Listing 12.03 applies to illnesses characterized by delusions, hallucinations, disorganized thought or behavior, and/or grossly disorganized or catatonic motor activity. Classic examples include schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder, and psychotic disorder due to another medical condition. When the documented psychosis produces either marked/extreme functional limits or meets SSA’s “serious-and-persistent” standard, the claimant is found disabled at Step 3—without considering past work or vocational adjustment.
Regulatory Text
12.03 Schizophrenia spectrum and other psychotic disorders, satisfied by A and B, or A and C:
- Medical documentation of one or more of the following:
1. Delusions or hallucinations;
2. Disorganized thinking (speech);
3. Grossly disorganized behavior or catatonia;
AND
- Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
1. Understand, remember, or apply information;
2. Interact with others;
3. Concentrate, persist, or maintain pace;
4. Adapt or manage oneself;
OR
- The mental disorder is “serious and persistent” (see 12.00G2) with documented medical treatment over a period of at least 2 years and marginal adjustment, that is, minimal capacity to adapt to changes not already part of daily life.
(Effective Jan 17 2017; technical corrections May 18 2018.)
Key Elements (at a Glance)
- Criterion A (Core Psychotic Features)
- Must show at least one: delusions/hallucinations, disorganized speech/thought, or grossly disorganized or catatonic behavior.
- Functional Severity
- Paragraph B: Extreme limitation in one—or marked limitation in any two—of the four mental-function domains.
- Paragraph C: ≥ 2 years of medically documented disorder plus ongoing treatment/structured setting and marginal adjustment.
- Duration
- Limitations must have lasted or be expected to last 12 months (Paragraph B) or satisfy the ≥ 2-year seriousness requirement (Paragraph C).
Tips on Proving Listing 12.03
| Evidence Type | What to Gather | How It Fits Criteria |
|---|---|---|
| Psychiatric progress notes | Diagnoses by psychiatrists; descriptions of delusions, auditory/visual hallucinations, disorganized thought or catatonia | Satisfy Criterion A |
| In-patient/ER records | Psychiatric hospitalizations, restraints, or catatonic episodes | Shows frequency & severity; supports Paragraph B “extreme” limitations |
| Medication history | Antipsychotic regimens (e.g., clozapine, long-acting injectables), dosage changes, side-effects | Demonstrates ongoing treatment (Paragraph C) and persistence |
| Standardized scales | PANSS, BPRS, CGI-S scores; mental-status exams noting thought-process and perceptual disturbances | Objectively quantifies psychosis and decline in cognitive/social domains |
| Neuropsychological / cognitive testing | WAIS-IV, Trail-Making, Stroop for executive dysfunction | Maps to “understand/remember/apply information” & “concentrate/persist” domains |
| Function reports & third-party statements | Family, social workers, employers describe social withdrawal, paranoia, self-neglect, inability to maintain pace | Link psychotic symptoms to Paragraph B domains |
| Structured-setting proof | ACT-team notes, group home logs, supervised housing documentation | Critical to Paragraph C (ongoing structured environment + marginal adjustment) |
| Rule-out investigations | Toxicology screens, metabolic panels, brain imaging when etiology unclear | Shows thorough evaluation; bolsters credibility of primary psychotic diagnosis |
Testing cues from SSA Medical-Tests Guide
- Neuroimaging (MRI, fMRI) may reveal ventricular enlargement or cortical thinning—supportive but not essential.
- Blood tests to monitor antipsychotic side-effects (e.g., clozapine ANC counts) show treatment compliance.
Practical Takeaway
To meet Listing 12.03, pair robust clinical evidence of psychosis (Criterion A) with either marked/extreme functional limits (Paragraph B) or a long-standing, treatment-resistant course with marginal adaptation (Paragraph C). A Social Security Disability lawyer can help gather comprehensive psychiatry notes, standardized rating scales, corroborating lay statements, and proof of persistent treatment form the backbone of a winning Step 3 argument.