PEP Step VII -- How we evaluate your capacity to perform other work
WAC 388-448-0110
WAC 388-448-0110
Effective September 1, 2000
WAC 388-448-0110 PEP Step VII -- How we evaluate your capacity to perform other work
If we decide you cannot do work that you’ve done before, we then decide if you can do any other work. In making this decision, we again consider vocational factors of age, education and limited English proficiency (LEP).
We approve incapacity if you have a physical impairment only and meet the vocational factors below:
Highest Work Level Assigned by the Practitioner
Your Age
Your Education Level
Other Vocational Factors
Sedentary
Any age
Any level
Does not apply
Light
50 and older
Any level
Does not apply
Light
35 and older
Illiterate or LEP
Does not apply
Light
18 and older
Limited Education
Does not have any past work
Medium
50 and older
Limited education
Does not have any past work
Medium
55 and older
Any level
Does not apply
Heavy
55 and older
Any level
Environmental restrictions apply
We approve incapacity when you have a mental disorder only and meet the age and social functioning limitations below:
Social Limitation
Age
Can not appropriately relate to coworkers and supervisors (rated three); and;
Can not tolerate the pressures of a work setting (rated four).
50 years and older
Can not tolerate the pressures of a work setting (rated five).
Can not appropriately relate to coworkers and supervisors (rated three); and
Can not tolerate the pressures of a work setting (rated four).
18-49
We approve incapacity when you have both mental and physical impairments and vocational factors interfere with working as follows:
Your Age
Your Education
Your Other Restrictions
Any age
Any level
Can not appropriately relate to coworkers and supervisors (rated three); and
Can not tolerate pressures of a work setting (rated four).
50 or older
Limited education
Restricted to medium work level or less.
18 to 49
Limited education
Restricted to light work level.
If we do not find that you are incapacitated by the end of Step VII of the PEP, an administrative review team (ART) makes the incapacity decision. The review team consists of two or more persons within the community service office (CSO) who are not in the position of providing direct eligibility or incapacity services to you. The ART reviews the medical evidence and your vocational factors.
The Administrative Review Team (ART) may be comprised of any two or more Community Services Division (CSD) employees who did not determine eligibility for the case before the ART. The team may include region staff, hearing coordinators, or other CSD employees who have knowledge of medical information and the GA incapacity or SSI disability rules.
Worker Responsibilities
Referral Information
When the Social Worker (SW) completes the Step VII of the PEP without reaching a decision to approve or deny GA, the SW refers the case to the Administrative Review Team (ART).
The ISW completes the ART REFERRAL INFORMATION section of the Administrative Review Team Documentation Worksheet (14-235b). The sections following ART REFERRAL INFORMATION are completed by the ART.
Consider these items when writing the referral summary:
Be concise.
Highlight the main points of the case.
Base your assessment on facts.
Describe a person's strengths and abilities along with limitations.
Let the ART know if you adjusted a provider's rating or did not accept medical evidence.
The Administrative Review Team is responsible for the incapacity decision. This is an introduction to them.
Supervisor Review
The supervisor of the referring social worker should first review the objective medical evidence in the electronic case record (ECR), the person’s health, education, and employment history (form 14-050), incapacity rules (WAC 388-448-001 – 388-448-0160),and the progressive evaluation process (PEP) as completed by the social worker.
If any part of the PEP is inconsistent with the medical evidence or the 14-050, or if the medical evidence is incomplete, return the case to the incapacity social worker for immediate correction. Do not proceed with an ART decision until the PEP has been reviewed and corrected.
When evaluating vocational and social factors, you are assessing whether or not there are jobs the person is able to do even though they have functional limitations. Look at a person's strengths, skills, and abilities and try to find jobs that the person is capable of. Consider the person’s age, education, and skills obtained through past work or hobbies. When a person is not able to perform other work, approve incapacity.
NOTE:
The availability of jobs in your area is not a factor when determining incapacity.
EXAMPLE
Tony worked for a large delivery company where they were required to scan packages, track addresses, and drive to delivery locations, He may not be able to return to the same line of work due to being limited to light exertional limitation (unable to lift more than 25 pounds). Tony is able to perform other types of work because of the skills acquired during previous employment. Tony could work as an order clerk, customer service representative, etc. Deny Incapacity.
EXAMPLE
Nadia is 40 years old, has a moderate anxiety disorder, is able to relate to coworkers and supervisors, but is markedly impaired in her ability to tolerate the pressures of a work setting. The psychologist noted that Nadia was most stressed when confronted with new situations or meeting new people. Nadia worked as a hair stylist before her anxiety symptoms worsened three years ago. Nadia has no clerical skills and would be unlikely to be able find a job which she is both qualified for and would be able to tolerate. Approve Incapacity.
EXAMPLE
Terry has moderate depression, is moderately impaired in his ability to relate to coworkers and supervisors, and to tolerate the pressures of a work setting. The psychologist stated Terry would be able to withstand the pressures of a work setting with limited public contact. Terry has no physical impairments and lists woodworking as a hobby. He has worked as a customer service representative for the last five years. Terry could work a cabinetmaker, bookbinder, stocking shelves, security guard, etc. Deny Incapacity.
Briefly describe how the ART made the decision to approve or deny incapacity, factors considered in the decision, other relevant information, and outcome to the ISW.
Dictionary of Occupational Titles (DOT), published by the U.S. Department of Labor. This publication was last revised in 1991 and will not be updated. This two volume resource contains job listings and the strength and education needed to perform each job.
Disability Evaluation Under Social Security, U.S. Department of Health and Human Services. Also known as "The Listings," this book describes Social Security Administration disability criteria.
PRINT REFERENCE SOURCES:
International Statistical Classification of Diseases, 9th Revision, published by the American Medical Association. A CD-ROM version is available.
Physicians' Current Procedural Terminology, published by the American Medical Association. This book describes each of the CPT codes and standard medical practice for different levels of service.
Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. This is the standard reference for mental disorders.
Modification Date: November 5, 2009
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