Chapter 388-449 WAC
Last Update: 6/18/24AGED, BLIND, OR DISABLED
WAC Sections
| HTMLPDF | 388-449-0001 | What are the disability requirements for the aged, blind, or disabled (ABD) program? |
| HTMLPDF | 388-449-0005 | Sequential evaluation process step 1—How does the department determine if you are performing substantial gainful employment? |
| HTMLPDF | 388-449-0010 | What evidence do we consider to determine disability? |
| HTMLPDF | 388-449-0015 | What medical evidence do I need to provide? |
| HTMLPDF | 388-449-0020 | How does the department evaluate functional capacity for mental health impairments? |
| HTMLPDF | 388-449-0030 | How does the department evaluate functional capacity for physical impairments? |
| HTMLPDF | 388-449-0035 | How does the department assign severity ratings to my impairment? |
| HTMLPDF | 388-449-0040 | How does the department determine the severity of mental impairments? |
| HTMLPDF | 388-449-0045 | How does the department determine the severity of physical impairments? |
| HTMLPDF | 388-449-0050 | How does the department determine the severity of multiple impairments? |
| HTMLPDF | 388-449-0060 | Sequential evaluation process step II—How does the department review medical evidence to determine if I am eligible for benefits? |
| HTMLPDF | 388-449-0070 | Sequential evaluation process step III—How does the department determine if you meet SSA listing of impairments criteria? |
| HTMLPDF | 388-449-0080 | Sequential evaluation process step IV—How does the department evaluate if I am able to perform relevant past work? |
| HTMLPDF | 388-449-0100 | Sequential evaluation process step V—How does the department evaluate if I can perform other work when determining disability? |
| HTMLPDF | 388-449-0150 | When does my eligibility for aged, blind, or disabled (ABD) cash benefits end? |
| HTMLPDF | 388-449-0200 | Am I eligible for cash assistance for aged, blind, or disabled (ABD) while waiting for supplemental security income (SSI)? |
| HTMLPDF | 388-449-0210 | What is interim assistance and how do I assign it to the department? |
| HTMLPDF | 388-449-0220 | How does substance use affect my eligibility for the aged, blind, or disabled (ABD) cash and pregnant women assistance (PWA) programs? |
| HTMLPDF | 388-449-0225 | Am I required to participate in vocational rehabilitation services if I receive ABD cash grant? |
| HTMLPDF | 388-449-0230 | What aged, blind, or disabled (ABD) program rules may the department implement during a state of emergency? |
PDF388-449-0001
What are the disability requirements for the aged, blind, or disabled (ABD) program?
(1) For the purposes of this chapter, the following definitions apply:
(a) "We" and "us" mean the department of social and health services.
(b) "You" means the applicant or recipient.
(c) "Disabled" means the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which has lasted or can be expected to last for a continuous period of not less than 12 months with available treatment or result in death.
(d) "Physical impairment" means a diagnosable physical illness.
(e) "Mental impairment" means a diagnosable mental disorder. We exclude any diagnosis of or related to a substance use disorder.
(2) We review if you meet disability requirements when:
(a) You apply for ABD cash benefits;
(b) You become employed; or
(c) A disability review is required under WAC 388-449-0150.
(3) You are likely to meet disability requirements if:
(a) You are determined to meet SSA disability criteria by the Social Security Administration (SSA);
(b) You are determined to meet SSA disability criteria by disability determination services (DDDS) based on the most recent DDDS determination;
(c)SSA stops your supplemental security income (SSI) payments solely because you are not a citizen;
(d) You are eligible for services through the developmental disabilities administration (DDA) for a medical condition that is expected to last 12 months or more or result in death;
(e) You are eligible for long-term care services from the aging and long-term support administration (ALTSA) for a medical condition that is expected to last 12 months or more or result in death;
(f) You have been civilly committed to eastern or western state hospital;
(g) You have been placed in eastern or western state hospital for an offense you have been found not guilty by reason of insanity;
(h) You have been diagnosed as having an intellectual disability based on a full scale score of 70 or lower on the Wechsler adult intelligence scale (WAIS); or
(i) You are approved through the sequential evaluation process (SEP) defined in WAC 388-449-0005 through 388-449-0100. The SEP is the sequence of five steps. Step 1 considers whether you are currently working. Steps 2 and 3 consider medical evidence and whether you are likely to meet or equal a listed impairment under Social Security's rules. Steps 4 and 5 consider your residual functional capacity and vocational factors such as age, education, and work experience in order to determine your ability to do your past work or other work.
