.  This is why accurately identifying the functional limitation matters.

Saying “the claimant has depression” does not tell a vocational expert what the person can do.

Saying that medically supported symptoms cause specific work-related limitations provides much more useful information.

Recommended Reading: What is a Vocational Expert and Why Functional Limitations Matter More Than Medical Diagnoses.

 

The Law

Under 20 C.F.R. §§ 404.1520a and 416.920a, Social Security evaluates mental impairments using four broad functional areas, including concentrating, persisting, or maintaining pace.

Section 12.00E3 of the Adult Listing of Impairments explains that this area concerns the ability to focus attention on work activities and stay on task at a sustained rate.

Social Security gives examples including initiating and performing tasks, working at an appropriate and consistent pace, completing tasks in a timely manner, ignoring or avoiding distractions, working close to others without interrupting or distracting them, sustaining an ordinary routine and regular attendance, and working a full day without needing more than the expected number or length of rest periods.

Social Security evaluates the person’s ability to function independently, appropriately, effectively, and on a sustained basis.

If the claimant’s severe mental impairment does not meet or medically equal a Listing, Social Security generally proceeds to a more detailed assessment of the claimant’s Residual Functional Capacity.

The broad paragraph B rating for concentration, persistence, or pace is not itself a complete mental RFC. The RFC must address the work-related limitations supported by the entire record.

The Bottom Line

Problems with concentration, persistence, and pace can be extremely important in a Social Security Disability claim.  But the issue is not simply\ “Can you concentrate?”

And it is not “Can you perform this task once?”

The better questions are:

Can you stay focused?

Can you keep working without excessive interruptions?

Can you finish what you start?

Can you perform accurately?

Can you work at an acceptable pace?

Can you do so without excessive breaks or redirection?

Can you do it throughout a normal workday?

Can you come back and do it again tomorrow?

A person may understand exactly what a job requires and even possess all of the skills necessary to perform it, but if a medically determinable impairment prevents that person from remaining focused, persisting with the work, or maintaining an acceptable pace, the person may still be unable to sustain competitive employment.

Experience With Social Security Disability Claims

At Powell & Denny, P.C., we have extensive experience representing people whose physical conditions, mental-health conditions, or combination of impairments prevent them from maintaining employment. A disability claim should not stop with a list of diagnoses. The evidence should explain what those conditions actually do to the person’s ability to function—including the ability to understand instructions, remain focused, complete tasks, maintain an acceptable pace, interact with other people, adapt to ordinary workplace demands, and sustain those abilities throughout a normal workweek.

A diagnosis identifies the medical condition.

The disability analysis asks how that condition affects your ability to work.

Recommended Reading: Can Problems Dealing With Supervisors, Coworkers, or the Public Help Qualify Me for Social Security Disability? In the next article in this series, we will look at Social Security’s third major question from a different direction: even if you can understand the work and stay focused on it, can your medical conditions allow you to interact appropriately with the people you have to deal with at work?

An experienced Social Security Disability attorney can evaluate your medical evidence together with your vocational factors to determine how the law applies to your specific situation.  At Powell & Denny, we have represented injured and disabled workers throughout Alabama for more than 30 years. We understand that serious claims are rarely decided by a diagnosis alone. They are decided by how the injury affects the person’s ability to function, work, and earn a living.

If you have questions about an Alabama Workers’ Compensation claim, or a claim for Social Security Disability benefits, don’t hesitate to contact the experienced attorneys at Powell and Denny today a free consultation; remember. Virtual appointments are available through Zoom so you can meet with one of the attorneys of Powell and Denny from wherever you live, and remember-there is no fee unless you win.

Powell & Denny: We Work When You Can’t.

Offices in Birmingham, Alabama and Huntsville, AL