WAC 388-449-0015

Effective June 1, 2012

WAC 388-449-0015 What medical evidence do I need to provide?

You must give us medical evidence of your impairment(s) and how they affect your 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:
    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 documentation of a physical examination; and
    5. Hospital history and physical reports and admission and discharge summaries; or
    6. Other medical history and physical reports related to your current impairments.
  2. Objective evidence for mental impairments means:
    1. Clinical interview observations, including objective mental status exam results and interpretation.
    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).
    3. Hospital, outpatient and other treatment records related to your current impairments.
    4. 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.
  3. Medical evidence sufficient for a disability determination must be from a medical professional described in WAC 388-449-0010 and must include:
    1. A diagnosis for the impairment, or impairments, based on an examination performed by an acceptable medical source defined in WAC 388-449-0010 within five years of application;
    2. A clear description of how the impairment relates to your ability to perform the work-related activities listed in WAC 388-449-0005;
    3. Documentation of how long a condition has impaired your ability to perform work related activities;
    4. A prognosis, or written statement of how long an impairment will impair you ability to perform work related activities; and
    5. A written statement  from a medical  professional (defined in WAC 388-449-0010) describing what you are capable of doing despite your impairment (medical source statement) based on an examination performed within ninety days of the date of application or the forty-five days before the month of disability  review.
  4. We consider documentation in addition to objective evidence to support the acceptable medical source or treating provider’s opinion that you are unable to perform substantial gainful employment, such as proof of hospitalization.     
  5. When making a disability decision, we don’t use your report of symptoms as evidence unless objective evidence shows there is an impairment that could reasonably be expected to produce those symptoms.
  6. We don't use symptoms related to substance abuse or a diagnosis of addiction or chemical dependency when determining disability if we have evidence substance use is material to your impairment(s).
  7. We consider substance use to be material to your impairment(s) if you are disabled primarly because of drug or alcohol abuse or addition.
  8. If you impairment will persist at least sixty days after you stop using drugs or alcohol, we do not consider substance use to be material to your impairment.
  9. If you can't obtain medical evidence sufficient for us to determine if you are likely to be disabled without cost to you, and you meet meet the other eligibility conditions in WAC 388-400-0060, we pay the costs to obtain objective evidence based on published payment limits and fee schedules.
  10. We determine the likelihood of disability based solely on the objective information we receive. We are not obligated to accept another agency's or person's decision that you are disabled or unemployable.

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.