(4) If you have a physical or mental impairment and you are impaired by a substance use disorder and do not meet the other disability criteria in subsections (2)(a) - (c) of this section, we decide if you are eligible for ABD cash by applying the sequential evaluation process described in WAC 388-449-0005 through 388-449-0100. You are not eligible for ABD cash benefits if you are disabled primarily because of a substance use disorder.
(5) In determining disability, we consider only your ability to perform basic work-related activities. "Basic work-related activities" are activities that anyone would be required to perform in a work setting. They consist of: Sitting, standing, walking, lifting, carrying, handling, and other physical functions (including manipulative or postural functions such as pushing, pulling, reaching, handling, stooping, or crouching), seeing, hearing, communicating, remembering, understanding and following instructions, responding appropriately to supervisors, co-workers, and usual work situations, maintaining appropriate behavior, and adapting to changes in a routine work setting.
(6) We determine you are not likely to meet disability criteria if SSA denied your application for SSI or Social Security Disability Insurance (SSDI) based on disability in the last 12 months unless:
(a) You file a timely appeal with SSA;
(b) SSA decides you have good cause for a late appeal; or
(c) You give us medical evidence of a potentially disabling condition that SSA did not consider or medical evidence confirming your condition has deteriorated.
[Statutory Authority: RCW 74.04.050 and 74.08.090. WSR 24-07-052, § 388-449-0001, filed 3/14/24, effective 4/14/24. Statutory Authority: RCW 74.04.005, 74.04.0052, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.04.805, 74.08.025, 74.08.043, 74.08.090, 74.08.335, 74.08A.100, 74.62.030, and 2022 c 297 § 205(22). WSR 23-01-057, § 388-449-0001, filed 12/14/22, effective 1/14/23. Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.0052, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.08.043, 74.08.090, 74.08.335, 74.08A.100, 74.09.035, 74.09.530, 74.62.030, and 41.05.021. WSR 22-07-020, § 388-449-0001, filed 3/8/22, effective 4/8/22. Statutory Authority: 2014 c 218, 2011 1st sp.s. c 15, RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, 41.05.021, 74.09.035, and 74.09.530. WSR 15-03-031, § 388-449-0001, filed 1/12/15, effective 2/12/15. Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, and 2013 2nd sp.s. c 10. WSR 13-24-040, § 388-449-0001, filed 11/26/13, effective 1/1/14. 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, § 388-449-0001, filed 4/27/12, effective 6/1/12.]
PDF388-449-0005
Sequential evaluation process step 1—How does the department determine if you are performing substantial gainful employment?
We deny disability if you are engaging in substantial gainful activity (SGA) when you apply for aged, blind, or disabled (ABD) benefits. "Substantial gainful activity" means you are performing, in a regular and predictable manner, an activity usually done for pay or profit.
(1) You must be earning less than the SGA standard as defined by the Social Security Administration (SSA) to be eligible for ABD cash, unless:
(a) You work under special conditions that go beyond the employer providing reasonable accommodation, such as a sheltered workshop; or
(b) You provide evidence you work occasionally or part-time because your impairment limits the hours you are able to work compared to unimpaired workers in the same job.
PDF388-449-0010
What evidence do we consider to determine disability?
(1) To determine whether a medically determinable impairment exists, we consider medical evidence from "acceptable medical sources." "Acceptable medical sources" include the following:
(a) For a physical impairment, a health professional licensed in Washington state or where the examination was performed:
(i) Medical doctor (MD);
(ii) Doctor of osteopathy (DO);
(iii) Doctor of optometry (OD) for visual disorders;
(iv) Doctor of podiatry (DP) for foot and ankle disorders;
(v) Physician assistant (PA) for impairments within their licensed scope of practice;
(vi) Advanced registered nurse practitioner (ARNP) for impairments within their licensed scope of practice;
(vii) Audiologist for impairments of hearing loss, auditory processing disorders, and balance disorders within their licensed scope of practice; and
(viii) Qualified speech-language pathologist, for purposes of establishing speech or language impairments.
(b) For a mental impairment, a health professional licensed in Washington state or where the examination was performed:
(i) Psychiatrist;
(ii) Psychologist;
(iii) Advanced registered nurse practitioner (ARNP) for impairments within their licensed scope of practice;
(iv) Physician assistant (PA) for impairments within their licensed scope of practice; and
(v) School psychologist or other licensed or certified individual who performs the same function as a school psychologist in a school setting for impairments of intellectual disability, learning disability, or borderline intellectual functioning.
