TN 2 (09-15)
DI 34132.007 Mental Listings from 09/20/00 to 12/17/07
12.00 Mental Disorders
A. Introduction: The evaluation of disability on the basis of mental disorders requires the documentation
of a medically determinable impairment(s), consideration of the degree of limitation
such impairment(s) may impose on your ability to work, and consideration of whether
these limitations have lasted or are expected to last for a continuous period of at
least 12 months. The listings for mental disorders are arranged in nine diagnostic
categories: Organic mental disorders (12.02); schizophrenic, paranoid and other psychotic
disorders (12.03); affective disorders (12.04); mental retardation (12.05); anxiety-related
disorders (12.06); somatoform disorders (12.07); personality disorders (12.08); substance
addiction disorders (12.09); and autistic disorder and other pervasive developmental
disorders (12.10). Each listing, except 12.05 and 12.09, consists of a statement describing
the disorder(s) addressed by the listing, paragraph A criteria, (a set of medical
findings), and paragraph B criteria (a set of impairment-related functional limitations).
There are additional functional criteria (paragraph C criteria) in 12.02, 12.03, 12.04,
and 12.06, discussed herein. We will assess the paragraph B criteria before we apply
the paragraph C criteria. We will assess the paragraph C criteria only if we find
that the paragraph B criteria are not satisfied. We will find that you have a listed
impairment if the diagnostic description in the introductory paragraph and the criteria
of both paragraphs A and B (or A and C, when appropriate) of the listed impairment
are satisfied.
The criteria in paragraph A substantiate medically the presence of a particular mental
disorder. Specific symptoms, signs, and laboratory findings in the paragraph A criteria
of any of the listings in this section cannot be considered in isolation from the
description of the mental disorder contained at the beginning of each listing category.
Impairments should be analyzed or reviewed under the mental category(ies) indicated
by the medical findings. However, we may also consider mental impairments under physical
body system listings, using the concept of medical equivalence, when the mental disorder
results in physical dysfunction. (See, for instance, 12.00D12 regarding the evaluation
of anorexia nervosa and other eating disorders.)
The criteria in paragraphs B and C describe impairment-related functional limitations
that are incompatible with the ability to do any gainful activity. The functional
limitations in paragraphs B and C must be the result of the mental disorder described
in the diagnostic description, that is manifested by the medical findings in paragraph
A
The structure of the listing for mental retardation (12.05) is different from that
of the other mental disorders listings. Listing 12.05 contains an introductory paragraph
with the diagnostic description for mental retardation. It also contains four sets
of criteria (paragraphs A through D). If your impairment satisfies the diagnostic
description in the introductory paragraph and any one of the four sets of criteria,
we will find that your impairment meets the listing. Paragraphs A and B contain criteria
that describe disorders we consider severe enough to prevent your doing any gainful
activity without any additional assessment of functional limitations. For paragraph
C, we will assess the degree of functional limitation the additional impairment(s)
imposes to determine if it significantly limits your physical or mental ability to
do basic work activities, i.e., is a "severe" impairment(s), as defined in §§ 404.1520
(c) and 416.920 (c). If the additional impairment(s) does not cause limitations that
are "severe" as defined in 404.1520 (c ) and 416.920 (c), we will not find that the
additional impairment(s) imposes "an additional and significant work-related limitation
of function," even if you are unable to do your past work because of the unique features
of that work. Paragraph D contains the same functional criteria that are required
under paragraph B of the other mental disorders listings.
The structure of the listing for substance addiction disorders, 12.09, is also different
from that for the other mental disorder listings. Listing 12.09 is structured as a
reference listing; that is, it will only serve to indicate which of the other listed
mental or physical impairments must be used to evaluate the behavioral or physical
changes resulting from regular use of addictive substances.
The listings are so constructed that an individual with an impairment that meets or
is equivalent in severity to the criteria of a listing could not reasonably be expected
to do any gainful activity. These listings are only examples of common mental disorders
that are considered severe enough to prevent an individual from doing any gainful
activity. When you have a medically determinable severe mental impairment that does
not satisfy the diagnostic description or the requirements of the paragraph A criteria
of the relevant listing, the assessment of the paragraph B and C criteria is critical
to a determination of equivalence.
