Program Operations Manual System (POMS)
Basic (02-01)
DI 25225.020 How We Define “Marked” and “Extreme” Limitations (Section 416.926a(e))
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1.
When we decide whether you have a "marked" or an "extreme" limitation, we will consider
your functional limitations resulting from all of your impairments, including their
interactive and cumulative effects. We will consider all the relevant information
in your case record that helps us determine your functioning, including your signs,
symptoms, and laboratory findings, the descriptions we have about your functioning
from your parents, teachers, and other people who know you, and the relevant factors
explained in DI 25210.001 ff., DI 25215.001 ff., and DI 24501.020.
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2.
The medical evidence may include formal testing that provides information about your
development or functioning in terms of percentiles, percentages of delay, or age or
grade equivalents. Standard scores (e.g., percentiles) can be converted to standard
deviations. When you have such scores, we will consider them together with the information
we have about your functioning to determine whether you have a "marked" or "extreme"
limitation in a domain.
B. Policy – marked limitation
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1.
We will find that you have a "marked" limitation in a domain when your impairment(s)
interferes seriously with your ability to independently initiate, sustain, or complete
activities. Your day-to-day functioning may be seriously limited when your impairment(s)
limits only one activity or when the interactive and cumulative effects of your impairment(s)
limit several activities. "Marked" limitation also means a limitation that is "more
than moderate" but "less than extreme." It is the equivalent of the functioning we
would expect to find on standardized testing with scores that are at least two, but
less than three, standard deviations below the mean.
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2.
If you have not attained age 3, we will generally find that you have a "marked" limitation
if you are functioning at a level that is more than one-half but not more than two-thirds
of your chronological age when there are no standard scores from standardized tests
in your case record.
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3.
If you are a child of any age (birth to the attainment of age 18), we will find that
you have a "marked" limitation when you have a valid score that is two standard deviations
or more below the mean, but less than three standard deviations, on a comprehensive
standardized test designed to measure ability or functioning in that domain, and your
day-to-day functioning in domain-related activities is consistent with that score.
(See DI 25225.020D.)
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4.
For the sixth domain of functioning, "Health and physical well-being," we may also
consider you to have a "marked" limitation if you are frequently ill because of your
impairment(s) or have frequent exacerbations of your impairment(s) that result in
significant, documented symptoms or signs. For purposes of this domain, "frequent"
means that you have episodes of illness or exacerbations that occur on an average
of 3 times a year, or once every 4 months, each lasting 2 weeks or more. We may also
find that you have a "marked" limitation if you have episodes that occur more often
than 3 times in a year or once every 4 months but do not last for 2 weeks, or occur
less often than an average of 3 times a year or once every 4 months but last longer
than 2 weeks, if the overall effect (based on the length of the episode(s) or its
frequency) is equivalent in severity.
C. Policy – extreme limitation
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1.
We will find that you have an "extreme" limitation in a domain when your impairment(s)
interferes very seriously with your ability to independently initiate, sustain, or
complete activities. Your day-to-day functioning may be very seriously limited when
your impairment(s) limits only one activity or when the interactive and cumulative
effects of your impairment(s) limit several activities. "Extreme" limitation also
means a limitation that is "more than marked." "Extreme" limitation is the rating
we give to the worst limitations. However, "extreme limitation" does not necessarily
mean a total lack or loss of ability to function. It is the equivalent of the functioning
we would expect to find on standardized testing with scores that are at least three
standard deviations below the mean.
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2.
If you have not attained age 3, we will generally find that you have an "extreme"
limitation if you are functioning at a level that is one-half of your chronological
age or less when there are no standard scores from standardized tests in your case
record.
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3.
If you are a child of any age (birth to the attainment of age 18), we will find that
you have an "extreme" limitation when you have a valid score that is three standard
deviations or more below the mean on a comprehensive standardized test designed to
measure ability or functioning in that domain, and your day-to-day functioning in
domain-related activities is consistent with that score. (See DI 25225.020D.)
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4.
For the sixth domain of functioning, "Health and physical well-being," we may also
consider you to have an "extreme" limitation if you are frequently ill because of
your impairment(s) or have frequent exacerbations of your impairment(s) that result
in significant, documented symptoms or signs substantially in excess of the requirements
for showing a "marked" limitation in DI 25225.020B.4. However, if you have episodes of illness or exacerbations of your impairment(s)
that we would rate as "extreme" under this definition, your impairment(s) should meet
or medically equal the requirements of a listing in most cases. See DI 25220.010.
D. Policy – how we will consider your test scores
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1.
As indicated in DI 25210.001B.2., we will not rely on any test score alone. No single piece of information taken
in isolation can establish whether you have a "marked" or an "extreme" limitation
in a domain.
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2.
We will consider your test scores together with the other information we have about
your functioning, including reports of classroom performance and the observations
of school personnel and others.
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a.
We may find that you have a "marked" or "extreme" limitation when you have a test
score that is slightly higher than the level provided in DI 25225.020B or DI 25225.020C, if other information in your case record shows that your functioning in day-to-day
activities is seriously or very seriously limited because of your impairment(s). For
example, you may have IQ scores above the level in DI 25225.020B, but other evidence shows that your impairment(s) causes you to function in school,
home, and the community far below your expected level of functioning based on this
score.
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b.
On the other hand, we may find that you do not have a "marked" or "extreme" limitation,
even if your test scores are at the level provided in DI 25225.020B or DI 25225.020C, if other information in your case record shows that your functioning in day-to-day
activities is not seriously or very seriously limited by your impairment(s). For example,
you may have a valid IQ score below the level in DI 25225.020B, but other evidence shows that you have learned to drive a car, shop independently,
and read books near your expected grade level.
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3.
If there is a material inconsistency between your test scores and other information
in your case record, we will try to resolve it. The interpretation of the test is
primarily the responsibility of the psychologist or other professional who administered
the test. But it is also our responsibility to ensure that the evidence in your case
is complete and consistent or that any material inconsistencies have been resolved.
Therefore, we will use the following guidelines when we resolve concerns about your
test scores:
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a.
We may be able to resolve the inconsistency with the information we have. We may need
to obtain additional information; e.g., by recontact with your medical source(s),
by purchase of a consultative examination to provide further medical information,
by recontact with a medical source who provided a consultative examination, or by
questioning individuals familiar with your day-to-day functioning.
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b.
Generally, we will not rely on a test score as a measurement of your functioning within
a domain when the information we have about your functioning is the kind of information
typically used by medical professionals to determine that the test results are not
the best measure of your day-to-day functioning. When we do not rely on test scores,
we will explain our reasons for doing so in your case record or in our decision.
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| DI 25225.020 - How We Define <Quote>Marked</Quote> and <Quote>Extreme</Quote> Limitations (Section 416.926a(e)) - 02/06/2001
Batch run: 06/26/2024
Rev:02/06/2001 |