If a person has a mental impairment that is evaluated under one of the mental disorders listings, but the findings related to the impairment do not satisfy the paragraph A criteria (for every listing except listing 12.05), determine whether the clinical findings are at least of equal medical significance to the listed paragraph A criteria. The mental impairment must also impose limitations as described in paragraph B (of every listing except 12.05) or paragraph C (for listings 12.02, 12.03, 12.04, 12.06, and 12.15), as appropriate. There are not findings that can be substituted for the paragraph B or paragraph C criteria. When the paragraph B or paragraph C criteria are not satisfied, the person does not have a mental impairment that meets or medically equals a listed mental impairment.

NOTE: For special instructions regarding listing 12.05, see DI 24583.010B.

There are not mental disorders listings for all mental impairments. If a person’s mental impairment is not part of a listed mental disorders category, compare the clinical findings of the unlisted mental impairment to the paragraph A criteria in a closely analogous mental disorders listing (for every listing except 12.05) and determine whether the clinical findings are at least of equal medical significance to the analogous listing. The mental impairment must also impose limitations as described in paragraph B (of every listing except 12.05) or paragraph C (for listings 12.02, 12.03, 12.04, 12.06, and 12.15), as appropriate.

EXAMPLE: Dissociative identity disorder is an unlisted mental impairment that may sometimes reach listing level severity under one or more listings. Dissociative identity disorder could be evaluated under listing 12.04, Depressive, bipolar, and related disorders based on the similarities in diagnostic features. However, based on the individual presentation of signs and symptoms in a given person, evaluation under a different listing may also be appropriate.

NOTE: For special instructions regarding listing 12.05, see DI 24583.010B.

If a person has a combination of mental impairments, their condition may medically equal a mental disorders listing in three ways, as described below. The combination of mental impairments must also impose restrictions as described in paragraph B (of every listing except 12.05) or paragraph C (for listings 12.02, 12.03, 12.04, 12.06, and 12.15), as appropriate.

NOTE: For special instructions regarding listing 12.05, see DI 24583.010B.

NOTE: It is generally not appropriate to medically equal a mental disorders listing using a combination of physical and mental impairments. However, in cases where the mental effects of multiple physical and mental disorders cannot be separated, it may be appropriate to consider medical equivalence using a combination of physical and mental impairments. For example, consider a case with a claimant with a neurological disorder causing physical and mental limitations that do not meet the criteria of any neurological disorders listing, along with a coexisting mental impairment, the effects of which cannot be separated from those of the neurological disorder. In such a situation, it may be appropriate to medically equal a mental disorders listing.

Do not find that an impairment medically equals 12.05A. There are no clinical findings at least of equal medical significance to an inability to participate in standardized tests of intellectual functioning, dependence upon others for personal needs, or onset during the developmental period.

In most cases involving intellectual disorder in combination with other impairments, it is not possible to medically equal the criteria in 12.05B.2 because the functional limitations must result from intellectual disorder. The criteria in 12.05B.2, which are the paragraph B criteria in the other mental disorders listings, are used to assess the intellectual disorder requirement for significant deficits in adaptive functioning. These deficits must be present before age 22. When a case involves intellectual disorder in combination with another impairment that arose after age 22 and you cannot differentiate which impairment affects the rating of the paragraph B criteria, you cannot establish that deficits in adaptive functioning were present before age 22.

Instead, consider whether the impairment meets or medically equals 12.11 for neurodevelopmental disorders or 12.02 for neurocognitive disorders, rather than whether the impairment medically equals listing 12.05. In limited circumstances, medical equivalence may be appropriate for cases involving a combination of intellectual disorder and another mental disorder that began prior to attainment of age 22, such as autism spectrum disorder.

Do not make a finding of medical equivalence when considering the requirement that the intellectual disorder began prior to the attainment of age 22. If the person’s cognitive impairment satisfies the requirements in 12.05B.1 and 12.05B.2 but there is no evidence supporting the conclusion the disorder began prior to the attainment of age 22, consider whether the impairment meets or medically equals 12.11 for neurodevelopmental disorders or 12.02 for neurocognitive disorders, rather than whether the impairment medically equals listing 12.05.

NOTE: We do not require evidence that existed or was recorded prior to when the person attained age 22. We only need evidence that is consistent with the conclusion the disorder began prior to age 22. For more information about this criterion, see DI 34001.032 (12.00H.4 of the adult mental disorders listings).