If your impairment(s) does not meet or is not equivalent in severity to the criteria
of any listing, you may or may not have the residual functional capacity (RFC) to
do substantial gainful activity (SGA). The determination of mental RFC is crucial
to the evaluation of your capacity to do SGA when your impairment(s) does not meet
or equal the criteria of the listings, but is nevertheless severe.
RFC is a multidimensional description of the work-related abilities you retain in
spite of medical impairments. An assessment of your RFC complements the functional
evaluation necessary for paragraphs B and C of the listings by requiring consideration
of an expanded list of work-related capacities that may be affected by mental disorders
when your impairment(s) is severe but neither meets nor is equivalent in severity
to a listed mental disorder.
B. Need for Medical Evidence: We must establish the existence of a medically determinable impairment(s) of the
required duration by medical evidence consisting of symptoms, signs, and laboratory
findings (including psychological test findings). Symptoms are your own description
of your physical or mental impairment(s). Psychiatric signs are medically demonstrable
phenomena that indicate specific psychological abnormalities, e.g., abnormalities
of behavior, mood, thought, memory, orientation, development, or perception, as described
by an appropriate medical source. Symptoms and signs generally cluster together to
constitute recognizable mental disorders described in the listings. The symptoms and
signs may be intermittent or continuous depending on the nature of the disorder.
C. Assessment of Severity: We measure severity according to the functional limitations imposed by your medically
determinable mental impairment(s). We assess functional limitations using the four
criteria in paragraph B of the listings: Activities of daily living; social functioning;
concentration, persistence, or pace; and episodes of decompensation. Where we use
“marked” as a standard for measuring the degree of limitation, it means more than
moderate but less than extreme. A marked limitation may arise when several activities
or functions are impaired, or even when only one is impaired, as long as the degree
of limitation is such as to interfere seriously with your ability to function independently,
appropriately, effectively, and on a sustained basis. See §§ 404.1520a and 416.920a.
1. Activities of daily living include adaptive activities such as cleaning, shopping, cooking, taking public transportation,
paying bills, maintaining a residence, caring appropriately for your grooming and
hygiene, using telephones and directories, and using a post office. In the context
of your overall situation, we assess the quality of these activities by their independence,
appropriateness, effectiveness, and sustainability. We will determine the extent to
which you are capable of initiating and participating in activities independent of
supervision or direction.
We do not define “marked” by a specific number of different activities of daily living
in which functioning is impaired, but by the nature and overall degree of interference
with function. For example, if you do a wide range of activities of daily living,
we may still find that you have a marked limitation in your daily activities if you
have serious difficulty performing them without direct supervision, or in a suitable
manner, or on a consistent, useful, routine basis, or without undue interruptions
or distractions.
2. Social functioning refers to your capacity to interact independently, appropriately, effectively, and
on a sustained basis with other individuals. Social functioning includes the ability
to get along with others, such as family members, friends, neighbors, grocery clerks,
landlords, or bus drivers. You may demonstrate impaired social functioning by, for
example, a history of altercations, evictions, firings, fear of strangers, avoidance
of interpersonal relationships, or social isolation. You may exhibit strength in social
functioning by such things as your ability to initiate social contacts with others,
communicate clearly with others, or interact and actively participate in group activities.
We also need to consider cooperative behaviors, consideration for others, awareness
of others' feelings, and social maturity. Social functioning in work situations may
involve interactions with the public, responding appropriately to persons in authority
(e.g., supervisors), or cooperative behaviors involving coworkers.
We do not define “marked” by a specific number of different behaviors in which social
functioning is impaired, but by the nature and overall degree of interference with
function. For example, if you are highly antagonistic, uncooperative, or hostile but
are tolerated by local storekeepers, we may nevertheless find that you have a marked
limitation in social functioning because that behavior is not acceptable in other
social contexts.
3. Concentration, persistence, or pace refers to the ability to sustain focused attention and concentration sufficiently
long to permit the timely and appropriate completion of tasks commonly found in work
settings. Limitations in concentration, persistence, or pace are best observed in
work settings, but may also be reflected by limitations in other settings. In addition,
major limitations in this area can often be assessed through clinical examination
or psychological testing. Wherever possible, however, a mental status examination
or psychological test data should be supplemented by other available evidence.
On mental status examinations, concentration is assessed by tasks such as having you
subtract serial sevens or serial threes from 100. In psychological tests of intelligence
or memory, concentration is assessed through tasks requiring short-term memory or
through tasks that must be completed within established time limits.
