TN 2 (09-15)
DI 34132.005 Mental Listings from 12/12/90 to 09/19/00
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) as well as consideration of the degree of
limitation such impairment(s) may impose on the individual's ability to work and 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 eight diagnostic
categories: organic mental disorders (12.02); schizophrenic, paranoid and other psychotic
disorders (12.03); affective disorders (12.04); mental retardation and autism (12.05);
anxiety-related disorders (12.06); somatoform disorders (12.07); personality disorders
(12.08); and substance addiction disorders (12.09). Each diagnostic group, except
listings 12.05 and 12.09, consists of a set of clinical findings (paragraph A criteria),
one or more of which must be met, and which, if met, lead to a test of functional
restrictions (paragraph B criteria), two or three of which must also be met. There
are additional considerations (paragraph C criteria) in listings 12.03 and 12.06,
discussed therein.
The purpose of including the criteria in paragraph A of the listings for mental disorders
is to medically substantiate the presence of a mental disorder. Specific signs and
symptoms under any of the listings 12.02 through 12.09 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)
which is supported by the individual's clinical findings.
The purpose of including the criteria in paragraphs B and C of the listings for mental
disorders is to describe those functional limitations associated with mental disorders
which are incompatible with the ability to work. The restrictions listed in paragraphs
B and C must be the result of the mental disorder which is manifested by the clinical
findings outlined in paragraph A. The criteria included in paragraphs Band C of the
listings for mental disorders have been chosen because they represent functional areas
deemed essential to work. An individual who is severely limited in these areas as
the result of an impairment identified in paragraph A is presumed to be unable to
work.
The structure of the listing for substance addiction disorders, listing 12.09, is
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 for mental disorders are so constructed that an individual meeting or
equaling the criteria could not reasonably be expected to engage in gainful work activity.
Individuals who have an impairment with a level of severity which does not meet the
criteria of the listings for mental disorders may or may not have the residual functional
capacity (RFC) which would enable them to engage in substantial gainful work activity.
The determination of mental RFC is crucial to the evaluation of an individual's capacity
to engage in substantial gainful work activity when the criteria of the listings for
mental disorders are not met or equaled but the impairment is nevertheless severe.
RFC may be defined as a multidimensional description of the work-related abilities
which an individual retains in spite of medical impairments. RFC complements the criteria
in paragraphs B and C of the listings for mental disorders by requiring consideration
of an expanded list of work-related capacities which may be impaired by mental disorder
when the impairment is severe but does not meet or equal a listed mental disorder.
B. Need for Medical Evidence: The existence of a medically determinable impairment of the required duration must
be established by medical evidence consisting of clinical signs, symptoms, or laboratory
or psychological test findings. These findings may be intermittent or persistent depending
on the nature of the disorder. Clinical signs are medically demonstrable phenomena
which reflect specific abnormalities of behavior, affect, thought, memory, orientation,
or contact with reality. These signs are typically assessed by a psychiatrist or psychologist
and/or documented by psychological tests. Symptoms are complaints presented by the
individual. Signs and symptoms generally cluster together to constitute recognizable
clinical syndromes (mental disorders). Both symptoms and signs which are part of the
diagnosed mental disorder must be considered in evaluating severity.
C. Assessment of Severity: For mental disorders, severity is assessed in terms of the functional limitations
imposed by the impairment. Functional limitations are assessed using the criteria
in paragraph B of the listings for mental disorders (descriptions of restrictions
of activities of daily living; social functioning; concentration, persistence, or
pace; and ability to tolerate increased mental demands associated with competitive
work). Where “marked” is used 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,
so long as the degree of limitation is such as to seriously interfere with the ability
to function independently, appropriately, and effectively. Four areas are considered.
1. Activities of daily living include adaptive activities such as cleaning, shopping, cooking, taking public transportation,
paying bills, maintaining a residence, caring appropriately for one's grooming and
hygiene, using telephones and directories, or using a post office. In the context
of the individual's overall situation, the quality of these activities is judged by
their independence, appropriateness, and effectiveness. It is necessary to define
the extent to which the individual is capable of initiating and participating in activities
independent of supervision or direction.
“Marked” is not the number of activities which are restricted but the overall degree
of restriction or combination of restrictions which must be judged. For example, a
person who is able to cook and clean might still have marked restrictions of daily
activities if the person were too fearful to leave the immediate environment of home
and neighborhood, hampering the person's ability to obtain treatment or to travel
away from the immediate living environment.
