Listing 12.06 is triggered when severe anxiety-based illnesses—generalized anxiety disorder (GAD), panic disorder, agoraphobia, or obsessive-compulsive disorder (OCD)—cause such pervasive symptoms that they either (1) create marked or extreme functional limitations in daily life or (2) remain serious and persistent despite continuous treatment. Meeting or medically equaling this listing at Step 3 ends the disability inquiry; vocational steps are unnecessary.
Regulatory Text
12.06 Anxiety and obsessive-compulsive disorders, satisfied by A and B, or A and C:
- Medical documentation of one or more of the following:
1. Anxiety disorder, characterized by three or more of the following: restlessness; easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance;
OR
2. Panic disorder or agoraphobia, characterized by panic attacks followed by a persistent concern or worry about additional panic attacks or their consequences, or disproportionate fear or anxiety about at least two different situations;
OR
3. Obsessive-compulsive disorder, characterized by involuntary, time-consuming preoccupation with intrusive, unwanted thoughts, or repetitive behaviors aimed at reducing anxiety;
AND
- Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:
1. Understand, remember, or apply information;
2. Interact with others;
3. Concentrate, persist, or maintain pace;
4. Adapt or manage oneself;
OR
- The disorder is “serious and persistent” (see 12.00G2): evidence of the disorder over a period of at least 2 years, with
1. Ongoing medical treatment, mental-health therapy, psychosocial support, or highly structured setting that diminishes symptoms; and
2. Marginal adjustment—minimal capacity to adapt to changes not already part of daily life.
(Effective Jan 17 2017; technical corrections May 18 2018.)
Key Elements
- Criterion A: Diagnostic Proof
- GAD: at least 3 classic physiologic/cognitive symptoms.
- Panic/Agoraphobia: documented panic attacks + persistent worry or avoidance of ≥ 2 situations.
- OCD: intrusive obsessions or compulsions that are time-consuming and distressing.
- Functional Severity
- Paragraph B: Extreme in 1 domain or marked in any 2 of 4 mental-function domains.
- Paragraph C: ≥ 2-year history plus ongoing treatment/structured setting and marginal adjustment to change.
- 12-Month (B) or 24-Month (C) Duration
- Symptoms and functional limits must persist or be expected to persist for the required period.
Tips on Proving Listing 12.06
| Evidence | What to Collect | How It Supports Criteria |
|---|---|---|
| Comprehensive psychiatry notes | Diagnoses (DSM-5), frequency & severity of panic attacks, compulsions, avoidance behaviors | Establish Criterion A and longitudinal persistence |
| Standardized scales | • GAD-7 or HAM-A for anxiety • Panic Disorder Severity Scale (PDSS) • Yale-Brown Obsessive Compulsive Scale (Y-BOCS) |
Quantify symptom intensity; map to “marked/extreme” limitations |
| Therapy & medication history | SSRIs/SNRIs, benzodiazepines, CBT exposure logs, EMDR, ERP for OCD | Shows continuous treatment (Paragraph C) and residual symptoms |
| Neuropsychological / cognitive tests | Trail-Making, CPT-3 for attention/persistence deficits | Correlate with “concentrate, persist, maintain pace” domain |
| Function reports & third-party statements | Descriptions of avoidance (won’t leave home alone), ritualistic behaviors delaying tasks, emotional outbursts, inability to handle change | Document marked/extreme limits in interaction, adaptation, pace |
| Hospital & crisis records | ER visits for panic attacks, psychiatric admissions after compulsive episodes | Reinforce severity and frequency |
| Structured-setting proof (Paragraph C) | Records from intensive outpatient programs (IOP), group homes, ACT teams, or supported–employment coaches | Demonstrates need for highly structured environment & marginal adjustment |
| Laboratory/physiologic tests (when relevant) | Rule-out labs (thyroid panel, toxicology) to exclude medical mimics | Strengthens credibility of primary anxiety/OCD diagnosis |
Testing pointers from the 2024 SSA Medical-Tests guide
- Heart-rate variability monitoring during panic-provocation tasks can validate physiologic anxiety spikes.
- Resting cortisol or CRP elevations may support chronic stress but should supplement—not replace—clinical documentation.
Practical Takeaway
Winning under Listing 12.06 requires (1) clear diagnostic evidence of an anxiety or OCD spectrum disorder and (2) proof of marked/extreme functional interference (Paragraph B) or a serious-and-persistent course with marginal adaptation (Paragraph C). A Social Security Disability lawyer can help marry psychiatric notes, standardized symptom scales, ongoing treatment logs, and detailed functional reports to build a persuasive Step 3 narrative.