WAC 182-508-0030 Required medical evidence.

An individual must provide medical evidence of an impairment (s) and how the impairment (s) affects the ability to perform regular and continuous work activity. Medical evidence must be in writing and be clear, objective and complete.

(1)  Objective evidence for physical impairments means:

(a)  Laboratory test results;

(b)  Pathology reports;

(c)  Radiology findings including results of X rays and computer imaging scans;

(d) Clinical finding including, but not limited to, ranges of joint motion, blood pressure, temperature or pulse; and documentation of a physical examination; or

(e)  Hospital history and physical reports and admission and discharge summaries; or

(f)  Other medical history and physical reports related to the individual's current impairments.

(2)  Objective evidence for mental impairments means:

(a)  Clinical interview observations, including objective mental status exam results and interpretation.

(b)  Explanation of how examination findings meet the clinical and diagnostic criteria of the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

(c)  Hospital, outpatient and other treatment records related to the individual's current impairments.

(d)  Testing results, if any, including:

(i)  Description and interpretation of tests of memory, concentration, cognition or intelligence; or

(ii)  Interpretation of medical tests to identify or exclude a connection between the mental impairment and physical illness.

(3)  Medical evidence sufficient for an incapacity determination must be from a medical professional described in WAC 182-508-0020  and must include:

(a)  A diagnosis for the impairment, or impairments, based on an examination performed within twelve months of application;

(b)  A clear description of how the impairment relates to the individual's ability to perform the work-related activities listed in WAC 182-508-0015  (5); and

(c)  Documentation of how the impairment, or impairments, is currently limiting the individual's ability to work based on an examination  performed within the ninety days of the date of application or the forty-five days before the month of incapacity review; and

(4)  When making an incapacity decision, the agency or the agency's designee considers documentation in addition to objective evidence to support the acceptable medical source or treating provider's opinion that the individual is unable to perform substantial gainful employment, such as proof of hospitalization.

(5)  The agency or the agency's designee doesn't use symptoms related to substance abuse or a diagnosis of addiction or chemical dependency when determining incapacity when the only impairment supported by objective medical evidence is drug or alcohol addiction.

(6)  The agency or the agency's designee considers diagnoses that are independent of addiction or chemical dependency when determining incapacity.

(7)  The agency or the agency's designee determines the individual has a diagnosis that is independent of addiction or chemical dependency if the impairment will persist at least sixty days after the individual stops using drugs or alcohol.

(8)  If the individual can't obtain medical evidence sufficient for the agency or its designee to determine if the individual is likely to be disabled without cost to the individual, and the individual meets other eligibility conditions in WAC182-508-0005, the agency pays the costs to obtain objective evidence based on the agency's published payment limits and fee schedules.

(9)  The agency or the agency's designee can't use a statement from a medical professional to determine that the individual is incapacitated unless the statement is supported by objective medical evidence.