Purpose: Document the referral, review of medical evidence, vocational factors, and outcome of the ART decision on the DSHS 14-235B(X), Administrative Review Team Documentation Worksheet.
WAC 388-448-0110 PEP Step VII -- How we evaluate your capacity to perform other work
If we decide you cannot do work that you’ve done before, we then decide if you can do any other work. In making this decision, we again consider vocational factors of age, education and limited English proficiency (LEP).
We approve incapacity if you have a physical impairment only and meet the vocational factors below:
Highest Work Level Assigned by the Practitioner
Your Age
Your Education Level
Other Vocational Factors
Sedentary
Any age
Any level
Does not apply
Light
50 and older
Any level
Does not apply
Light
35 and older
Illiterate or LEP
Does not apply
Light
18 and older
Limited Education
Does not have any past work
Medium
50 and older
Limited education
Does not have any past work
Medium
55 and older
Any level
Does not apply
Heavy
55 and older
Any level
Environmental restrictions apply
We approve incapacity when you have a mental disorder only and meet the age and social functioning limitations below:
Social Limitation
Age
Can not appropriately relate to coworkers and supervisors (rated three); and;
Can not tolerate the pressures of a work setting (rated four).
50 years and older
Can not tolerate the pressures of a work setting (rated five).
Can not appropriately relate to coworkers and supervisors (rated three); and
Can not tolerate the pressures of a work setting (rated four).
18-49
We approve incapacity when you have both mental and physical impairments and vocational factors interfere with working as follows:
Your Age
Your Education
Your Other Restrictions
Any age
Any level
Can not appropriately relate to coworkers and supervisors (rated three); and
Can not tolerate pressures of a work setting (rated four).
50 or older
Limited education
Restricted to medium work level or less.
18 to 49
Limited education
Restricted to light work level.
If we do not find that you are incapacitated by the end of Step VII of the PEP, an administrative review team (ART) makes the incapacity decision. The review team consists of two or more persons within the community service office (CSO) who are not in the position of providing direct eligibility or incapacity services to you. The ART reviews the medical evidence and your vocational factors.
The ISW referring the case to ART may not participate in the ART decision process.
A Financial Worker who is involved in determining financial eligibility (including screening and referring the client to the ISW) for the person may not participate in the ART. A Financial Worker that is not responsible for determining financial eligibility may participate in the ART.
The ART must contain two or more people.
The CSOA is encouraged to designate CSO workers who are knowledgeable about the GA program.
Include non-CSO professionals when possible.
EXAMPLE
Everyone in the unit, except for the worker referring the case for ART participates in the decision making. Social Workers take turns leading the ART.
EXAMPLE
The team starts with two CSO Supervisors as ART leaders. The Supervisors involve specialists such as the person's Therapist or Mental Health Counselor, an Employment Security Department Job Counselor, a Chemical Dependency Counselor, or a Division of Vocational Rehabilitation Counselor.
When the Social Worker (SW) completes the Step VII of the PEP without reaching a decision to approve or deny GA, the SW refers the case to the Administrative Review Team (ART).
The ISW completes the ART REFERRAL INFORMATION section of the Administrative Review Team Documentation Worksheet (14-235b). The sections following ART REFERRAL INFORMATION are completed by the ART.
Consider these items when writing the referral summary:
Keep it brief.
Highlight the main points of the case.
Base your assessment on facts.
Describe a person's strengths and abilities along with limitations.
Let the ART know if you adjusted a provider's rating or did not accept medical evidence.
The Administrative Review Team is responsible for the incapacity decision. This is an introduction to them.
Process
NOTE:
Do not give weight to factors such as employer preferences or business and economic conditions when evaluating GAU incapacity.
The ART will check to see if the PEP was done accurately, review the medical evidence, assess vocational factors, and communicate the ART decision to the ISW through the 14-235B. The ART may approve incapacity, deny incapacity, or refer/remand the case back to the ISW for further action.
The ART reviews how the ISW applied the PEP. If any answer to the following is "no," refer (remand) the case back to the ISW and specify what action is needed.
Did the Social Worker have all the necessary medical evidence to determine incapacity?
Was the assigned diagnosis supported by clear and objective medical evidence?
Each member of the ART reviews the medical evidence.
Refer questions about how to interpret medical evidence to a medical consultant if necessary.
Identify the functional limitations for work-related activities according to the objective medical evidence. See PEP Step V for information about work-related activities for physical and mental impairments. Document the functional limitations on the 14-235B. (For example: "Right-handed person is unable to use right arm due to severed tendon.")
When evaluating vocational factors, you are assessing whether or not there are jobs the person is able to do even though they have functional limitations. Look at a person's strengths, skills, and abilities and try to find jobs that the person is capable of. When a person is not able to perform other work, approve incapacity.
Consider the person's age. Use the tables in PEP Step VII as guidelines for considering age as a vocational factor.
Evaluate literacy and education.
Consider grade level or history of special education and how these factors influence the person's ability to perform work-related activities such as understanding and following directions.
Look at ability to read and understand work instructions, directions, job orders and warning labels.
Assess skills obtained through advanced or post-secondary education.
Assess transferable skills.
Consider whether the person has the basic skills obtained through education or work experience to perform unskilled and semi-skilled jobs, e.g., entry-level clerical worker or cashier.
Look at the relevant work history and the skills needed to do the work. Make a list of skills that could transfer to jobs within the person's capabilities.
Include information about hobbies and volunteer activities when determining a person's transferable work skills.
Briefly describe how the ART made the decision, factors considered in the decision, other relevant information, and outcome to the ISW. If the case is remanded/referred back to the ISW, describe items needing the attention of the ISW.
Dictionary of Occupational Titles (DOT), published by the U.S. Department of Labor. This publication was last revised in 1991 and will not be updated. This two volume resource contains job listings and the strength and education needed to perform each job.
International Statistical Classification of Diseases, 9th Revision, published by the American Medical Association. A CD-ROM version is available.
Physicians' Current Procedural Terminology, published by the American Medical Association. This book describes each of the CPT codes and standard medical practice for different levels of service.
Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. This is the standard reference for mental disorders.
Disability Evaluation Under Social Security, U.S. Department of Health and Human Services. Also known as "The Listings," this book describes Social Security Administration disability criteria.
Links(Note: you may receive a "page not found" error if you do not work for DSHS)