2. Social functioning refers to an individual's capacity to interact appropriately and communicate effectively
with other individuals. Social functioning includes the ability to get along with
others; e.g., family members, friends, neighbors, grocery clerks, landlords, or bus
drivers. Impaired social functioning may be demonstrated by a history of altercations,
evictions, firings, fear of strangers, avoidance of interpersonal relationships, or
social isolation. Strength in social functioning may be documented by an individual's
ability to initiate social contacts with others, communicate clearly with others,
interact and actively participate in group activities. Cooperative behaviors, consideration
for others, awareness of others" feelings, and social maturity also need to be considered.
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.
“Marked” is not the number of areas in which social functioning is impaired, but the
overall degree of interference in a particular area or combination of areas of functioning.
For example, a person who is highly antagonistic, uncooperative, or hostile but is
tolerated by local storekeepers may nevertheless have marked restrictions in social
functioning because that behavior is not acceptable in other social contexts.
3. Concentration, persistence, and pace refer to the ability to sustain focused attention sufficiently long to permit the
timely completion of tasks commonly found in work settings. In activities of daily
living, concentration may be reflected in terms of ability to complete tasks in everyday
household routines. Deficiencies in concentration, persistence, and pace are best
observed in work and work-like settings. Major impairment in this area can often be
assessed through direct psychiatric examination or psychological testing, although
mental status examination or psychological test data alone should not be used to accurately
describe concentration and sustained ability to adequately perform work-like tasks.
On mental status examinations, concentration is assessed by tasks requiring short-term
memory or through tasks that must be completed within established time limits. In
work evaluations, concentration, persistence, and pace are assessed through such tasks
as filing index cards, locating telephone numbers, or disassembling and reassembling
objects. Strengths and weaknesses in areas of concentration can be discussed in terms
of frequency of errors, time it takes to complete the task, and extent to which assistance
is required to complete the task.
4. Deterioration or decompensation in work or work-like settings refers to repeated failure to adapt to stressful circumstances which cause the individual
either to withdraw from that situation or to experience exacerbation of signs and
symptoms (i.e., decompensation) with an accompanying difficulty in maintaining activities
of daily living, social relationships, or maintaining concentration, persistence,
or pace (i.e., deterioration which may include deterioration of adaptive behaviors).
Stresses common to the work environment include decisions, attendance, schedules,
completing tasks, interactions with supervisors, or interactions with peers.
D. Documentation: The presence of a mental disorder should be documented primarily on the basis of
reports from individual providers, such as psychiatrists and psychologists, and facilities
such as hospitals and clinics. Adequate descriptions of functional limitations must
be obtained from these or other sources which may include programs and facilities
where the individual has been observed over a considerable period of time.
Information from both medical and nonmedical sources may be used to obtain detailed
descriptions of the individual's activities of daily living; social functioning; concentration,
persistence, and pace; or ability to tolerate increased mental demands (stress). This
information can be provided by programs such as community mental health centers, day
care centers, or sheltered workshops. It can also be provided by others, including
family members, who have knowledge of the individual's functioning. In some cases,
descriptions of activities of daily living or social functioning given by individuals
or treating sources may be insufficiently detailed or may be in conflict with the
clinical picture otherwise observed or described in the examinations or reports. It
is necessary to resolve any inconsistencies or gaps that may exist in order to obtain
a proper understanding of the individual's functional restrictions.
An individual's level of functioning may vary considerably over time. The level of
functioning at a specific time may seem relatively adequate or, conversely, rather
poor. Proper evaluation of the impairment must take any variations in level of functioning
into account in arriving at a determination of impairment severity over time. Thus,
it is vital to obtain evidence from relevant sources over a sufficiently long period
prior to the date of adjudication in order to establish the individual's impairment
severity. This evidence should include treatment notes, hospital discharge summaries,
and work evaluation or rehabilitation progress notes if these are available.
Some individuals 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, which may have been of either short or long duration.
Information concerning the individual's behavior during any attempt to work and the
circumstances surrounding termination of the work effort are particularly useful in
determining the individual's ability or inability to function in a work setting.
The results of well-standardized psychological tests such as the Wechsler Adult Intelligence
Scale (WAIS), the Minnesota Multiphasic Personality Inventory (MMPI), the Rorschach
and the Thematic Apperception Test (TAT), may be useful in establishing the existence
of a mental disorder. For example, the WAIS is useful in establishing mental retardation,
and the MMPI, Rorschach, and TAT may provide data supporting several other diagnoses.
