individual who ‘meets or equals’ them in step 3 of sequential evaluation cannot reasonably be expected to work and the claimant is awarded SSA disability benefits.

The fourth step applies to those severe claims that have not been found so severe as to be allowed disability benefits on the basis of medical evidence alone. For these claims, the nonmedical factors of age, education, and work history are taken into account. Another difference in this step is that the Reviewing Medical Consultant provides additional input into the decision by completing the Mental Residual Functional Capacity Assessment (MRFCA) (see description below); it is the Disability Analyst who combines the narrative summary of the MRFCA with the age, educational level, and work history of the claimant to determine whether or not the claimant is capable of working at the level of her or his past employment. This decision is made in light of jobs available in the national economy. If the Disability Analyst finds that the claimant can do previous work, the claim is denied. If the finding is that the claimant cannot do previous work, the claim continues one final step in the initial review.

The fifth step applies the same claim material to the question of whether the claimant can do any job in the national economy. If the Disability Analyst determines that the claimant can do work—irrespective of whether it is locally available or whether the person would actually be hired—then the claim is denied. If the person cannot do any work in the national economy, then the claimant is awarded disability benefits.

The next section describes the standards and guidelines upon which these medical judgments are based.

Listings of Mental Impairments

The Listings of Impairments (SSA, 2001) are published by the SSA and updated periodically. Chapter 12 of the Listings is devoted to mental disorders, otherwise known as the Listings of Mental Impairments. Major revisions to the Listings of Mental Impairments, currently being applied to claims for disability benefits, were published in 19853 and have since undergone relatively minor modifications. The 1985 revision was intended to bring the Listings in line with then-current psychiatric practice to reflect the APA’s third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III) (APA, 1980). The process of this revision was unique in SSA’s history. It was the first time that the SSA had sought outside expertise to revise its Listings. The APA, the American Psychological


The most recent edition of the Listings of Impairments was published in 2001. No substantive changes were made to the Listings of Mental Impairment that have impact on this report.

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