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.
a. Medical equivalence to the paragraph A criteria through a combination of mental impairments
Medical equivalence may be appropriate when the paragraph A criteria of a mental disorders
listing (for every listing except 12.05) are satisfied through a combination of mental
impairments. These cases will always involve limitations resulting from a combination
of mental impairments to satisfy the paragraph B criteria or paragraph C criteria.
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.
EXAMPLE: The person has generalized anxiety disorder and posttraumatic stress disorder that
do not individually satisfy the paragraph A criteria of either listing 12.06 or 12.15.
If the combination of generalized anxiety disorder and posttraumatic stress disorder
result in clinical findings that are at least of equal medical significance to the
listed paragraph A criteria, then a finding of medical equivalence may be appropriate.
b. Medical equivalence to the paragraph B criteria through a combination of mental impairments
In many cases involving multiple mental impairments, it is not possible to identify
which mental impairment causes the functional limitations that satisfy the paragraph
B criteria. In these cases, medical equivalence may be appropriate because the combination
of mental impairments results in extreme limitation of one, or marked limitation of
two, of the four areas of mental functioning in the paragraph B criteria (for every
listing except 12.05, see DI 24583.010B.3).
EXAMPLE: The person has generalized anxiety disorder and posttraumatic stress disorder that
individually satisfy the paragraph A criteria of listings 12.06 and 12.15, respectively.
The person also has marked limitations in the paragraph B criteria for interact with
others and concentrate, persist, or maintain pace. However, it is not clear from the
medical evidence whether the functional limitations result from the generalized anxiety
disorder, the posttraumatic stress disorder, or the combination of the two mental
impairments. A finding of medical equivalence would be appropriate.
c. Medical equivalence to the paragraph C criteria through a combination of mental impairments
A finding of medical equivalence for the paragraph C criteria is appropriate only
in cases that involve a combination of mental impairments that are all evaluated under
listings that contain paragraph C criteria. Do not find medical equivalence when one
of the mental impairments is evaluated under a listing that does not contain paragraph
C criteria.
EXAMPLE: The person has schizoaffective disorder and depressive disorder that individually
satisfy the paragraph A criteria of listings 12.03 and 12.04, respectively. The person
has only mild or moderate limitations in each of the paragraph B criteria. If the
person’s combination of depressive disorder and schizoaffective disorder satisfy the
requirements of the paragraph C criteria, a finding of medical equivalence may be
appropriate because both listings 12.03 and 12.04 contain paragraph C criteria.
EXAMPLE: The person has bipolar disorder and borderline personality disorder that individually
satisfy the paragraph A criteria of listings 12.04 and 12.08. The person has only
mild or moderate limitations in each of the paragraph B criteria. Even if the person’s
combination of mental impairments satisfy the requirements of the paragraph C criteria
of listing 12.04, do not find medical equivalence because listing 12.08 does not contain
paragraph C criteria.