These are the rules SSDI uses to evaluate disabilities. This is
the Listings of Impairments referred to in: What Parkinsonians
Should Know About Social Security Disability Insurance  Item#
3665 in the archives. Part 1 covers the basic rules and
Neurological disorders. Part 2 covers Mental disorders.
12.00   Mental Disorders
 
A.      Introduction: The evaluation of disability on the basis of
mental disorders requires the documentation of a medically
determinable impairment(s) as well as consideration of the
degree of limitation such impairment(s) may impose on the
individual's ability to work and whether these limitations have
lasted or are expected to last for a continuous period of at
least 12 months. The listings for mental disorders are arranged
in eight diagnostic categories: organic mental disorders
(12.02); schizophrenic, paranoid and other psychotic disorders
(12.03); affective disorders (12.04); mental retardation and
autism (12.05 anxiety related disorders (12.06); somatoform
disorders (12.07); personality disorders (12.08); and substance
addiction disorders (12.09). Each diagnostic group except
listings 12.05 and 12.09, consists of a set of clinical findings
(paragraph A criteria), one or more of which must be met, and
which, if met lead to a test of functional restrictions
(paragraph B criteria), two or three of which must also be met.
There are additional considerations (paragraph C criteria) in
listings 12.03 and 12.06, discussed therein.
 
The purpose of including the criteria in paragraph A of the
listings for mental disorders is to medically substantiate the
presence of a mental disorder. Specific signs and symptoms under
any of the listings 12.02 through 12.09 cannot he considered in
isolation from the description of the mental disorder contained
at the beginning of each listing category. Impairments should be
analyzed or reviewed under the mental category(ies) which is
supported by the individual's clinical findings.
 
The purpose of including the criteria in paragraphs B and C of
the listings for mental disorders is to describe those
functional limitations associated with mental disorders which
are incompatible with the ability to work. The restrictions
listed in paragraphs B and C must be the results of the mental
disorder which is manifested by the clinical findings outlined
in paragraph A. The criteria included in paragraphs B and C of
the listings for mental disorders have been chosen because they
represent functional areas deemed essential to work. An
individual who is severely limited in these areas as the result
of an impairment identified in paragraph A is presumed to be
unable to work.
 
The structure of the listing for substance addiction disorders,
listing 12.09, is different from that for the other mental
disorder listings. Listing 12.09 is structured as a reference
listing; that is, it will only serve to indicate which of the
other listed mental or physical impairments must be used to
evaluate the behavioral or physical changes resulting from
regular use of addictive substances.
 
 The listings for mental disorders are so constructed that an
individual meeting or equaling the criteria could not reasonably
be expected to engage in gainful work activity.
 
Individuals who have an impairment with a level of severity
which does meet the criteria of the listings for mental
disorders may or may not have the residual functional capacity
(RFC) which would enable them to engage substantial gainful work
activity. The determination of mental RFC is crucial to the
evaluation of an individual's capacity to engage in substantial
gainful work activity when the criteria of the listings for
mental disorders are not met or equaled but the impairment is
nevertheless severe.
 
RFC may be defined as a multidimensional description of the
work-related abilities which an individual retains in spite of
medical impairments. RFC complements the criteria in paragraphs
A and C of the listings for mental disorders by requiring
consideration of an expanded list of work-related capacities
which may be impaired by mental disorder when the impairment is
severe but does not meet or equal a listed mental disorder.
 
B. Need for Medical Evidence: The existence of a medically
determinable impairment of the required duration must be
established by medical evidence consisting of clinical signs,
symptoms and/or laboratory or psychological test findings. These
findings may be intermittent or persistent depending on the
nature of the disorder. Clinical signs are medically
demonstrable phenomena which reflect specific abnormalities of
behavior, affect, thought, memory, orientation, or contact with
reality. These signs are typically assessed by a psychiatrist or
psychologist and/or documented by psychological tests. Symptoms
are complaints presented by the individual. Signs and symptoms
generally cluster together to constitute recognizable clinical
syndromes (mental disorders). Both symptoms and signs which are
part of the diagnosed mental disorder must be considered in
evaluating severity.
 
