DI 25025: Medical-Vocational Guidelines
TN 6 (02-15)
A. Rule 204.00 cannot direct a determination
When rule 204.00 applies, always use it as a framework for a determination of disabled or not disabled. Use rule 204.00 as a framework when finding a claimant:
not disabled based an impairment that results in nonexertional limitations only; or
disabled based on a consideration of his or her impairment-related nonexertional limitations only.
B. Examples of determinations using rule 204.00 as a framework
1. Favorable determination using medical-vocational rule 204.00 as a framework
The claimant is 35 years old with a 9th grade education. His only work was for 2 years, part-time as a dishwasher. Earnings were below SGA level. He alleges disability due to depression and back pain. He indicates he was in special education classes in school. Purchased IQ testing and mental status exam show IQs in the low borderline range, flat affect, and psychomotor retardation. Contact with his previous employer reveals that he required constant prompting to follow through on his work, which was to wash dishes for a restaurant. He had a difficult time relating to the other restaurant employees who often ribbed him for being slow. The restaurant fired him because he required excessive supervision in order for him to get his work done, the quality of his work was poor, and because he punched another employee, whom he perceived was making fun of him. His mental residual functional capacity (MRFC) supports an inability to meet these basic demands of unskilled work:
understand, carry out, and remember simple instructions; and
respond appropriately to supervision, coworkers, and work situations.
Because he cannot meet the basic demands of unskilled work due to his mental impairments, an allowance is appropriate using medical-vocational rule 204.00 as a framework. You do not need to consider the additional impact his physical allegations of back pain would have on the occupation base.
2. Unfavorable determination using medical-vocational rule 204.00 as a framework
The claimant is 30 years of age with a 12th grade education and past relevant work as clerk in a food mart. He alleges disability due to anxiety and vision problems. He has normal visual fields by confrontation exam and best corrected vision of 20/30 bilaterally. He stopped work because he was present during a robbery at the food mart 2 years ago. He has been too anxious to work with the public since. He sees his treating physician (TP) every three months for refills on Klonopin. He has never seen a counselor or had a psychiatric hospitalization. If he does not take his medication, he has anxiety attacks. His last anxiety attack was a year ago when he went to the emergency room for chest pain. The emergency room physician diagnosed him with an anxiety disorder and started him on Klonopin. He gave the claimant information about treatment at a local mental health center, but he did not follow through on the referral. Because the Klonopin helps him, his TP agreed to monitor his medication for him. TP notes indicate the claimant complains of anxiety in crowds and difficulty interacting with others despite good compliance with medication. His TP has continued to recommend counseling, but the claimant is not comfortable with this recommendation. The medical evidence supports the claimant is unable to work with the public. He retains the capacity to work with coworkers and supervisors. Because the nonexertional limitations resulting from his mental and visual impairments do not significantly erode the unskilled occupational base, medical vocational rule 204.00 applies as a framework for a denial.