(2) We accept medical evidence of how your impairment(s) affect your ability to function from "treating medical sources" once a diagnosis of a medically determinable impairment has been established by an "acceptable medical source" listed in subsection (1) of this section. "Treating medical sources" must be licensed to provide healthcare and include, but are not limited to:
(a) Physician treating you for a mental impairment;
(b) Clinical social worker;
(c) Mental health professional (MHP);
(d) Naturopath;
(e) Chiropractor;
(f) Physical therapist; and
(g) Chemical dependency professional (CDP) when requesting information on the effects of substance use disorders.
(3) "Other evidence" means information from sources not listed in subsections (1) and (2) of this section who can provide supporting documentation of functioning for impairments established by an "acceptable medical source" in subsection (1) of this section. Sources of "other evidence" may include public and private agencies, schools, family members, friends, caregivers, and employers.
[Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, 41.05.021, 74.09.035, and 74.09.530. WSR 18-05-075, § 388-449-0010, filed 2/20/18, effective 3/23/18. 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, § 388-449-0010, filed 4/27/12, effective 6/1/12.]
PDF388-449-0015
What medical evidence do I need to provide?
You must give us medical evidence of your impairment(s) and how they affect your ability to perform regular and continuous work activity. Medical evidence must be in writing and be clear, objective, and complete.
(1) Objective evidence for physical impairments means:
(a) Laboratory test results;
(b) Pathology reports;
(c) Radiology findings including results of X-rays and computer imaging scans;
(d) Clinical findings, including but not limited to ranges of joint motion, blood pressure, temperature or pulse, and documentation of a physical examination; and
(e) Hospital history and physical reports and admission and discharge summaries; or
(f) Other medical history and physical reports related to your current impairments.
(2) Objective evidence for mental impairments means:
(a) Clinical interview observations, including objective mental status exam results and interpretation;
(b) Explanation of how examination findings meet the clinical and diagnostic criteria of the most recent edition of the diagnostic and statistical manual of mental disorders (DSM);
(c) Hospital, outpatient, and other treatment records related to your current impairments; and
(d) Testing results, if any, including:
(i) Description and interpretation of tests of memory, concentration, cognition, or intelligence; or
(ii) Interpretation of medical tests to identify or exclude a connection between the mental impairment and physical illness.
(3) Medical evidence sufficient for a disability determination must be from a medical professional described in WAC 388-449-0010 and must include:
(a) A diagnosis for the impairment, or impairments, based on an examination performed by an acceptable medical source defined in WAC 388-449-0010 within five years of application;
(b) A clear description of how the impairment relates to your ability to perform the work-related activities listed in WAC 388-449-0005;
(c) Documentation of how long a condition has impaired your ability to perform work related activities;
(d) A prognosis, or written statement of how long an impairment will impair your ability to perform work related activities; and
(e) A written statement from a medical professional (defined in WAC 388-449-0010) describing what you are capable of doing despite your impairment (medical source statement) based on an examination performed within 90 days of the date of application or disability review.
(4) We consider documentation in addition to objective evidence to support the acceptable medical source or treating provider's opinion that you are unable to perform substantial gainful employment, such as proof of hospitalization.
(5) When making a disability decision, we don't use your report of symptoms as evidence unless objective evidence shows there is an impairment that could reasonably be expected to produce those symptoms.
(6) We don't use symptoms related to substance use disorder or a diagnosis of substance use disorder when determining disability if we have evidence substance use is material to your impairment(s).
(7) We consider substance use to be material to your impairment(s) if you are disabled primarily because of a substance use disorder.
(8) If your impairment will persist at least 60 days after you stop using drugs or alcohol, we do not consider substance use to be material to your impairment.
(9) If you can't obtain medical evidence sufficient for us to determine if you are likely to be disabled without cost to you, and you meet the other eligibility conditions in WAC 388-400-0060, we pay the costs to obtain objective evidence based on published payment limits and fee schedules.
(10) We determine the likelihood of disability based solely on the objective information we receive. We are not obligated to accept another agency's or person's decision that you are disabled or unemployable.
[Statutory Authority: RCW 74.04.005, 74.04.0052, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.08.043, 74.08.090, 74.08.335, and 74.08A.100. WSR 24-13-094, § 388-449-0015, filed 6/18/24, effective 7/19/24. 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, § 388-449-0015, filed 4/27/12, effective 6/1/12.]
PDF388-449-0020
How does the department evaluate functional capacity for mental health impairments?