C.      Assessment of Severity: For mental disorders, severity is
assessed in terms of the functional limitations imposed by the
impairment. Functional limitations are assessed using the
criteria in paragraph B or the listings for mental disorders
(descriptions of restrictions of activities of daily living;
social functioning; concentration, persistence, or pace: and
ability to tolerate increased mental demands associated with
competitive work). Where "marked" is used as a standard for
measuring the degree of limitation, it means more than moderate
but less than extreme. A marked limitation may arise when
several activities or functions are impaired or even when only
one is impaired, so long as the degree of limitation is such as
to seriously interfere with the ability to function
independently, appropriately and effectively. Four areas are
considered.
 
1.      Activities of daily living include adaptive activities such
as cleaning, shopping, cooking, taking public transportation,
paying bills, maintaining a residence, caring appropriately for
one's grooming and hygiene, using telephones and directories,
using a post office, etc. In the context of the individual's
overall situation, the quality of these activities is judged by
their independence, appropriateness and effectiveness. It is
necessary to define the extent to which the individual is
capable of initiating and participating in activities
independent of supervision or direction.
 
"Marked" is not the number of activities which are restricted
but the overall degree of restriction or combination of
restrictions which must be judged. For example, a person who is
able to cook and clean might still have marked restrictions of
daily activities if the person were too fearful to leave the
immediate environment of home and neighborhood, hampering the
persons ability to obtain treatment or to travel away from the
immediate living environment.
 
2.      Social functioning refers to an individual's capacity to
interact appropriately and communicate effectively with other
individuals. Social functioning includes the ability to get
along with others, e.g., family members, friends, neighbors,
grocery clerks, landlords, bus drivers, etc. Impaired social
functioning may be demonstrated by a history of altercations,
evictions, firings, fear of strangers, avoidance of
interpersonal relationships, social isolation, etc. Strength in
social functioning may be documented by an individual's ability
to initiate social contacts with others, communicate clearly
with others, interact and actively participate in group
activities, etc. Cooperative behaviors, consideration for
others, awareness of others' feelings, and social maturity also
need to be considered. Social functioning in work situations may
involve interactions with the public, responding appropriately
to persons in authority, e.g., supervisors, or cooperative
behaviors involving coworkers.
 
"Marked" is not the number of areas in which social functioning
is impaired but the overall degree of interference in a
particular area or combination of areas of functioning. For
example, a person who is highly antagonistic, uncooperative,
hostile but is tolerated by local storekeepers may nevertheless
have marked restrictions in social functioning because that
behavior is not acceptable in social contexts.
 
3. Concentration, persistence and pace refer to the ability to
sustain focused attention sufficiently long to permit the timely
completion of tasks commonly found is work settings. In
activities of daily living, concentration may be reflected in
terms of ability to complete tasks in everyday household
routines. Deficiencies in concentration, persistence and pace
are best observed in work and work-like settings. Major
impairment in this area can often be assessed through direct
psychiatric examination and for psychological testing, although
mental status examination or psychological test data alone
should not be used to accurately describe concentration and
sustained ability to adequately perform work-like tasks. On
mental status examinations, concentration is assessed by tasks
such as having the individual subtract serial sevens from 100.
In psychological tests of intelligence or memory, concentration
is assessed through tasks that must be completed within
established time limits. In work evaluation, concentration,
persistence, and pace are assessed through such tasks as filing
index cards, locating telephone numbers, or disassembling and
reassembling objects. Strengths and weaknesses in areas of
concentration can be discussed in terms of frequency of errors,
time it takes to complete the task, and extent to which
assistance is required to complete the task.
 
4.      Deterioration or decompensation in work or work-like settings
refers to repeated failure to adapt to stressful circumstances
which cause the individual either to withdraw from that
situation or to experience exacerbation of signs and symptoms
(i.e., decompensation) with an accompanying difficulty in
maintaining activities of daily living. social relationships,
and/or maintaining concentration, persistence, or pace (i.e.,
deterioration which may include deterioration of adaptive
behaviors). Stresses common to the work environment include
decisions, attendance. schedules, completing tasks, interacting
with supervisors, interactions with peers, etc.
 
