Disability Determination - Step 2

Created on: 
Oct 21 2014

WAC 388-449-0035 How does the department assign severity ratings to my impairment?

WAC 388-449-0040 How does the department determine the severity of mental impairments?

WAC 388-449-0045 How does the department determine the severity of physical impairments?

WAC 388-449-0050 How does the department determine the severity of multiple impairments?

WAC 388-449-0060 Sequential Evaluation Process step II - How does the department review medical evidence to determine if I am eligible for benefits?

  1. The severity of an impairment is the extent to which it affects the individual's ability to perform basic work activities.
  2. The Disability Specialist determines severity based on medical and other evidence received by the Department. When the individual needs help obtaining necessary evidence (e.g. meets Equal Access criteria or requests assistance), the Disability Specialist assists the individual in obtaining necessary evidence.
  3. Severity ratings are assigned to all medically determinable impairments, meaning all impairments that could reasonably result from a condition diagnosed by an acceptable medical source identified in WAC 388-449-0010.
  4. Severity ratings are assigned by the Disability Specialist based on the overall medical evidence and input received from the contracted Review of Medical Evidence (RME).
EXAMPLE - Betty provides a physical evaluation that indicates she has severe hyperlipidemia. Betty has no symptoms that currently impair her ability to perform basic work activities resulting from the condition. The Disability Specialist assigns a severity of "none" to Betty's hyperlipidemia.
EXAMPLE - Tim has been diagnosed with multi-level degenerative disc disease involving his lumbar spine. An L-spine MRI indicates a broad based disc protrusion mildly indents the thecal sac at the L4-5 level. Available medical evidence indicates Tim experiences intermittent numbness and weakness in his left leg and has significantly limited range of motion in his back secondary to pain. The Disability Specialist assigns a "marked" severity to Tim’s degenerative disc disease.
EXAMPLE - Phil has been diagnosed with Generalized Anxiety Disorder by a contracted psychologist. The Psychological Evaluation indicates Phil has suffered from frequent anxiety and excessive worry, which he is unable to control, for at least the past 12 months. The psychologist notes Phil has difficulty concentrating, becomes irritable, and has difficulty sleeping. The BAI completed as part of the Psychological Evaluation is consistent with marked-to-severe anxiety. The contracted psychologist notes significant limits on Phil's ADLs and assigned a GAF of 45. Based on the overall clinical findings and objective evidence, the Disability Specialist assigns a "marked" severity.
  1. When an individual has multiple impairments, we consider whether the impairments have a cumulative effect on their ability to perform basic work activities.
  2. The Disability Specialist assigns a higher overall severity if the cumulative effect of multiple impairments results in a greater impact on the individual's ability to perform one or more basic work activity.
EXAMPLE - Jerry has been diagnosed with moderate C-spine degenerative disc disease. He also has moderate arthritis involving his dominant hand. Based on medical and other evidence received, the two conditions result in a very significant limitation in Jerry's ability to handle and manipulate objects. Based on the cumulative effect on Jerry's ability to perform a basic work activity, the Disability Specialist assigns a "marked" overall severity.

Clarifying Information

  1. ABD Disability Determinations are made by a team consisting of a Disability Specialist and a contracted doctor.
  2. The contracted doctor reviews the diagnosis, severity, functional limitations, duration and onset date recorded by the Disability Specialist if the individual has at least a moderate overall severity that has lasted or is expected to last 12 months or more or result in death.
  3. The Disability Specialist makes necessary adjustments to the diagnosis, severity, functional impairments, and onset date based on the contracted doctor's professional medical opinion when supported by objective medical evidence. All adjustments are made prior to determining whether the individual meets the disability criteria in Step 2 of the ABD Sequential Evaluation Process (SEP).
  4. If the severity ratings or functional limitations provided by the evaluating medical provider are adjusted, the Disability Specialist must clearly describe the reason why we rejected the medical evidence provider's opinion and identify the medical evidence used to make the determination.
  5. If the overall impairment is of at least a moderate severity and the impairment has lasted or is expected to last 12 months or more or result in death, the Disability Specialist proceeds with the ABD Sequential Evaluation process.
  6. The Disability Specialist denies ABD at Step II if:
    1. The overall impairment is mild, meaning there is not a significant impact on the ability to perform at least one basic work activity.
    2. The impairment has not lasted or is not expected to last 12 months or more or result in death; or
    3. Medical evidence indicates substance use is material to the impairment as defined in WAC 388-449-0015.
NOTE: In general, the opinion of a treating provider is given more weight than that of the contracted RME doctor who has not examined or treated the individual. In addition, the opinion of a specialist involving an area of his or her expertise is given more weight than that of a non-specialist.