If you have a mental impairment, we evaluate ability to function in a work setting based on an objective clinical assessment from a medical professional as described in WAC 388-449-0010. We may also use other evidence as described in WAC 388-449-0010. Functioning means your ability to perform typical tasks that would be required in a routine job setting and your ability to interact effectively while working.
(1) We evaluate cognitive and social functioning by assessing your ability to:
(a) Understand, remember, and persist in tasks by following very short and simple instructions.
(b) Understand, remember, and persist in tasks by following detailed instructions.
(c) Perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances without special supervision.
(d) Learn new tasks.
(e) Perform routine tasks without special supervision.
(f) Adapt to changes in a routine work setting.
(g) Make simple work-related decisions.
(h) Be aware of normal hazards and take appropriate precautions.
(i) Ask simple questions or request assistance.
(j) Communicate and perform effectively in a work setting with public contact.
(k) Communicate and perform effectively in a work setting with limited public contact.
(l) Complete a normal workday and workweek without interruptions from psychologically based symptoms.
(m) Set realistic goals and plan independently.
(n) Maintain appropriate behavior in a work setting.
PDF388-449-0030
How does the department evaluate functional capacity for physical impairments?
If you have a physical impairment, we evaluate your ability to work based on objective medical evidence from a medical professional as described in WAC 388-449-0010. We may also use other evidence as described in WAC 388-449-0010.
(1) "Exertion level" means having strength, flexibility, and mobility to lift, carry, stand or walk as needed to fulfill job duties in the following work levels. For this section, "occasionally" means less than one-third of the time and "frequently" means one-third to two-thirds of the time.
The following table is used to determine your exertion level. Included in this table is a strength factor, which is your ability to perform physical activities, as defined in Appendix C of the Dictionary of Occupational Titles (DOT), Revised Edition, published by the U.S. Department of Labor as posted on the Occupational Information Network (O*NET).
If you are able to: | Then we assign this exertion level |
(a) Lift ten pounds maximum and frequently lift or carry lightweight articles. Walking or standing only for brief periods. | Sedentary |
(b) Lift twenty pounds maximum and frequently lift or carry objects weighing up to ten pounds. Walk six out of eight hours per day or stand during a significant portion of the workday. Sitting and using pushing or pulling arm or leg movements most of the day. | Light |
(c) Lift fifty pounds maximum and frequently lift or carry up to twenty-five pounds. | Medium |
(d) Lift one hundred pounds maximum and frequently lift or carry up to fifty pounds. | Heavy |
(2) "Exertional limitation" means a restriction in mobility, agility or flexibility in the following twelve activities: balancing, bending, climbing, crawling, crouching, handling, kneeling, pulling, pushing, reaching, sitting, and stooping. We consider any exertional limitations when we determine your ability to work.
(3) "Functional physical capacity" means the degree of strength, agility, flexibility, and mobility you can apply to work-related activities. We consider the effect of the physical impairment on the ability to perform work-related activities when the severity of the physical impairment(s) is moderate, marked, or severe. We determine functional physical capacity based on your exertional and nonexertional limitations. All limitations must be substantiated the medical evidence and directly related to the diagnosed impairment(s).
(4) "Nonexertional physical limitation" means a restriction on work activities that does not affect strength, mobility, agility, or flexibility. Nonexertional restrictions may include, among other things, your inability to work at heights or in an area where you would be exposed to chemicals.
(5) "Functional limitations" means a restriction on work activities related to unrelieved pain or the effects of prescribed medication. We determine your functional limitations based on objective documentation from a medical professional as described in WAC 388-449-0010. We may also use other evidence as described in WAC 388-449-0010. We evaluate functioning by assessing your ability to:
(a) Perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances.
(b) Perform routine tasks without undue supervision.
(c) Make simple work-related decisions.
(d) Be aware of normal hazards and take appropriate precautions.
(e) Ask simple questions or request assistance.
(f) Maintain appropriate behavior in a work setting.
PDF388-449-0035
How does the department assign severity ratings to my impairment?
(1) "Severity rating" is a rating of the extent of your impairment and how it impacts your ability to perform basic work activities. The following chart provides a description of limitations on work activities and the severity ratings assigned to each.
Effect on Work Activities | Degree of Impairment | Numerical Value |
(a) There is no effect on your performance of one or more basic work-related activities. | None | 1 |
(b) There is no significant limit on your performance of one or more basic work-related activities. | Mild | 2 |
(c) There are significant limits on your performance of one or more basic work-related activities. | Moderate | 3 |
(d) There are very significant limits on your performance of one or more basic work-related activities. | Marked | 4 |
(e) You are unable to perform basic work-related activities. | Severe | 5 |
(2) We use the description of how your condition impairs your ability to perform work activities given by the acceptable medical source or your treating provider, and review other evidence you provide, to establish severity ratings when the impairments are supported by, and consistent with, the objective medical evidence.