D.      Documentation: The presence of a mental disorder should he
documented primarily on the basis of reports from individual
providers, such as psychiatrists and psychologists, and
facilities such as hospitals and clinics. Adequate descriptions
of functional limitations must he obtained from these or other
sources which may include programs and facilities where the
individual has been observed over a considerable period of time.
 
Information from both medical and nonmedical sources may be used
to obtain detailed descriptions of the individual's activities
of daily living; social functioning; concentration, persistence,
and pace; or ability to tolerate increased mental demands
(stress). This information can be provided by programs such as
community mental health centers, day care centers, sheltered
workshops, etc. It can also be provided by others including
family members, who have knowledge of the individual's
functioning. In some cases descriptions of activities of daily
living or social functioning given by individuals or treating
sources may be insufficiently detailed and/or may be in conflict
with the clinical picture otherwise observed or described in the
examinations or reports. It is necessary to resolve any
inconsistencies or gaps that may exist in order to obtain a
proper understanding of the individual's functional restrictions.
 
An individual's level of functioning may vary considerably over
time. The level of functioning at a specific time may seem
relatively adequate or, conversely, rather poor. Proper
evaluation of the impairment must take any variations in level
of functioning into account in arriving at a determination of
impairment severity over time. Thus, it is vital to obtain
evidence from relevant sources over a sufficiently long period
prior to the date of adjudication in order to establish the
individual's impairment severity. This evidence should include
treatment notes, hospital discharge summaries, and work
evaluation or rehabilitation progress notes if these are
available.
 
Some individuals may have attempted to work or may actually have
worked during the period of time pertinent to the determination
of disability. This may have been an independent attempt at
work, or it may have been in conjunction with a community mental
health or other sheltered program which may have been of either
short or long duration. Information concerning the individual's
behavior during any attempt to work and the circumstances
surrounding termination of the work effort are particularly
useful in determining individual's ability or inability to
function in a work setting.
 
The results of well-standardized psychological tests such as the
Wechsler Adult Intelligence Scale (WAIS), the Minnesota
Multiphasic Personality Inventory (MMPI), the Rorschach, and the
Thematic Apperception Test (TAT), may be useful in establishing
the existence of a mental disorder. For example, the WAIS is
useful in establishing mental retardation, and the MMPI,
Rorschach, and TAT may provide data supporting several other
diagnoses. Broad-based neuropsychological assessments using, for
example, the Halstead-Reitan or the Luria-Nebraska batteries may
be useful in determining brain function
 
deficiencies, particularly in cases involving subtle findings
such as may be seen  in traumatic brain injury. In addition, the
process of taking a standardized test requires concentration,
persistence, and pace; performance on such tests may provide
useful data. Test results should, therefore, include both the
objective data and a narrative description of clinical findings.
Narrative reports of intellectual assessment should include a
discussion of whether or not obtained IQ scores are considered
valid and consistent with the individual's developmental history
and degree of functional restriction.
 
In cases involving impaired intellectual functioning, a
standardized intelligence test, e.g., the WAIS, should be
administered and interpreted by a psychologist, or psychiatrist
qualified by training and experience to perform such an
evaluation. In special circumstances, nonverbal measures, such
as the Raven Progressive Matrices, the Lieter international
scale, or the Arthur adaption of the Lieter may be substituted.
 
Identical IQ scores obtained from different tests do not always
reflect a similar degree of intellectual functioning. In this
connection, it must be noted that on the WAIS, for example, IQs
of 70 and below are characteristic of approximately the lowest 2
percent of the general population. In instances where other
administered, it would be necessary to convert the IQ to the
corresponding percentile rank in the general population in order
to determine the actual degree of impairment reflected by those
IQ scores.
 
In cases where more than one IQ is customarily derived from the
test administered, i.e., where verbal, performance, and
full-scale IQs are provided as on the WAIS, the lowest of these
is used in conjunction with listing 12.05.
 