In work evaluation, concentration, persistence, or pace is assessed by testing your
ability to sustain work using appropriate production standards, in either real or
simulated work tasks (e.g., filing index cards, locating telephone numbers, or disassembling
and reassembling objects). Strengths and weaknesses in areas of concentration and
attention can be discussed in terms of your ability to work at a consistent pace for
acceptable periods of time and until a task is completed, and your ability to repeat
sequences of action to achieve a goal or an objective.
We must exercise great care in reaching conclusions about your ability or inability
to complete tasks under the stresses of employment during a normal workday or work
week based on a time-limited mental status examination or psychological testing by
a clinician, or based on your ability to complete tasks in other settings that are
less demanding, highly structured, or more supportive. We must assess your ability
to complete tasks by evaluating all the evidence, with an emphasis on how independently,
appropriately, and effectively you are able to complete tasks on a sustained basis.
We do not define "marked" by a specific number of tasks that you are unable to complete,
but by the nature and overall degree of interference with function. You may be able
to sustain attention and persist at simple tasks but may still have difficulty with
complicated tasks. Deficiencies that are apparent only in performing complex procedures
or tasks would not satisfy the intent of this paragraph B criterion. However, if you
can complete many simple tasks, we may nevertheless find that you have a marked limitation
in concentration, persistence, or pace if you cannot complete these tasks without
extra supervision or assistance, or in accordance with quality and accuracy standards,
or at a consistent pace without an unreasonable number and length of rest periods,
or without undue interruptions or distractions.
4. Episodes of decompensation are exacerbations or temporary increases in symptoms or signs accompanied by a loss
of adaptive functioning, as manifested by difficulties in performing activities of
daily living, maintaining social relationships, or maintaining concentration, persistence,
or pace. Episodes of decompensation may be demonstrated by an exacerbation in symptoms
or signs that would ordinarily require increased treatment or a less stressful situation
(or a combination of the two). Episodes of decompensation may be inferred from medical
records showing significant alteration in medication; or documentation of the need
for a more structured psychological support system (e.g., hospitalizations, placement
in a halfway house, or a highly structured and directing household); or other relevant
information in the record about the existence, severity, and duration of the episode.
The term repeated episodes of decompensation, each of extended duration in these listings means three episodes within 1 year, or an average of once every
4 months, each lasting for at least 2 weeks. If you have experienced more frequent
episodes of shorter duration or less frequent episodes of longer duration, we must
use judgment to determine if the duration and functional effects of the episodes are
of equal severity and may be used to substitute for the listed finding in a determination
of equivalence.
D. Documentation. The evaluation of disability on the basis of mental disorder requires sufficient
evidence to (1) establish the presence of a medically determinable mental impairment(s),
(2) assess the degree of functional limitation the impairment(s) imposes, and (3)
project the probable duration of the impairment(s). See §§ 404.1512 and 416.912 for
a discussion of what we mean by "evidence" and how we will assist you in developing
your claim. Medical evidence must be sufficiently complete and detailed as to symptoms,
signs, and laboratory findings to permit an independent determination. In addition,
we will consider information you provide from other sources when we determine how
the established impairment(s) affects your ability to function. We will consider all
relevant evidence in your case record.
1. Sources of evidence.
a. Medical evidence. There must be evidence from an acceptable medical source showing that you have a
medically determinable mental impairment. See §§ 404.1508, 404.1513, 416.908, and
416.913. We will make every reasonable effort to obtain all relevant and available
medical evidence about your mental impairment(s), including its history, and any records
of mental status examinations, psychological testing, and hospitalizations and treatment.
Whenever possible, and appropriate, medical source evidence should reflect the medical
source's considerations of information from you and other concerned persons who are
aware of your activities of daily living; social functioning; concentration, persistence,
or pace; or episodes of decompensation. Also, in accordance with standard clinical
practice, any medical source assessment of your mental functioning should take into
account any sensory, motor, or communication abnormalities, as well as your cultural
and ethnic background.
b. Information from the individual. Individuals with mental impairments can often provide accurate descriptions of their
limitations. The presence of a mental impairment does not automatically rule you out
as a reliable source of information about your own functional limitations. When you
have a mental impairment and are willing and able to describe your limitations, we
will try to obtain such information from you. However, you may not be willing or able
to fully or accurately describe the limitations resulting from your impairment(s).