(3) A contracted doctor reviews your medical evidence and the ratings assigned to your impairment when:
(a) The medical evidence indicates functional limitations consistent with at least a moderate physical or mental health impairment;
(b) Your impairment has lasted or is expected to last, twelve months or more with available medical treatment; and
(c) You are not an active ABD recipient previously determined likely to be disabled as defined in WAC 388-449-0010 through 388-449-0100.
(4) The contracted doctor reviews your medical evidence, severity rating, and functional assessment to determine whether:
(a) The medical evidence is objective and sufficient to support the findings of the provider;
(b) The description of the impairment(s) is supported by the medical evidence; and
(c) The severity rating, duration, and assessment of functional limitations assigned by DSHS are consistent with the medical evidence.
(5) If the medical provider's description of your impairment(s) is not consistent with the objective evidence, we will:
(a) Assign a severity rating, duration, and functional limitations consistent with the objective medical evidence; and
(b) Clearly describe why we rejected the medical evidence provider's opinion; and
(c) Identify the medical evidence used to make the determination.
[Statutory Authority: 2014 c 218, 2011 1st sp.s. c 15, RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, 41.05.021, 74.09.035, and 74.09.530. WSR 15-03-031, § 388-449-0035, filed 1/12/15, effective 2/12/15. Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, and 2013 2nd sp.s. c 10. WSR 13-24-040, § 388-449-0035, filed 11/26/13, effective 1/1/14. 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, § 388-449-0035, filed 4/27/12, effective 6/1/12.]
PDF388-449-0040
How does the department determine the severity of mental impairments?
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) We review the following psychological evidence to determine the severity of your mental impairment:
(a) Psychosocial and treatment history records;
(b) Clinical findings of specific abnormalities of behavior, mood, thought, orientation, or perception;
(c) Results of psychological tests; and
(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) 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) 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) 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:
(a) Short term memory impairment;
(b) Perceptual or thinking disturbances;
(c) Disorientation to time and place; or
(d) Labile, shallow, or coarse affect.
(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:
(a) Affect your ability to perform basic work related activities; and
(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) 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) 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) |
PDF388-449-0045
How does the department determine the severity of physical impairments?
We must decide if your physical impairment is serious enough to significantly limit your ability to perform substantial gainful activity. "Severity of a physical impairment" means the degree that an impairment restricts you from performing basic work-related activities (see WAC 388-449-0005). Severity ratings range from none to severe. We will assign severity ratings according to the table in WAC 388-449-0035.
We assign to each physical impairment a severity rating that is supported by medical evidence.
PDF388-449-0050
How does the department determine the severity of multiple impairments?
(1) If you have more than one impairment, we decide the overall severity rating by determining if your impairments have a combined effect on your ability to be gainfully employed.
(2) When you have two or more diagnosed impairments that limit work activities, we assign an overall severity rating as follows:
Your Condition | Severity Rating |
(i) All impairments are mild and there is no cumulative effect on basic work activities. | Mild |
(ii) All impairments are mild and there is a significant cumulative effect on one or more basic work activities. | Moderate |
(iii) Two or more impairments are of moderate severity and there is a very significant cumulative effect on basic work activities. | Marked |
(iv) Two are more impairments are of marked severity. | Severe |
PDF388-449-0060
Sequential evaluation process step II—How does the department review medical evidence to determine if I am eligible for benefits?
When we receive your medical evidence, we review it to determine if it is sufficient to decide whether your circumstances meet disability requirements.
(1) We require written medical evidence to determine disability. The medical evidence must:
(a) Contain sufficient information as described under WAC 388-449-0015;
(b) Be written by an acceptable medical source or treating provider described in WAC 388-449-0010;
(c) Document the existence of a potentially disabling condition by an acceptable medical source described in WAC 388-449-0010; and
(d) Document the impairment has lasted or is expected to last twelve continuous months or more with available treatment, or result in death.
(2) If the information received isn't clear, we may require more information before we determine whether you meet ABD disability requirements. As examples, we may require you to get more medical tests or be examined by a medical specialist.
(3) We deny disability if:
(a) We don't have evidence that your impairment is of at least moderate severity as defined in WAC 388-449-0035, 388-449-0040, 388-449-0045, or 388-449-0050;
(b) Your impairment hasn't lasted or isn't expected to last twelve or more months with available treatment or result in death; or
(c) We have evidence drug or alcohol abuse or addiction is material to your impairment(s).