In cases where the nature of the individual's intellectual
impairment test as described above, are precluded, medical
reports specifically describing the level of intellectual,
social, and physical function should be obtained. Actual
observations by Social Security administration or State agency
personnel, reports from educational institutions and information
furnished by public welfare agencies or other reliable objective
sources should be considered as additional evidence.
 
E.      Chronic Mental Impairments: Particular problems are often
involved in evaluating mental impairments in individuals who
have long histories of repeated hospitalizations or prolonged
outpatient care with supportive therapy and medication.
Individuals with chronic psychotic disorders commonly have their
lives structured in such a way as to minimize stress and reduce
their signs and symptoms. Such individuals may be much more
impaired for work than their signs and symptoms would indicate.
The results of a single examination may not adequately describe
these individuals' sustained ability to function. It is,
therefore, vital to review all pertinent information relative to
the individual's condition, especially at times of increased
stress. It is mandatory to attempt to obtain adequate
descriptive information from all sources which have treated the
individual either currently or in the time period relevant to
the decision.
 
F.      Effects of Structured Settings: Particularly in cases
involving chronic mental disorders, overt symptomatology may be
controlled or attenuated by psychosocial factors such as
placement in a hospital, board and care facility, or other
environment that provides similar structure. Highly structured
and supportive settings may greatly reduce the mental demands
placed on an individual. With lowered mental demands, overt
signs and symptoms of the underlying mental disorder may be
minimized. At the same time, however, the individual's ability
to function outside of such a structured and/or supportive
setting may not have changed. An evaluation of individuals whose
symptomatology is controlled or attenuated by psychosocial
factors must consider the ability of the individual to function
outside of such highly structured settings. (For these reasons
the paragraph C criteria were added to Listings 12.03 and 12.06.)
 
G.      Effects of Medication: Attention must be given to the effect
of medication on the individual's signs, symptoms and ability to
function. While psychotropic medications may control certain
primary manifestations of a mental disorder, e.g.,
hallucinations, such treatment may or may not affect the
functional limitations imposed by the mental disorder. In cases
where overt symptomatology is attenuated by the psychotropic
medications, particular attention must be focused on the
functional restrictions which may persist. These functional
restrictions are also to be used as the measure of impairment
severity. (see the paragraph C criteria in Listings 12.03 and
12.06.)
 
Neuroleptics, the medicines used in the treatment of some mental
illnesses, may cause drowsiness, blunted effect or other side
effects involving other body systems. Such side effects must be
considered in evaluating overall impairment severity. Where
adverse effects of medications contribute to the impairment
severity and the impairment does not meet or equal the listings
but is nonetheless severe, such adverse effects must be
considered in the assessment of the mental residual functional
capacity.
 
H. Effect of Treatment: It must be remembered that with adequate
treatment some individuals suffering with chronic mental
disorders not only have their symptoms and signs ameliorated but
also return to a level of function close to that of their
premorbid status. Our discussion here in 12.00H has been
designed to reflect the fact that present day treatment of a
mentally impaired individual may or may not assist in the
achievement of an adequate level of adaption required in the
work place. (See the paragraph C criteria in Listings 12.03 and
12.06.)
 
I.      Technique for Reviewing the Evidence in Mental Disorders
Claims to Determine Level of impairment Severity. A special
technique has been developed to ensure that all evidence needed
for the evaluation of impairment severity in claims involving
mental impairment is obtained, considered and properly
evaluated. This technique, which is used in connection with the
sequential evaluation process is explained in  404.l520a and '
416.920a.
 
12.01   Category of Impairments - Mental
 
12.02   Organic Mental Disorders: Psychological or behavioral
abnormalities associated with a dysfunction of the brain.
History and physical examination or laboratory tests demonstrate
the presence of a specific organic factor judged to be
etiologically related to the abnormal mental state and loss of
previously acquired functional abilities.
 
The required level of severity for these disorders is met when
the requirements in both A and B are satisfied.
 
