WAC 388-448-0050

Effective September 1, 2000

WAC 388-448-0050 PEP Step II - How we determine the severity of mental impairments

If you are diagnosed with a mental impairment by a professional described in WAC 388-448-0020, we use information from the provider to determine if your impairment prevents you from being able to work.


     (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 practitioner that show how your impairment affects your ability to perform basic work-related activities.

 

     (2)  We exclude diagnosis and related symptoms of alcohol or substance abuse or addiction.

     (3) If you are diagnosed with mental retardation, 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 a functional 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 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).


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

Symptom Ratings or Condition

Severity Rating

  1. The functional mental impairment is diagnosed with psychotic features;

  2. You have had two or more hospitalizations for psychiatric reasons in the past two years;

  3. You have had more than six months of continuous psychiatric hospital or residential treatment in the past two years;

  4. The overall assessment of symptoms is rated three; or

  5. At least three symptoms are rated three or higher.

3

  1. The overall assessment of symptoms is rated four; or

  2. At least three symptoms are rated four or five.

4

  1. The overall assessment of symptoms is rated five; or

  2. At least three symptoms are rated five.

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

  1. Two or more disorders with ratings of three; or

  2. One or more disorders rated three, and one rated four.

4
  1. Two or more disorders rated four.

5

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

(9) We approve incapacity when you have an overall mental severity rating of five.

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.