[Statutory Authority: 2014 c 218, 2011 1st sp.s. c 15, RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, 41.05.021, 74.09.035, and 74.09.530. WSR 15-03-031, § 388-449-0060, filed 1/12/15, effective 2/12/15. Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, and 2013 2nd sp.s. c 10. WSR 13-24-040, § 388-449-0060, filed 11/26/13, effective 1/1/14. 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, § 388-449-0060, filed 4/27/12, effective 6/1/12.]
PDF388-449-0070
Sequential evaluation process step III—How does the department determine if you meet SSA listing of impairments criteria?
We approve disability when we determine your impairment(s) meet a listing described in appendix 1 to Subpart P of Part 404 within Title 20 of the Code of Federal Regulations.
PDF388-449-0080
Sequential evaluation process step IV—How does the department evaluate if I am able to perform relevant past work?
(1) If we neither deny disability at Step 1 or 2 nor approve it at Step 3, we consider our assessment of your physical and/or mental functional capacity, per WAC 388-449-0020 and 388-449-0030, to determine if you can do work you have done in the past.
(2) We evaluate your work experience to determine if you have relevant past work and transferable skills. "Relevant past work" means work:
(a) Defined as substantial gainful activity per WAC 388-449-0005;
(b) You have performed in the past fifteen years; and
(c) You performed long enough to acquire the knowledge and skills necessary to continue performing the job. You must meet the specific vocational preparation level as defined in Appendix C of the Dictionary of Occupational Titles.
(3) For each relevant past work situation, we compare:
(a) The exertional, nonexertional, and skill requirements of the job based on the Appendix C of the Dictionary of Occupational Titles; and
(b) Current cognitive, social, exertional, and nonexertional factors that significantly limit your ability to perform past work.
(4) We deny disability when we determine that you are able to perform any of your relevant past work.
(5) We approve disability when you are fifty-five years of age or older and don't have the physical, cognitive, or social ability to perform past work.
[Statutory Authority: 2014 c 218, 2011 1st sp.s. c 15, RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, 41.05.021, 74.09.035, and 74.09.530. WSR 15-03-031, § 388-449-0080, filed 1/12/15, effective 2/12/15. Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.08.090, 74.08A.100, 74.04.770, 74.62.030, and 2013 2nd sp.s. c 10. WSR 13-24-040, § 388-449-0080, filed 11/26/13, effective 1/1/14. 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, § 388-449-0080, filed 4/27/12, effective 6/1/12.]
PDF388-449-0100
Sequential evaluation process step V—How does the department evaluate if I can perform other work when determining disability?
If we decide you cannot do work that you have done before, we consider your age, education, and other factors to decide if you have the residual functional capacity to perform other work.
(1) We evaluate education in terms of formal schooling or other training to acquire skills that enable you to meet job requirements. We classify education as:
If you | Then your education level is |
(a) Can't read or write a simple communication, such as two sentences or a list of items. | Illiterate |
(b) Have no formal schooling or vocational training beyond the sixth grade. | Marginal education |
(c) Have no formal schooling or vocational training beyond the eleventh grade; or (d) Had participated in special education in basic academic classes of reading, writing or mathematics in high school. | Limited education |
(e) Have received a high school diploma or general equivalency degree (GED) and don't meet the special education definition in (d) above; or (f) Have received skills training and were awarded a certificate, degree or license. | High school and above level of education |
(2) We approve disability when you have a moderate, marked, or severe physical health impairment and you meet the criteria below:
Exertional level | Your age | Your education level | Work history | Nonexertional and functional limitations |
Restricted to less than sedentary | Any age | Any level | Does not apply | Does not apply |
Restricted to sedentary | Any age | Any level | Does not apply | You have nonexertional or functional impairments that preclude all sedentary work |
Restricted to sedentary | Fifty and older | Any level | Does not apply | Does not apply |
Restricted to sedentary | Forty-five and older | Marginal education, illiterate, or unable to communicate in English | Unskilled or none | Does not apply |
Restricted to light | Any age | Any level | Does not apply | You have nonexertional or functional impairments that preclude all sedentary work |
Restricted to light | Fifty and older | Marginal education or unable to communicate in English | Does not apply | Does not apply |
(3) We approve disability when you have a moderate, marked, or severe mental impairment and you meet the criteria below:
Your age | Your education | Work history | Social and cognitive limitations |
Any age | Any level | Any level | Substantial loss of ability to: • Understand, remember, and persist in tasks by following very short and simple instructions; • Perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances without special supervision; • Perform routine tasks without special supervision; • Adapt to changes in a routine work setting; • Make simple work-related decisions; • Be aware of normal hazards and take appropriate precautions; • Ask simple questions or request assistance; • Communicate and perform effectively in a work setting; • Complete a normal workday and workweek without interruptions from psychologically based symptoms; or • Maintain appropriate behavior in a work setting. |
Fifty and older | Any level | Any level | Substantial loss of ability to: • Understand, remember, and persist in tasks by following detailed instructions; • Set realistic goals and plan independently; or • Learn new tasks. |
(4) "Substantial loss of ability" means you are not able to perform the particular activity in regular competitive employment or outside of a sheltered work setting.