Thus, we will carefully examine the statements you provide to determine if they are
consistent with the information about, or general pattern of, the impairment as described
by the medical and other evidence, and to determine whether additional information
about your functioning is needed from you or other sources.
c. Other information. Other professional health care providers (e.g., psychiatric nurse, psychiatric social
worker) can normally provide valuable functional information, which should be obtained
when available and needed. If necessary, information should also be obtained from
nonmedical sources, such as family members and others who know you, to supplement
the record of your functioning in order to establish the consistency of the medical
evidence and longitudinality of impairment severity, as discussed in 12.00D2. Other
sources of information about functioning include, but are not limited to, records
from work evaluations and rehabilitation progress notes.
2. Need for longitudinal evidence. Your level of functioning may vary considerably over time. The level of your functioning
at a specific time may seem relatively adequate or, conversely, rather poor. Proper
evaluation of your impairment(s) must take into account any variations in the level
of your functioning in arriving at a determination of severity over time. Thus, it
is vital to obtain evidence from relevant sources over a sufficiently long period
prior to the date of adjudication to establish your impairment severity.
3. Work attempts. You may have attempted to work or may actually have worked during the period of time
pertinent to the determination of disability. This may have been an independent attempt
at work, or it may have been in conjunction with a community mental health or other
sheltered program, and it may have been of either short or long duration. Information
concerning your behavior during any attempt to work and the circumstances surrounding
termination of your work effort are particularly useful in determining your ability
or inability to function in a work setting. In addition, we should also examine the
degree to which you require special supports (such as those provided through supported
employment or transitional employment programs) in order to work.
4. Mental status examination. The mental status examination is performed in the course of a clinical interview
and is often partly assessed while the history is being obtained. A comprehensive
mental status examination generally includes a narrative description of your appearance,
behavior, and speech; thought process (e.g., loosening of associations); thought content
(e.g., delusions); perceptual abnormalities (e.g., hallucinations); mood and affect
(e.g., depression, mania); sensorium and cognition (e.g., orientation, recall, memory,
concentration, fund of information, and intelligence); and judgment and insight. The
individual case facts determine the specific areas of mental status that need to be
emphasized during the examination.
5. Psychological testing.
a. Reference to a "standardized psychological test" indicates the use of a psychological
test measure that has appropriate validity, reliability, and norms, and is individually
administered by a qualified specialist. By "qualified," we mean the specialist must
be currently licensed or certified in the State to administer, score, and interpret
psychological tests and have the training and experience to perform the test.
b. Psychological tests are best considered as standardized sets of tasks or questions
designed to elicit a range of responses. Psychological testing can also provide other
useful data, such as the specialist's observations regarding your ability to sustain
attention and concentration, relate appropriately to the specialist, and perform tasks
independently (without prompts or reminders). Therefore, a report of test results
should include both the objective data and any clinical observations.
c. The salient characteristics of a good test are: (1) Validity, i.e., the test measures
what it is supposed to measure; (2) reliability, i.e., the consistency of results
obtained over time with the same test and the same individual; (3) appropriate normative
data, i.e., individual test scores can be compared to test data from other individuals
or groups of a similar nature, representative of that population; and (4) wide scope
of measurement, i.e., the test should measure a broad range of facets/aspects of the
domain being assessed. In considering the validity of a test result, we should note
and resolve any discrepancies between formal test results and the individual's customary
behavior and daily activities.
6. Intelligence tests.
a. The results of standardized intelligence tests may provide data that help verify
the presence of mental retardation or organic mental disorder, as well as the extent
of any compromise in cognitive functioning. However, since the results of intelligence
tests are only part of the overall assessment, the narrative report that accompanies
the test results should comment on whether the IQ scores are considered valid and
consistent with the developmental history and the degree of functional limitation.
b. Standardized intelligence test results are essential to the adjudication of all
cases of mental retardation that are not covered under the provisions of 12.05A. Listing
12.05A may be the basis for adjudicating cases where the results of standardized intelligence
tests are unavailable, e.g., where your condition precludes formal standardized testing.
c. Due to such factors as differing means and standard deviations, identical IQ scores
obtained from different tests do not always reflect a similar degree of intellectual
functioning. The IQ scores in 12.05 reflect values from tests of general intelligence
that have a mean of 100 and a standard deviation of 15; e.g., the Wechsler series.
