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peter-cascianoBy Peter Casciano, Esq.
(301) 244-4523
pcasciano@a-f.net

Recently, a new edition (the fifth) of the Diagnostic and Statistical Manual of Mental Disorders was published by the American Psychiatric Association. In the new edition, Axis V, the Global Assessment of Functioning (GAF) was omitted. The GAF was a numerical score that enabled doctors to report how they felt the patient was functioning overall.

Use of the GAF

As a disability attorney, the GAF was a helpful way for me to prove how symptoms and limitations affected my client’s ability to work. The GAF used a scale, from 0 to 100, that provided helpful examples as to how an individual would be functioning (or not functioning) if they were assessed with any particular score. For instance, according to the Diagnostic and Statistical Manual of Mental Disorders –IV, those with a GAF of 35 experience “some impairment in reality testing or communication or major impairment in several areas, such as work or school, family relations, judgment, thinking or mood.”

Those with a GAF of 75, on the other hand, tend to have symptoms of a “transient and expectable reaction to psycho-social stressors; no more than slight impairment in social, occupational or school functioning.”

Loss of the GAF

What we are seeing now is a reluctance in the medical community to stop using the GAF and I attribute that to several factors. First, this is always how doctors assessed their patients, so I am sure that the old way is simply more convenient and habitual for them. Second, it is an organized way to provide one’s general and comprehensive opinion on an issue that is unbelievably complex. So many factors contribute to one’s ability to function that it can be hard for a doctor to provide an opinion on each detail. Lastly, I think we are still seeing widespread use of the GAF because it enables doctors to use a clinical score to say: “I think my client is disabled.” By definition, anyone with a GAF assessed lower than 50 was considered disabled to work.

Going forward, it isn’t just doctors and attorneys struggling with the loss of the GAF. The insurance companies and federal agencies charged with deciding who is disabled are now grappling with how to treat medical records that still contain the GAF.

For example, the Social Security Administration (SSA) recently published a rule stating that the GAF score should be looked at as opinion evidence. This opinion evidence, according to the SSA, must be examined and treated differently based on the relevant factors of the case and on each medical treatment provider.

If you have a question about any emotional impairment or the use of the GAF, please contact me by e-mail at pcasciano@a-f.net or by phone at (301) 244-4523.