(5) We approve disability when you have both mental and physical impairments, with an overall severity that is moderate, marked, or severe, and you meet the criteria below:
Your age | Your education level | Exertional level | Social and cognitive limitations | Other vocational factors |
Any age | Any level | Restricted to light or less | You have a substantial loss of ability to: • Communicate and perform effectively in a work setting; or • Maintain appropriate behavior in a work setting. | No transferable skills to work level |
Fifty or older | Limited education or unable to communicate in English | Restricted to light or less | Does not apply | No transferable skills to work level |
Any age | Marginal education, illiterate, or unable to communicate in English | Restricted to medium or less | You have a substantial loss of ability to: • Communicate and perform effectively in a work setting with limited public contact; or • Maintain appropriate behavior in a work setting. | No transferable skills to work level |
(6) If you don't meet the criteria listed above, and there are jobs you can do in the national economy, we will find you able to perform other work and take the following actions:
(a) Deny disability; and
(b) Give you examples of jobs you can do in the national economy despite your impairments(s).
(7) If there are no jobs you can do in the national economy despite your impairment(s), we approve disability.
PDF388-449-0150
When does my eligibility for aged, blind, or disabled (ABD) cash benefits end?
(1) The maximum period of eligibility for ABD cash is 24 months before we must review additional medical evidence. If you remain on ABD cash at the end of the 24-month period, we determine your eligibility using current medical evidence.
(2) If your application for SSI is denied:
(a) We review your eligibility for the ABD cash program;
(b) We stop your benefits if you do not provide proof you have filed an appeal with SSA within 60 days of a SSI denial for not being disabled.
(3) We stop your benefits after the final decision on your application for SSI/SSA benefits or if you fail to follow through with any part of the SSI/SSA application or appeals process.
(4) We review your eligibility for the ABD cash program when you discharge from a public institution, as defined in WAC 182-500-0050.
[Statutory Authority: RCW 74.04.005, 74.04.0052, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.04.805, 74.08.025, 74.08.043, 74.08.090, 74.08.335, 74.08A.100, 74.62.030, and 2022 c 297 § 205(22). WSR 23-01-057, § 388-449-0150, filed 12/14/22, effective 1/14/23. 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, § 388-449-0150, filed 4/27/12, effective 6/1/12.]
PDF388-449-0200
Am I eligible for cash assistance for aged, blind, or disabled (ABD) while waiting for supplemental security income (SSI)?
(1) You may receive ABD benefits while you are waiting to receive supplemental security income (SSI) benefits only when you:
(a) Have filed your SSI application with the Social Security Administration (SSA), follow through with SSA directions and requirements to process your application including keeping all interview and consultative examination appointments, and do not withdraw your application;
(b) Agree to assign the initial or reinstated SSI payment to us provided under WAC 388-449-0210;
(c) Are otherwise eligible according to WAC 388-400-0060; and
(d) Meet disability criteria listed in WAC 388-449-0001.
(2) To demonstrate your impairments are disabling despite medical treatment, you must participate in medical treatment for the impairments that keep you from working, unless you have a good cause. Good cause includes, but is not limited to, the following reasons:
(a) The treatment provider has identified a risk that the treatment may cause further limitations or loss of a function or an organ and you are not willing to take that risk;
(b) Treatment is not available because you can't obtain it without cost to you;
(c) You are so fearful of the treatment that your fear could interfere with the treatment or reduce its benefits; or
(d) You practice an organized religion that prohibits the treatment.
(3) If you refuse or fail to participate in medical treatment without good cause, your benefits may end and you will remain ineligible until you reapply and provide proof you are pursuing treatment as recommended.
(4) ABD recipients who reside in a public institution as defined in WAC 182-500-0050, are not subject to the requirements of subsections (1)(a)-(b) of this section. The requirements to apply for and assign SSI benefits will be addressed after discharge once an ABD recipient no longer resides in a public institution.