IQs obtained from standardized tests that deviate from a mean of 100 and a standard
deviation of 15 require conversion to a percentile rank so that we can determine the
actual degree of limitation reflected by the IQ scores. In cases where more than one
IQ is customarily derived from the test administered, e.g., where verbal, performance,
and full scale IQs are provided in the Wechsler series, we use the lowest of these
in conjunction with 12.05.
d. Generally, it is preferable to use IQ measures that are wide in scope and include
items that test both verbal and performance abilities. However, in special circumstances,
such as the assessment of individuals with sensory, motor, or communication abnormalities,
or those whose culture and background are not principally English-speaking, measures
such as the Test of Nonverbal Intelligence, Third Edition (TONI-3), Leiter International
Performance Scale-Revised (Leiter-R), or Peabody Picture Vocabulary Test-Third Edition
(PPVT-III) may be used.
e. We may consider exceptions to formal standardized psychological testing when an
individual qualified by training and experience to perform such an evaluation is not
available, or in cases where appropriate standardized measures for your social, linguistic,
and cultural background are not available. In these cases, the best indicator of severity
is often the level of adaptive functioning and how you perform activities of daily
living and social functioning.
7. Personality measures and projective testing techniques. Results from standardized personality measures, such as the Minnesota Multiphasic
Personality Inventory-Revised (MMPI-II), or from projective types of techniques, such
as the Rorschach and the Thematic Apperception Test (TAT), may provide useful data
for evaluating several types of mental disorders. Such test results may be useful
for disability evaluation when corroborated by other evidence, including results from
other psychological tests and information obtained in the course of the clinical evaluation,
from treating and other medical sources, other professional health care providers,
and nonmedical sources. Any inconsistency between test results and clinical history
and observation should be explained in the narrative description.
8. Neuropsychological assessments. Comprehensive neuropsychological examinations may be used to establish the existence
and extent of compromise of brain function, particularly in cases involving organic
mental disorders. Normally, these examinations include assessment of cerebral dominance,
basic sensation and perception, motor speed and coordination, attention and concentration,
visual-motor function, memory across verbal and visual modalities, receptive and expressive
speech, higher-order linguistic operations, problem-solving, abstraction ability,
and general intelligence. In addition, there should be a clinical interview geared
toward evaluating pathological features known to occur frequently in neurological
disease and trauma, e.g., emotional lability, abnormality of mood, impaired impulse
control, passivity and apathy, or inappropriate social behavior. The specialist performing
the examination may administer one of the commercially available comprehensive neuropsychological
batteries, such as the Luria-Nebraska or the Halstead-Reitan, or a battery of tests
selected as relevant to the suspected brain dysfunction. The specialist performing
the examination must be properly trained in this area of neuroscience.
9. Screening tests. In conjunction with clinical examinations, sources may report the results of screening
tests; i.e., tests used for gross determination of level of functioning. Screening
instruments may be useful in uncovering potentially serious impairments, but often
must be supplemented by other data. However, in some cases the results of screening
tests may show such obvious abnormalities that further testing will clearly be unnecessary.
10. Traumatic brain injury (TBI). In cases involving TBI, follow the documentation and evaluation guidelines in 11.00F.
11. Anxiety disorders. In cases involving agoraphobia and other phobic disorders, panic disorders, and posttraumatic
stress disorders, documentation of the anxiety reaction is essential. At least one
detailed description of your typical reaction is required. The description should
include the nature, frequency, and duration of any panic attacks or other reactions,
the precipitating and exacerbating factors, and the functional effects. If the description
is provided by a medical source, the reporting physician or psychologist should indicate
the extent to which the description reflects his or her own observations and the source
of any ancillary information. Statements of other persons who have observed you may
be used for this description if professional observation is not available.
12. Eating disorders. 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.
E. Chronic mental impairments: Particular problems are often involved in evaluating mental impairments in individuals
who have long histories of repeated hospitalizations or prolonged outpatient care
with supportive therapy and medication. For instance, if you have chronic organic,
psychotic, and affective disorders, you may commonly have your life structured in
such a way as to minimize your stress and reduce your symptoms and signs. In such
a case, you may be much more impaired for work than your symptoms and signs would
indicate. The results of a single examination may not adequately describe your sustained
ability to function. It is, therefore, vital that we review all pertinent information
relative to your condition, especially at times of increased stress. We will attempt
to obtain adequate descriptive information from all sources that have treated you
in the time period relevant to the determination or decision.
