Disability Determination - Step 3

Created on: 
Oct 21 2014

Purpose:

Process to determine if a person's impairments meet the SSA listings of impairments criteria.

WAC 388-449-0070 Sequential Evaluation Process step III — How does the department determine if you meet SSA listing of impairments criteria?


Clarifying Information 

  1. Individuals whose impairments meet the SSA listing of impairments criteria are determined to be disabled regardless of their ability to do past work or other work.
  2. The listing of impairments have very specific criteria defined by SSA that must be met in order to determine a person is disabled at this step.
  3. The overall mental or physical impairment severity must be at least marked to consider an for meeting listing criteria.
  4. If the specific diagnostic and other medical criteria for a specific listing is met, the functional impairments that meet the remainder of the listing criteria do not need to be the direct result of the disabling impairments. Other impairments or the treatment of the primary or secondary impairments may contribute to the person's  functional limitations.
    EXAMPLE- Terry has been diagnosed with systemic sclerosis and major depression. The Disability Program Specialist takes all the medical and other evidence into consideration when determining if Terry meets the functional impairment criteria for listing 14.04 (Systemic sclerosis). The Disability Program Specialist does not need determine whether Terry's documented fatigue, weight loss, and social impairments are the result of the systemic sclerosis or the major depression.
  5. A person whose impairments do not meet listing criteria may found to be disabled at Step 4 or Step 5 of the Sequential Evaluation process.

​Worker Responsibilities

Select the body system for the most disabling impairment (SSA Blue Book):

1.00 Musculoskeletal System

2.00 Special Senses and Speech

3.00
Respiratory System

4.00 Cardiovascular System

5.00 Digestive System

6.00 Genitourinary Impairments

7.00
Hematological Disorders

8.00
Skin Disorders

9.00 Endocrine Disorders

10.00
Impairments that Affect
Multiple Body Systems

11.00 Neurological

12.00 Mental Disorders

13.00 Malignant Neoplastic Diseases

14.00 Immune System Disorders

  1. Review the overview for the listings in the appropriate body system.
  2. Determine the specific listing subcategory that describes the person’s impairment. Some listings are specific to only one diagnosis, others describe a chronic condition within a body system that may have multiple diagnosis or underlying causes for the listed impairments.
  3. Compare the description of listing subcategory with the medical evidence.
    • Does the person’s impairment, based on available medical evidence, match the description?
    • If the person’s impairment doesn’t match the description, the person cannot be approved at this step. Continue with the evaluation process (STEP 4).
    • For some listing categories, a documented diagnosis is all that is necessary to establish that an impairment meets a listing subcategory
  4. Compare the medical evidence testing and documentation requirements to the medical evidence in the ECR.
    • Does the available medical evidence meet the specific requirements given for listing category and sub category?
    • If the testing or medical documentation doesn’t match the specific criteria, the person cannot be approved at this step. Continue with the evaluation process (STEP 4).
  5. Compare the description of functional impairments with the medical evidence, other evidence and functional assessment. Typically the person must meet one the functional limitation descriptions associated with a listing. For mental illness and some physical disorders, the person’s functional limitations must meet all of the criteria listed or specific set as described for the specific listing subcategory.
    • Does the person’s functional limitations, based on available medical and other evidence, match all of the necessary criteria for the listing subcategory?
    • If the person’s impairment doesn’t meet the functional criteria, the person cannot be approved at this step. Continue with the evaluation process (Step 4).
  6. If the person’s impairments meet all the required diagnostic, testing, documentation, and functional impairment criteria for a specific listing subcategory:
    1. Approve disability for ABD.
    2. Document the testing (if applicable) and functional limitations that allowed for an approval at this step of the process.