[Statutory Authority: RCW 74.04.005, 74.04.0052, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.04.805, 74.08.025, 74.08.043, 74.08.090, 74.08.335, 74.08A.100, 74.62.030, and 2022 c 297 § 205(22). WSR 23-01-057, § 388-449-0200, filed 12/14/22, effective 1/14/23. Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.0052, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.08.043, 74.08.090, 74.08.335, 74.08A.100, 74.09.035, 74.09.530, 74.62.030, and 41.05.021. WSR 22-07-020, § 388-449-0200, filed 3/8/22, effective 4/8/22. 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, § 388-449-0200, filed 4/27/12, effective 6/1/12.]
PDF388-449-0210
What is interim assistance and how do I assign it to the department?
The ABD and SSI programs both provide cash assistance to meet your basic needs. You cannot receive this assistance for the same time period from both programs. When you are approved for or reinstated on SSI, you may receive a retroactive payment. When we made GA, DL, or ABD payments to you or on your behalf for the same time period, you must assign your interim assistance to repay us.
(1) "Assign" means that you sign a written authorization for the Social Security Administration (SSA) to send the SSI retroactive payment to us.
(2) "Interim assistance" means the monetary value of benefits we paid to you or on your behalf during:
(a) The time between your SSI application date and the month recurring SSI payments begin; or
(b) The period your SSI payments were suspended or terminated, and later reinstated.
PDF388-449-0220
How does substance use affect my eligibility for the aged, blind, or disabled (ABD) cash and pregnant women assistance (PWA) programs?
(1) For purposes of ABD, you must complete a substance use disorder assessment when we have information that indicates you may have a substance use disorder.
(2) For purposes of PWA, you must complete a substance use disorder assessment when we have information that indicates you may have a substance use disorder.
(3) You must participate in substance use disorder treatment if a certified substance use disorder professional indicates a need for treatment, unless you have good cause. Good cause includes, but is not limited to, the following reasons:
(a) We determine that your physical or mental health impairment prevents you from participating in treatment.
(b) The outpatient substance use disorder treatment you need isn't available in the county you live in.
(c) You need inpatient substance use disorder treatment at a location that you can't reasonably access.
(d) You are a parent or other relative personally providing care for a minor child or an incapacitated individual living in your household, child care or day care is necessary for you to participate in substance use disorder treatment, and such care is not available.
(3) If you refuse or do not complete an assessment or treatment without good cause, your benefits will end until you provide proof you are pursuing an assessment or treatment as required.
[Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.0052, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.04.805, 74.08.025, 74.08.043, 74.08.090, 74.08.335, 74.08A.100, 74.62.005, 74.62.030, and 2023 c 289. WSR 24-01-068, § 388-449-0220, filed 12/14/23, effective 1/14/24. 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, § 388-449-0220, filed 4/27/12, effective 6/1/12.]
PDF388-449-0225
Am I required to participate in vocational rehabilitation services if I receive ABD cash grant?
You must participate in vocational rehabilitation services through the division of vocational rehabilitation (DVR) if you are determined to be eligible for DVR services.
PDF388-449-0230
What aged, blind, or disabled (ABD) program rules may the department implement during a state of emergency?
During a declared state of emergency, the department may implement the following rules to help mitigate impacts to clients:
(1) Postpone review of your ABD cash eligibility beyond the 24 month period required in WAC 388-449-0150. The postponement of this review may occur retroactively to the date the governor declares the state of emergency.
(2) Accept a diagnosis of a medically determinable impairment from a "treating medical source" in subsection (2) of WAC 388-449-0010, or the predictive risk intelligence system (PRISM).
(3) Accept functional medical evidence beyond 90 days of the date of application or 45 days before the month of disability review, or otherwise waive the requirement of WAC 388-449-0015 (3)(e) in its entirety.
(4) Suspend or waive eligibility review requirements detailed in WAC 388-434-0005 for the ABD program.
[Statutory Authority: RCW 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.08.025, 74.08.043, 74.08.090, 74.08.335, 74.08A.100, 74.09.530, 74.62.030, and 2022 c 297 § 205(21). WSR 22-17-080, § 388-449-0230, filed 8/17/22, effective 9/17/22. Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.04.655, 74.04.770, 74.08.025, 74.08.043, 74.08.090, 74.08.335, 74.09.530, 74.08A.100. WSR 21-07-004, § 388-449-0230, filed 3/4/21, effective 4/4/21.]