F. Effects of structured settings: Particularly in cases involving chronic mental disorders, overt symptomatology
may be controlled or attenuated by psychosocial factors such as placement in a hospital,
halfway house, board and care facility, or other environment that provides similar
structure. Highly structured and supportive settings may also be found in your home.
Such settings may greatly reduce the mental demands placed on you. With lowered mental
demands, overt symptoms and signs of the underlying mental disorder may be minimized.
At the same time, however, your ability to function outside of such a structured or
supportive setting may not have changed. If your symptomatology is controlled or attenuated
by psychosocial factors, we must consider your ability to function outside of such
highly structured settings. For these reasons, identical paragraph C criteria are
included in 12.02, 12.03, and 12.04. The paragraph C criterion of 12.06 reflects the
uniqueness of agoraphobia, an anxiety disorder manifested by an overwhelming fear
of leaving the home.
G. Effects of medication: We must give attention to the effects of medication on your symptoms, signs, and
ability to function. While drugs used to modify psychological functions and mental
states may control certain primary manifestations of a mental disorder, e.g., hallucinations,
impaired attention, restlessness, or hyperactivity, such treatment may not affect
all functional limitations imposed by the mental disorder. In cases where overt symptomatology
is attenuated by the use of such drugs, particular attention must be focused on the
functional limitations that may persist. We will consider these functional limitations
in assessing the severity of your impairment. See the paragraph C criteria in 12.02,
12.03, 12.04, and 12.06.
Drugs used in the treatment of some mental illnesses may cause drowsiness, blunted
affect, or other side effects involving other body systems. We will consider such
side effects when we evaluate the overall severity of your impairment. Where adverse
effects of medications contribute to the impairment severity and the impairment(s)
neither meets nor is equivalent in severity to any listing but is nonetheless severe,
we will consider such adverse effects in the RFC assessment.
H. Effects of treatment: With adequate treatment some individuals with chronic mental disorders not only have
their symptoms and signs ameliorated, but they also return to a level of function
close to the level of function they had before they developed symptoms or signs of
their mental disorders. Treatment may or may not assist in the achievement of a level
of adaptation adequate to perform sustained SGA. See the paragraph C criteria in 12.02,
12.03, 12.04, and 12.06.
I. Technique for reviewing the evidence in mental disorders claims to determine the level
of impairment severity. We have developed a special technique to ensure that we obtain, consider, and properly
evaluate all the evidence we need to evaluate impairment severity in claims involving
mental impairment(s). We explain this technique in §§ 404.1520a. and 416.920a.
12.01 Category of Impairments, Mental
12.02 Organic Mental Disorders: Psychological or behavioral abnormalities associated with a dysfunction of the brain.
History and physical examination or laboratory tests demonstrate the presence of a
specific organic factor judged to be etiologically related to the abnormal mental
state and loss of previously acquired functional abilities.
The required level of severity for these disorders is met when the requirements in
both A and B are satisfied, or when the requirements in C are satisfied.
A. Demonstration of a loss of specific cognitive abilities or affective changes and
the medically documented persistence of at least one of the following:
1. Disorientation to time and place; or
2. Memory impairment, either short-term (inability to learn new information), intermediate,
or long-term (inability to remember information that was known sometime in the past);
or
3. Perceptual or thinking disturbances (e.g., hallucinations, delusions); or
4. Change in personality; or
5. Disturbance in mood; or
6. Emotional lability (e.g., explosive temper outbursts, or sudden crying) and impairment
in impulse control; or
7. Loss of measured intellectual ability of at least 15 I.Q. points from premorbid
levels or overall impairment index clearly within the severely impaired range on neuropsychological
testing, e.g., the Luria-Nebraska, or Halstead-Reitan;
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration;
OR
C. Medically documented history of a chronic organic mental disorder of at least 2
years' duration that has caused more than a minimal limitation of ability to do basic
work activities, with symptoms or signs currently attenuated by medication or psychosocial
support, and one of the following:
1. Repeated episodes of decompensation, each of extended duration; or
2. A residual disease process that has resulted in such marginal adjustment that even
a minimal increase in mental demands or change in the environment would be predicted
to cause the individual to decompensate; or
3. Current history of 1 or more years' inability to function outside a highly supportive
living arrangement, with an indication of continued need for such an arrangement.
