Disability Determinations - Medical and Other Evidence

Created on: 
Oct 21 2014

WAC 388-449-0010 What evidence do we consider to determine disability?

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

Clarifying Information - WAC 388-449-0010

  1. A diagnosis of a disabling impairment must be established by an acceptable medical source. This means report or chart notes from a physician, psychiatrist, or psychologist within the last 5 years.
  2. After a diagnosis of a potentially disabling impairment has been established, we can use medical evidence from treating providers (PAC’s and ARNP) for current medical evidence.
  3. Once we have an impairment established by a doctor, and current medical evidence, then we may, at our discretion, use documentation of how an impairment limits functioning from other sources. Other sources include, but are not limited to:
    1. Chiropractors
    2. Physical therapists
    3. Naturopaths
    4. Therapists
    5. Social workers
    6. Care givers
    7. Employers
    8. Family member

Clarifying Information-  WAC 388-449-0015

  1. Statements regarding how impairments limit a person’s functioning must be consistent with objective medical evidence.
  2. When determining if a medically determinable condition exists, we only use diagnosis of conditions that will produce potentially disabling symptoms or impairments. These symptoms can either be the direct result of the disease or injury, or as a result of treatment for the condition.
  3. Examples of diagnosis that don’t qualify as a diagnosis of a potentially disabling condition:
    1. ADHD, and other learning disorders, are not considered disabling conditions for adults by SSA and cannot be used as a disabling condition for ABD.
    2. Hypertension is typically asymptomatic and therefore is expected produce potentially disabling symptoms.
    3. Hepatitis is also typically asymptomatic or produces mild symptoms. if the disease has progressed, interferon treatment could result in significant fatigue, but way not meet the duration requirement for disability.
    4. Bereavement or grief is not acceptable diagnosis. While the severity may be temporarily disabling, it is not reasonable to expect the condition for 12 months or more.
  4. Pain cannot be used as a diagnosis. There must be a medically determinable condition (diagnosis of an injury or disease). Once the diagnosis has been established by an acceptable medical source, then written evidence from other treating professionals or non-medical sources can be used to determine how the impairment affects the person’s ability to function.
EXAMPLE Milly has a diagnosis of degenerative disc disease from a physician. Her MRI indicates moderate stenosis. Milly provides a letter from her daughter describing how her mother complains of tingling sensation in her hands and that she has recently seen her mother drop objects that weigh more than 10 lbs. Since Milly has a medically determinable condition that could result in the symptoms described, her daughters statement can be used to help determine the severity of her impairments and her exertional level.
EXAMPLE Bart states that pain in his knee keeps him from working. The physician who examined him found mild edema, but no crepitus, or other abnormal findings, and Bart’s gait and station were noted as WNL. Bart also provided a statement from a physician’s assistant (PAC) that he had seen previously that stated Bart was limited to sedentary work due to knee pain. Since Bart does not have a medically determinable condition, the statement from the PAC can’t be used to when making a determination of disability.