Broad-based neuropsychological assessments using, for example, the Halstead-Reitan
or the Luria-Nebraska batteries may be useful in determining brain function deficiencies,
particularly in cases involving subtle findings such as may be seen in traumatic brain
injury. In addition, the process of taking a standardized test requires concentration,
persistence and pace; performance on such tests may provide useful data. Test results
should, therefore, include both the objective data and a narrative description of
clinical findings. Narrative reports of intellectual assessment should include a discussion
of whether or not obtained IQ scores are considered valid and consistent with the
individual's developmental history and degree of functional restriction.
In cases involving impaired intellectual functioning, a standardized intelligence
test, e.g., the WAIS, should be administered and interpreted by a psychologist or
psychiatrist qualified by training and experience to perform such an evaluation. In
special circumstances, nonverbal measures, such as the Raven Progressive Matrices,
the Leiter international scale, or the Arthur adaptation of the Leiter may be substituted.
Identical IQ scores obtained from different tests do not always reflect a similar
degree of intellectual functioning. In this connection, it must be noted that on the
WAIS, for example, IQs of 70 and below are characteristic of approximately the lowest
2 percent of the general population. In instances where other tests are administered,
it would be necessary to convert the IQ to the corresponding percentile rank in the
general population in order to determine the actual degree of impairment reflected
by those IQ scores.
In cases where more than one IQ is customarily derived from the test administered,
i.e., where verbal, performance, and full-scale IQs are provided as on the WAIS, the
lowest of these is used in conjunction with listing 12.05.
In cases where the nature of the individual's intellectual impairment is such that
standard intelligence tests, as described above, are precluded, medical reports specifically
describing the level of intellectual, social, and physical function should be obtained.
Actual observations by Social Security Administration or State agency personnel, reports
from educational institutions and information furnished by public welfare agencies
or other reliable objective sources should be considered as additional evidence.
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. Individuals with chronic psychotic disorders
commonly have their lives structured in such a way as to minimize stress and reduce
their signs and symptoms. Such individuals may be much more impaired for work than
their signs and symptoms would indicate. The results of a single examination may not
adequately describe these individual's sustained ability to function. It is, therefore,
vital to review all pertinent information relative to the individual's condition,
especially at times of increased stress. It is mandatory to attempt to obtain adequate
descriptive information from all sources which have treated the individual either
currently or in the time period relevant to the 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,
board and care facility, or other environment that provides similar structure. Highly
structured and supportive settings may greatly reduce the mental demands placed on
an individual. With lowered mental demands, overt signs and symptoms of the underlying
mental disorder may be minimized. At the same time, however, the individual's ability
to function outside of such a structured /or supportive setting may not have changed.
An evaluation of individuals whose symptomatology is controlled or attenuated by psychosocial
factors, must consider the ability to function outside of such highly structured settings.
(For these reasons the paragraph C criteria were added to Listings 12.03, and 12.06.)
G. Effects of Medication: Attention must be given to the effect of medication on the individual's signs, symptoms,
and ability to function. While psychotropic medications may control certain primary
manifestations of a mental disorder; e.g., hallucinations, such treatment may or may
not affect the functional limitations imposed by the mental disorder. In cases where
overt symptomatology is attenuated by the psychotropic medications, particular attention
must be focused on the functional restrictions which may persist. These functional
restrictions are also to be used as the measure of impairment severity. (See the paragraph
C criteria in Listings 12.03 and 12.06.)
Neuroleptics, the medicines used in the treatment of some mental illnesses, may cause
drowsiness, blunted affect, or other side effects involving other body systems. Such
side effects must be considered in evaluating overall impairment severity. Where adverse
effects of medications contribute to the impairment severity and the impairment does
not meet or equal the listings but is nonetheless severe, such adverse effects must
be considered in the assessment of the mental residual functional capacity.
H. Effect of Treatment: It must be remembered that with adequate treatment some individuals suffering with
chronic mental disorders not only have their symptoms and signs ameliorated but also
return to a level of function close to that of their premorbid status. Our discussion
here in 12.00H has been designed to reflect the fact that present day treatment of
a mentally impaired individual may or may not assist in the achievement of an adequate
level of adaptation required in the work place. (See the paragraph C criteria in Listings
12.03 and 12.06.)
I. Technique for Reviewing the Evidence in Mental Disorders Claims to Determine Level
of Impairment Severity: A special technique has been developed to ensure that all the evidence needed for
the evaluation of impairment severity in claims involving mental impairment is obtained,
considered and properly evaluated. This technique, which is used in connection with
the sequential evaluation process is explained 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:
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, 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. Deficiencies of concentration, persistence, or pace resulting in frequent failure
to complete tasks in a timely manner (in work settings or elsewhere); or
4. Repeated episodes of deterioration or decompensation, in work or work-like settings
which cause the individual to withdraw from that situation or to experience exacerbation
of signs and symptoms (which may include deterioration of adaptive behavior).