12.03 Schizophrenic, Paranoid and Other Psychotic Disorders: Characterized by the onset of psychotic features with deterioration from a previous
level of functioning.
The required level of severity for these disorders is met when the requirements in
both A and B are satisfied, or when the requirements in C are satisfied.
A. Medically documented persistence, either continuous or intermittent, of one or
more of the following:
1. Delusions or hallucinations; or
2. Catatonic or other grossly disorganized behavior, or
3. Incoherence, loosening of associations, illogical thinking, or poverty of content
of speech if associated with one of the following:
a. Blunt affect; or
b. Flat affect; or
c. Inappropriate affect; or
4. Emotional withdrawal or isolation;
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration;
OR
C. Medically documented history of a chronic schizophrenic, paranoid, or other psychotic
disorder of at least 2 years' duration that has caused more than a minimal limitation
of ability to do basic work activities, with symptoms or signs currently attenuated
by medication or psychosocial support, and one of the following:
1. Repeated episodes of decompensation, each of extended duration; or
2. A residual disease process that has resulted in such marginal adjustment that even
a minimal increase in mental demands or change in the environment would be predicted
to cause the individual to decompensate; or
3. Current history of 1 or more years' inability to function outside a highly supportive
living arrangement, with an indication of continued need for such an arrangement.
12.04 Affective Disorders: Characterized by a disturbance of mood, accompanied by a full or partial manic or
depressive syndrome. Mood refers to a prolonged emotion that colors the whole psychic
life; it generally involves either depression or elation.
The required level of severity for these disorders is met when the requirements in
both A and B are satisfied, or when the requirements in C are satisfied.
A. Medically documented persistence, either continuous or intermittent, of one of
the following:
1. Depressive syndrome characterized by at least four of the following:
a. Anhedonia or pervasive loss of interest in almost all activities; or
b. Appetite disturbance with change in weight; or
c. Sleep disturbance; or
d. Psychomotor agitation or retardation; or
e. Decreased energy; or
f. Feelings of guilt or worthlessness; or
g. Difficulty concentrating or thinking; or
h. Thoughts of suicide; or
i. Hallucinations, delusions or paranoid thinking; or
2. Manic syndrome characterized by at least three of the following:
a. Hyperactivity; or
b. Pressure of speech; or
c. Flight of ideas; or
d. Inflated self-esteem; or
e. Decreased need for sleep; or
f. Easy distractibility; or
g. Involvement in activities that have a high probability of painful consequences
which are not recognized; or
h. Hallucinations, delusions or paranoid thinking;
OR
3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic
picture of both manic and depressive syndromes (and currently characterized by either
or both syndromes);
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration;
OR
C. Medically documented history of a chronic affective disorder of at least 2 years'
duration that has caused more than a minimal limitation of ability to do basic work
activities, with symptoms or signs currently attenuated by medication or psychosocial
support, and one of the following:
1. Repeated episodes of decompensation, each of extended duration; or
2. A residual disease process that has resulted in such marginal adjustment that even
a minimal increase in mental demands or change in the environment would be predicted
to cause the individual to decompensate; or
3. Current history of 1 or more years' inability to function outside a highly supportive
living arrangement, with an indication of continued need for such an arrangement.
12.05 Mental Retardation: Mental retardation refers to significantly subaverage general intellectual functioning
with deficits in adaptive functioning initially manifested during the developmental
period; i.e., the evidence demonstrates or supports onset of the impairment before
age 22.
The required level of severity for this disorder is met when the requirements in A,
B, C, or D are satisfied.
A. Mental incapacity evidenced by dependence upon others for personal needs (e.g.,
toileting, eating, dressing, or bathing) and inability to follow directions, such
that the use of standardized measures of intellectual functioning is precluded;
OR
B. A valid verbal, performance, or full scale IQ of 59 or less;
OR
C. A valid verbal, performance, or full scale IQ of 60 through 70 and a physical or
other mental impairment imposing an additional and significant work-related limitation
of function;
OR
D. A valid verbal, performance, or full scale IQ of 60 through 70, resulting in two
of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration.
