If you are diagnosed with a mental impairment by an acceptable medical source described in WAC 388-449-0010, we use information from medical sources described in WAC 388-449-0010 to determine how the impairment limits work-related activities.

1. (1) We review the following psychological evidence to determine the severity of your mental impairment:

   1. (a) Psychosocial and treatment history records;
   2. (b) Clinical findings of specific abnormalities of behavior, mood, thought, orientation, or perception;
   3. (c) Results of psychological tests; and
   4. (d) Symptoms observed by the examining practitioner, and other evidence, that show how your impairment affects your ability to perform basic work-related activities.
2. (2) We exclude diagnosis and symptoms related to alcohol or substance abuse or addiction, if we have evidence substance use is material to your impairment.

3. (3) If you are diagnosed with mental retardation, the diagnosis must be based on the Wechsler Adult Intelligence Scale (WAIS). The following test results determine the severity rating:

   Intelligence Quotient (IQ) Score	Severity Rating
   85 or above	None (1)
   71 to 84	Moderate (3)
   60 to 70	Marked (4)
   59 or lower	Severe (5)

4. (4) If you are diagnosed with a mental impairment with physical causes, we assign a severity rating based on the most severe of the following four areas of impairment:

   1. (a) Short term memory impairment;
   2. (b) Perceptual or thinking disturbances;
   3. (c) Disorientation to time and place; or
   4. (d) Labile, shallow, or coarse affect.

5. (5) We base the severity of an impairment diagnosed as a mood, thought, personality, anxiety, memory, or cognitive disorder on a clinical assessment of the intensity and frequency of symptoms that:

   1. (a) Affect your ability to perform basic work related activities; and
   2. (b) Are consistent with a diagnosis of a mental impairment as listed in the most recent published edition of the Diagnostic and Statistical Manual of Mental Disorders.

6. (6) We consider the combined effect of your symptoms on your ability to perform basic work activities. We determine the severity rating for a functional mental impairment as follows:

   Symptom Ratings or Condition	Severity Rating
   (a) The clinical findings and objective evidence are consistent with a significant limitation on performing one or more basic work activities.	Moderate (3)
   (b) You are diagnosed with a functional disorder with psychotic features.(c) You have had two or more hospitalizations for psychiatric reasons in the past two years.(d) You have had more than six months of continuous psychiatric inpatient or residential treatment in the past two years.(e) The clinical findings and objective evidence are consistent with a very significant limitations on ability to perform one or more basic work activities.	Marked (4)
   (f) The clinical findings and objective evidence are consistent with the inability to perform work activities.	Severe (5)

7. (7) If you are diagnosed with any combination of mental retardation, mental impairment with physical causes, or functional mental impairment, we assign a severity rating as follows:

   Condition	Severity Rating
   (a) Two or more disorders with moderate severity (3) ratings; or(b) One or more disorders rated moderate severity (3), and one rated marked severity (4).	Marked (4)
   (c) Two or more disorders rated marked severity (4).	Severe (5)

[Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, 74.08A.100, 74.04.770, 74.04.0052, 74.04.655, 74.08.043, 74.08.335, and 2011 1st sp.s. c 36. WSR 12-10-042, § 388-449-0040, filed 4/27/12, effective 6/1/12.]