Incapacity Determination - PEP Step II
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Incapacity Determination - PEP Step II


Revised December 30, 2013


PEP Step II - Determining the severity of mental impairments


WAC 388-447-0040Progressive Evaluation Process Step II - How does the department determine the severity of mental impairments?

<p>WAC 388-447-0040

WAC 388-447-0040

Effective January 1, 2014

WAC 388-447-0040 Progressive Evaluation Process Step II - How does the department determine the severity of mental impairments?

If you are diagnosed with a mental impairment by a professional described in WAC 388-447-0005, we use information from the medical evidence provider to determine how the impairment limits work-related activities.

(1) We review the following psychological evidence to determine the severity of your mental impairment:

(a) Psychosocial and treatment history records;

(b) Clinical findings of specific abnormalities of behavior, mood, thought, orientation, or perception;

(c) Results of psychological tests; and

(d) Symptoms observed by the examining professional that show how your impairment affects your ability to perform basic work-related activities.

(2) We do not consider diagnoses or symptoms of alcohol or sub-stance use or dependency when the only impairment supported by objective medical evidence is drug or alcohol addiction.

(3) If you are diagnosed with an intellectual disability, the diagnosis must be based on the Wechsler adult intelligence scale (WAIS). The following test results determine the severity rating:

 Intelligence Quotient (IQ) Score

 Severity Rating

 85 or above

 1

 71 to 84

 3

 70 or lower

 5

 


(4) If you are diagnosed with a mental impairment with physical causes, we assign a severity rating based on the most severe of the following four areas of impairment:

(a) Short term memory impairment;

(b) Perceptual or thinking disturbances;

(c) Disorientation to time and place; or

(d) Labile, shallow, or coarse affect.

(5) We base the severity of an impairment diagnosed as a mood, anxiety, thought, memory, personality, or cognitive disorder on a clinical assessment of the intensity and frequency of symptoms that:

(a) Affect your ability to perform basic work-related activities; and

(b) Are consistent with a diagnosis of a mental impairment as listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders(DSM).

(6) We base the severity rating for a functional mental impair-ment on accumulated severity ratings for the symptoms in subsection (5) of this section as follows:

 Condition

Severity Rating

(a) The clinical findings and objective evidence are consistent with a significant limitation on performing one or more basic work activities.

(b) You are diagnosed with a functional disorder with psychotic features; 

(c) You have had two or more hospitalizations for psychiatric reasons in the past two years;   

(d) You have had more than six months of continuous psychiatric inpatient or residential treatment in the past two years;   

(e) The clinical findings and objective evidence are consistent with very significant limitations on ability to perform one or more basic work activities.   

 Moderate (3)

(f) The clinical findings and objective evidence are consistent with an inability to perform one or more basic work activities.

 Severe (5)


(7) If you are diagnosed with any combination of mental retardation, mental impairment with physical causes, or functional mental impairment, we assign a severity rating as follows:

 Condition

 Severity Rating

(a) Two or more disorders with moderate severity (3) ratings; or 

(b) One or more disorders rated moderate severity (3), and one rated marked. 

    Marked (4)

(c) Two or more disorders rated marked severity (4).

Severe (5)

(8) We deny incapacity when you haven't been diagnosed with a significant physical impairment and the overall severity of your mental impairment is one or two;

(9) We approve incapacity when your overall mental severity rating is severe (5).

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

NOTE:

The DSHS 13-865 Psychological/Psychiatric Evaluation form, DOC 13-450 Behavioral Health Discharge Summary, or typed narrative evaluation may be used to assess mental health impairments.


CLARIFYING INFORMATION

  1. The Short Clinical Scale is no longer used in the mental health community and has been removed from the psychological evaluation form. Any symptom that affects work function and is listed in the DSM IV or DSM V may be listed by the mental health provider.
  2. Only consider symptoms that have an impact on work function when determining incapacity.
  3. See the learning disabilities and deficits chapter when a learning disorder is diagnosed. Most learning disorders aren't incapacitating.
  4. Don’t consider diagnosis and symptoms of alcohol or substance abuse, or dependence, when determining incapacity through the PEP.
  5. Alcohol and substance use information is requested in order to differentiate between substance use and mental health symptoms, and to provide information for the development of a case plan.
  6. A symptom that was not observed by the evaluator may be considered when determining incapacity accepted if consistent with others symptoms of a diagnosis the evaluator observed.
Modification Date: December 30, 2013