A.      Demonstration of a loss of specific cognitive abilities or
affective changes and the medically documented persistence of at
least one of the following:
1.      Disorientation to time and place; or
2.      Memory impairment, either short-term (inability to learn new
information), intermediate, or long-term (inability to remember
information that was known sometime in the past); or
3.      Perceptual or thinking disturbances (e.g., hallucinations,
delusions); or
4.      Change in personality; or
5.      Disturbance in mood; or
6.      Emotional lability (e.g., explosive temper outbursts, sudden
crying, and impairment in impulse control; or
7.      Loss of measured intellectual ability of at least 15 I.Q.
points from premorbid levels or overall impairment index clearly
within the severely impaired range on neuropsychological
testing, e.g., the Luria-Nebraska, Halstead-Reitan, etc; AND
 
B.      Resulting in at least two of the following:
1.      Marked restriction in activities of daily living; or
2.      Marked difficulties in maintaining social functioning; or
3.      Deficiencies of concentration, persistence or pace resulting
in frequent failure to complete tasks in a timely manner (in
work settings or elsewhere); or
4.      Repeated episodes of deterioration or decompensation in work
or work-like settings which cause the individual to withdraw
from that situation or to experience exacerbation of signs and
symptoms (which may include deterioration of adaptive behavior).
 
12.03   Schizophrenic, Paranoid and Other Psychotic Disorders:
Characterized by the onset of psychotic features with
deterioration from a previous level of functioning.
 
The required level of severity for these disorders is met when
the requires in both A and B are satisfied, or when the
requirements in C are satisfied.
 
A.      Medically documented persistence, either continuous or
intermittent, or more of the following:
1.   Delusions or hallucinations: or
2.      Catatonic or other grossly disorganized behavior, or
3.      Incoherence, loosening of associations, illogical thinking,
or poverty of content of speech if associated with one of the
following:
 
a.      Blunt affect: or
b.      Flat affect; or
c.      Inappropriate affect;
 
Or
 
4.      Emotional withdrawal and/or isolation:
 
AND
 
B.      Resulting in at least two of the following:
1.      Marked restriction in activities of daily living; or
2.      Marked difficulties in maintaining social functioning;
 
OR
 
3.      Deficiencies of concentration, persistence or pace resulting
in frequent failure to complete tasks in a timely manner (in
work settings or elsewhere); or
4.      Repeated episodes of deterioration or decompensation in work
or work-like settings which cause the individual to withdraw
from that situation or to experience exacerbation of signs and
symptoms (which may include deterioration of adaptive behavior).
 
OR
 
C.      Medically documented history of one or more episodes of acute
symptoms, signs, and functional limitations which at the time
met the requirements in A and B of this listing, although these
symptoms or signs are currently attenuated by medication or
psychosocial support, and one of the following:
 
1.      Repeated episodes of deterioration or decompensation in
situations which cause the individual to withdraw from that
situation or to experience exacerbation of signs or symptoms
(which may include deterioration of adaptive behaviors); or
2.      Documented current history of two or more years of inability
to function outside of a highly supportive living situation.
 
12.04   Affective Disorders: Characterized by a disturbance of
mood, accompanied by a full or partial manic or depressive
syndrome. Mood refers to a prolonged emotion that colors the
whole psychic life; it generally involves either depression or
elation
 
The required level of severity for these disorders is met when
the requirements in both A and B are satisfied.
 
A. Medically documented persistence, either continuous or
intermittent of one of the following;
 
1. Depressive syndrome characterized by at least four of the
following;
 
a.      Anhedonia or pervasive loss of interest in almost all
activities; or
b.      Appetite disturbance with change in weight; or
c.      Sleep disturbance; or
d.      Psychomotor agitation or retardation; or
e.      Decreased energy; or
f.      Feelings of guilt or worthlessness; or
g.      Difficulty concentrating or thinking; or
h.      Thoughts of suicide; or
i.      Hallucinations, delusions or paranoid thinking; or
 
2.      Manic syndrome characterized by at least three of the
following:
 
a.      Hyperactivity; or
b.      Pressure of speech; or
c.      Flight of ideas; or
d.      Inflated self-esteem; or
e.      Decreased need for sleep; or
f.      Easy distractibility; or
g.      Involvement in activities that have a high probability of
painful consequences which are not recognized; or
h.      Hallucinations, delusions or paranoid thinking;
 
OR
 
3.      Bipolar syndrome with a history of episodic periods
manifested by the full symptomatic picture of both manic and
depressive syndromes (and currently characterized by either or
both syndromes);
 
And
 
B. Resulting in at least two of the following:
 
1.      Marked restriction in activities of daily living; or
2.      Marked difficulties in maintaining social functioning; or
 
Deficiencies of concentration, persistence or pace resulting in
frequent failure to complete tasks in a timely manner (in work
settings or elsewhere); or
 
4.      Repeated episodes of deterioration or decompensation in work
or work-like settings which cause the individual to withdraw
from that situation or to experience exacerbation of signs and
symptoms (which may include deterioration of adaptive behaviors).
 
12.05   Mental Retardation and Autism: Mental retardation refers
to a significantly subaverage general intellectual functioning
with deficits in adaptive behavior initially manifested during
the developmental period (before age 22), (Note: The scores
specified below refer to those obtained on the WAIS, and are
used only for reference purposes. Scores obtained on other
standardized and individual administered tests arc acceptable,
but the numerical values obtained must indicate a similar level
of intellectual functioning.) Autism is a pervasive
developmental disorder characterized by social and significant
deficits originating in the developmental period.
 
The required level of severity for this disorder is met when the
requirements of A, B, C, or D are satisfied.
 
A. Mental incapacity evidenced by dependence upon others for
personal (e.g., toileting, eating, dressing, or bathing) and
inability to follow directions, such that the use of
standardized measures of intellectual functioning is precluded;
 
OR
 
B.      A valid verbal, performance, or full scale IQ of 59 or less;
Or
 
C. A valid, verbal, performance, or full scale IQ of 60 through
70 and a physical or other mental impairment imposing additional
and significant work-related limitation of function;
 
OR
 
D. A valid verbal, performance, or full scale IQ of 60 through
70, or in the case of autism, gross deficits of social and
communicative skills, with either conditions resulting in two of
the following:
 
1.      Marked restriction of activities of daily living; or
2.      Marked difficulties in maintaining social functioning; or
3.      Deficiencies of concentration, persistence or pace resulting
in frequent failure to complete tasks in a timely manner (in
work settings or elsewhere); or
4.      Repeated episodes of deterioration or decompensation in work
or work-like settings which cause the individual to withdraw
from that situation or to experience exacerbation of signs or
symptoms (which may include deterioration of adaptive behaviors).
 
12.06   Anxiety related disorders: In these disorders anxiety is
either the predominant disturbance or it is experienced if the
individual attempts to master symptoms; for example, confronting
the dreaded object or situation in a phobic disorder or
resisting the obsessions or compulsions in obsessive compulsive
disorders.
 
The required level of severity for these disorders is met when
the requirements in both A and B are satisfied, or when the
requirements in both A and C are satisfied.
 
A.      Medically documented findings of at least one of the
following:
 
1.      Generalized persistent anxiety accompanied by three out of
four of following signs or symptoms:
 
a.      Motor tension; or
b.      Autonomic hyperactivity; or
c.      Apprehensive expectation; or
d.      Vigilance and scanning; or
 
2.      A persistent irrational fear of a specific object, activity,
or situation which results in a compelling desire to avoid the
dreaded object, activity, or situation, or
 
3.     Recurrent severe panic attacks manifested by a sudden
unpredictable onset of intense apprehension, fear, terror and
sense of impending doom occurring on the average of at least
once a week; or
 
4.      Recurrent obsessions or compulsions which are a source of
marked distress; or
 
5.      Recurrent and intrusive recollection of a traumatic
experience, which are a source of marked distress
 
AND
 
B.      Resulting in at least two of the following:
 
1.      Marked restriction in activities of daily living; or
2.      Marked difficulties m maintaining social functioning; or
3.      Deficiencies of concentration, persistence or pace resulting
in frequent failure to complete tasks in a timely manner (in
work settings or elsewhere); or
4.      Repeated episodes of deterioration or decompensation in work
or work-like settings which cause the individual to withdraw
from that situation or to experience exacerbation of signs and
symptoms (which may include deterioration of adaptive
behaviors).
 