12.06 Anxiety-Related Disorders: In these disorders, anxiety is either the predominant disturbance or it is experienced
if the individual attempts to master symptoms; for example, confronting the dreaded
object or situation in a phobic disorder or resisting the obsessions or compulsions
in obsessive compulsive disorders.
The required level of severity for these disorders is met when the requirements in
both A and B are satisfied, or when the requirements in both A and C are satisfied.
A. Medically documented findings of at least one of the following:
1. Generalized persistent anxiety accompanied by three out of four of the following
signs or symptoms:
a. Motor tension; or
b. Autonomic hyperactivity; or
c. Apprehensive expectation; or
d. Vigilance and scanning; or
2. A persistent irrational fear of a specific object, activity, or situation which
results in a compelling desire to avoid the dreaded object, activity, or situation;
or
3. Recurrent severe panic attacks manifested by a sudden unpredictable onset of intense
apprehension, fear, terror and sense of impending doom occurring on the average of
at least once a week; or
4. Recurrent obsessions or compulsions which are a source of marked distress; or
5. Recurrent and intrusive recollections of a traumatic experience, which are a source
of marked distress;
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration;
OR
C. Resulting in complete inability to function independently outside the area of one's
home.
12.07 Somatoform Disorders: Physical symptoms for which there are no demonstrable organic findings or known physiological
mechanisms.
The required level of severity for these disorders is met when the requirements in
both A and B are satisfied.
A. Medically documented by evidence of one of the following:
1. A history of multiple physical symptoms of several years duration, beginning before
age 30, that have caused the individual to take medicine frequently, see a physician
often and alter life patterns significantly; or
2. Persistent nonorganic disturbance of one of the following:
a. Vision; or
b. Speech; or
c. Hearing; or
d. Use of a limb; or
e. Movement and its control (e.g., coordination disturbance, psychogenic seizures,
akinesia, dyskinesia); or
f. Sensation (e.g., diminished or heightened).
3. Unrealistic interpretation of physical signs or sensations associated with the
preoccupation or belief that one has a serious disease or injury.
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration.
12.08 Personality Disorders: A personality disorder exists when personality traits are inflexible and maladaptive
and cause either significant impairment in social or occupational functioning or subjective
distress. Characteristic features are typical of the individual's long-term functioning
and are not limited to discrete episodes of illness.
The required level of severity for these disorders is met when the requirements in
both A and B are satisfied.
A. Deeply ingrained, maladaptive patterns of behavior associated with one of the following:
1. Seclusiveness or autistic thinking; or
2. Pathologically inappropriate suspiciousness or hostility; or
3. Oddities of thought, perception, speech and behavior; or
4. Persistent disturbances of mood or affect; or
5. Pathological dependence, passivity, or aggressivity; or
6. Intense and unstable interpersonal relationships and impulsive and damaging behavior;
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration.
12.09 Substance Addiction Disorders: Behavioral changes or physical changes associated with the regular use of substances
that affect the central nervous system.
The required level of severity for these disorders is met when the requirements in
any of the following (A through I) are satisfied.
A. Organic mental disorders. Evaluate under 12.02.
B. Depressive syndrome. Evaluate under 12.04.
C. Anxiety disorders. Evaluate under 12.06.
D. Personality disorders. Evaluate under 12.08.
E. Peripheral neuropathies. Evaluate under 11.14.
F. Liver damage. Evaluate under 5.05.
G. Gastritis. Evaluate under 5.04.
H. Pancreatitis. Evaluate under 5.08.
I. Seizures. Evaluate under 11.02 or 11.03.
12.10 Autistic disorder and other pervasive developmental disorders: Characterized by qualitative deficits in the development of reciprocal social interaction,
in the development of verbal and nonverbal communication skills, and in imaginative
activity. Often, there is a markedly restricted repertoire of activities and interests,
which frequently are stereotyped and repetitive.
The required level of severity for these disorders is met when the requirements in
both A and B are satisfied.
A. Medically documented findings of the following:
1. For autistic disorder, all of the following:
a. Qualitative deficits in reciprocal social interaction; and
b. Qualitative deficits in verbal and nonverbal communication and in imaginative activity;
and
c. Markedly restricted repertoire of activities and interests;
OR
2. For other pervasive developmental disorders, both of the following:
a. Qualitative deficits in reciprocal social interaction; and
b. Qualitative deficits in verbal and nonverbal communication and in imaginative activity;
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration.