Incapacity Determination - Acceptable Medical Evidence

Revised on: June 25, 2025

WAC 388-447-0005 What evidence does the department consider to determine incapacity?

WAC 388-447-0010 What medical evidence do I need to provide?

---

 Clarifying Information- WAC 388-447-0005

1. A diagnosis of a medically determinable impairment must be from an “acceptable medical source” as defined in WAC 388-447-0005. The diagnosis must be supported by objective medical evidence described in WAC 388-447-0010 and be based on an examination within 5 years of the application date.
2. After a diagnosis is established, we can use “supplemental medical evidence” as current evidence.
3. Once we have a diagnosis and current medical evidence, we may include “other evidence” as supporting documentation.

Clarifying Information- WAC 388-447-0010

1. We use symptoms and a diagnosis of a substance use disorder (SUD) when determining incapacity.

   1. An SUD is classified as a mental disorder and must be contained in the current Diagnostic and Statistical Manual of Mental Disorders (DSM).

   2. A diagnosis of an SUD must be from an “acceptable medical source” listed in WAC 388-447-0005.

      1. Once an “acceptable medical source” has established a diagnosis, the Disability Specialist can use “supplemental medical evidence” (e.g. from a substance use disorder professional) and “other evidence” (e.g. public and private agencies, personal observation, etc.) as supporting documentation as needed.

   3. In addition to a diagnosis of a SUD, a client must meet all requirements under WAC 388-400-0070 (e.g. determined incapacitated via the PEP) to be eligible for the HEN Referral Program.