OR
 
C.      Resulting in complete inability to function independently
outside the area of one's home.
 
 12.07  Somatoform Disorders: Physical symptoms for which there
are no demonstrable organic findings or known physiological
mechanisms.
 
The required level of severity for these disorders is met when
the requirements in both A and B are satisfied.
 
A.      Medically documented by evidence of one of the following:
 
1.      A history of multiple physical symptoms of several years
duration beginning before age 30, that have caused the
individual to take medicine frequently, see a physician often
and alter life patterns significantly; or
 
2.      Persistent nonorganic disturbance of one of the following:
 
a.      Vision; or
b.      Speech; or
c.      Hearing; or
d.      Use of a limb; or
e.      Movement and its control (e.g. coordination disturbances,
psychogenic seizures, akinesia, dyskinesia); or
f.      Sensation (e.g., diminished or heightened); or
 
3.      Unrealistic interpretation of physical signs or sensations
associated with the preoccupation or belief that one has a
serious disease or injury.
 
AND
 
B.      Resulting in at least two of the following;
 
1.      Marked restriction in activities of daily living: or
2.      Marked difficulties in maintaining social functioning; or
3.      Deficiencies of concentration, persistence or pace resulting
in frequent failure to complete tasks in a timely manner (in
work settings or elsewhere); or
4.      Repeated episodes of deterioration or decompensation in work
or work-like settings which cause the individual to withdraw
from that situation or to experience exacerbation of signs and
symptoms (which may include deterioration of adaptive behavior).
 
12.08   Personality Disorders: A personality disorder exists when
personality traits are inflexible and maladaptive and cause
either significant impairment in social or occupational
functioning or subjective distress. Characteristic features are
typical of the individual's long-term functioning and are not
limited to discrete episodes of illness.
 
The required level of severity for these disorders is met when
the requirements in both A and B are satisfied.
 
A.      Deeply ingrained, maladaptive patterns of behavior associated
with one of the following:
 
1.      Seclusiveness or autistic thinking; or
2.      Pathologically inappropriate suspiciousness or hostility; or
3.      Oddities of thought, perception, speech and behavior; or
4.      Persistent disturbances of mood or affect; or
5.      Pathological dependence, passivity, or aggressivity; or
6.      Intense and unstable interpersonal relationships and
impulsive and damaging behavior:
 
AND
 
B.      Resulting in at least two of the following:
 
1.      Marked restriction in activities of daily living; or
2.      Marked difficulties in maintaining social functioning; or
3.      Deficiencies of concentration, persistence or pace resulting
in frequent failure to complete tasks in a timely manner (in
work settings or elsewhere); or
4.      Repeated episodes of deterioration or decompensation in work
or work-like settings which cause the individual to withdraw
from that situation or to experience exacerbation of signs and
symptoms (which may include deterioration of adaptive behaviors).
 
12.09   Substance Addiction Disorders: Behavioral changes or
physical changes associated with the regular use of substances
that affect the central nervous system.
 
The required level of severity for these disorders is met when
the requirements in any of the following (A through I) are
satisfied.
 
A.      Organic mental disorders. Evaluate under 12.02
B.      Depressive Syndrome. Evaluate under 12.04
C.      Anxiety Disorders. Evaluate under 12.06
D.      Personality disorders. Evaluate under 12.08
E.      Peripheral neuropathies. Evaluate under 11.14
F.      Liver Damage. Evaluate under 5.05
G.      Gastritis. Evaluate under 5.04
H.      Pancreatitis. Evaluate under 5.08
L.      Seizures. Evaluate under 11.02 or 11.03.
 
 
 
 
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