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. Deficiencies of concentration, persistence, or pace resulting in frequent failure
to complete tasks in a timely manner (in work settings or elsewhere); or
4. Repeated episodes of deterioration or decompensation, in work or work-like settings
which cause the individual to withdraw from that situation or to experience exacerbation
of signs and symptoms (which may include deterioration of adaptive behaviors).
OR
C. Medically documented history of one or more episodes of acute symptoms, signs,
and functional limitations which at the time met the requirements in A and B of this
listing, although these symptoms or signs are currently attenuated by medication or
psychosocial support, and one of the following:
1. Repeated episodes of deterioration or decompensation in situations which cause
the individual to withdraw from that situation or to experience exacerbation of signs
and symptoms (which may include deterioration of adaptive behaviors); or
2. Documented current history of two or more years of inability to function outside
a highly supportive living situation.
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.
A. Medically documented persistence, either continuous or intermittent, of one of
the following:
1. Depressive syndrome characterized by at least four of the following:
2. Anhedonia or pervasive loss of interest in almost all activities; or
3. Appetite disturbance with change in weight; or
4. Sleep disturbance; or
5. Psychomotor agitation or retardation; or
6. Decreased energy; or
7. Feelings of guilt or worthlessness; or
8. Difficulty concentrating or thinking; or
9. Thoughts of suicide; or
10. Hallucinations, delusions or paranoid thinking; or
B. Manic syndrome characterized by at least three of the following:
1. Hyperactivity; or
2. Pressure of speech; or
3. Flight of ideas; or
4. Inflated self-esteem; or
5. Decreased need for sleep; or
6. Easy distractibility; or
7. Involvement in activities that have a high probability of painful consequences
which are not recognized; or
8. Hallucinations, delusions or paranoid thinking; or
9. 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
C. 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. Deficiencies of concentration, persistence, or pace resulting in frequent failure
to complete tasks in a timely manner (in work settings or elsewhere);
4. Repeated episodes of deterioration or decompensation, in work or work-like settings
which cause the individual to withdraw from that situation or to experience exacerbation
of signs and symptoms (which may include deterioration of adaptive behaviors).
12.05 Mental Retardation and Autism: Mental retardation refers to significantly subaverage general intellectual functioning
with deficits in adaptive behavior initially manifested during the developmental period
(before age 22). (Note: The scores specified below refer to those obtained on the
WAIS, and are used only for reference purposes. Scores obtained on other standardized
and individually administered tests are acceptable, but the numerical values obtained
must indicate a similar level of intellectual functioning.) Autism is a pervasive
developmental disorder characterized by social and significant communication deficits
originating in the developmental period.
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 additional and significant work-related limitation
of function;
OR
D. A valid verbal, performance, or full scale IQ of 60 through 70, or in the case
of autism, gross deficits of social and communicative skills, with either condition
resulting in two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Deficiencies of concentration, persistence, or pace resulting in frequent failure
to complete tasks in a timely manner (in work settings or elsewhere); or
4. Repeated episodes of deterioration or decompensation, in work or work-like settings
which cause the individual to withdraw from that situation or to experience exacerbation
of signs and symptoms (which may include deterioration of adaptive behaviors).
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:
Generalized persistent anxiety accompanied by three out of four of the following signs
or symptoms:
1. Motor tension; or
2. Autonomic hyperactivity; or
3. Apprehensive expectation; or
4. Vigilance and scanning; or
5. 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
6. 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
7. Recurrent obsessions or compulsions which are a source of marked distress; or
8. 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. Deficiencies of concentration, persistence, or pace resulting in frequent failure
to complete tasks in a timely manner (in work settings or elsewhere); or
4. Repeated episodes of deterioration or decompensation, in work or work-like settings
which cause the individual to withdraw from that situation or to experience exacerbation
of signs and symptoms (which may include deterioration of adaptive behaviors):
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 three of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Deficiencies of concentration, persistence, or pace resulting in frequent failure
to complete tasks in a timely manner (in work settings or elsewhere); or
4. Repeated episodes of deterioration or decompensation, in work or work-like settings
which cause the individual to withdraw from that situation or to experience exacerbation
of signs and symptoms (which may include deterioration of adaptive behaviors).
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 three of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Deficiencies of concentration, persistence, or pace resulting in frequent failure
to complete tasks in a timely manner (in work settings or elsewhere); or
4. Repeated episodes of deterioration or decompensation, in work or work-like settings
which cause the individual to withdraw from that situation or to experience exacerbation
of signs and symptoms (which may include deterioration of adaptive behaviors).
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