WAC 388-448-0030 What medical evidence do I need to provide?

You must provide medical evidence that clearly explains if you have an impairment and how that impairment prevents you from being capable of gainful employment. Medical evidence must be in writing and be clear, objective and complete.

1. Objective evidence means:

   1. For physical impairment:

      1. Laboratory test results;  

      2. Pathology reports;

      3. Radiology findings including results of X rays and computer imaging scans;

      4. Clinical finding, including but not limited to ranges of joint motion, blood pressure, temperature or pulse; and observations from physical examination; or

      5. Hospital history and physical reports and admission and discharge summaries; or

      6. Other medical history and physical reports.

   2. For mental impairment:

      1. Examination results including:

         1. Clinical interview observations, including mental status exam results and interpretation; and

         2. 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).

      2. Testing results, if any, including:

         1. Description and interpretation of tests of memory, concentration, cognition or intelligence; or

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

2. To be complete, medical evidence must include:

   1. Diagnosis for the impairment;

   2. A clear description of how the impairment relates to your ability to perform the work-related activities listed in WAC 388-448-0010 (5) including signs and observations of drug or alcohol abuse and whether any limitations on ability to perform work-related activities would continue after sixty days of abstinence from use of drugs or alcohol;

   3. Facts in addition to objective evidence to support the medical provider's opinion that you are unable to be gainfully employed, such as proof of hospitalization; and

   4. Based on an examination done within the ninety days of the date of application or the forty-five days prior to the month of incapacity review.

3. When making an incapacity decision, we do not use your report of symptoms as evidence unless objective evidence shows there is an impairment that could reasonably be expected to produce those symptoms.

4. If you cannot get medical evidence without cost to you and you meet the eligibility conditions other than incapacity in WAC 388-400-0025, we pay the costs to obtain objective evidence based on our published payment limits and designated fee schedules.

5. We decide incapacity based solely on the objective information we receive. We are not obligated to accept a decision that you are incapacitated or unemployable made by another agency or person.