The A criteria are satisfied by medically documented persistence.
1. Either continuous or intermittent, of a depressive syndrome characterized by at least four of the following:
a. Anhedonia or pervasive loss of interest in almost all activities, b. Appetite disturbance with change in weight, c. Sleep disturbance, d. Psychomotor agitation or retardation, e. Decreased energy, f. Feelings of guilt or worthlessness, g. Difficulty concentrating or thinking, h. Thoughts of suicide, or i. Hallucinations, delusions, or paranoid thinking;
2. Manic syndrome characterized by at least three of the following: a. Hyperactivity, b. Pressure of speech, c. Flight of ideas, d. Inflated self-esteem, e. Decreased need for sleep, f. Easy distractibility, g. Involvement in activities that have a high probability of painful consequences which are not recognized, or h. Hallucinations, delusions or paranoid thinking;
OR
3. Bipolar syndrome with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes (and currently characterized by either or both syndromes).
The B criteria are satisfied when the symptoms listed in A result in at least two of the following:
1. Marked restriction of activities of daily living; 2. Marked difficulties in maintaining social functioning; 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration.
The requirements of C are satisfied by a medically documented history of a chronic affective disorder of at least 2 years' duration that has caused more than a minimal limitation of ability to do basic work activities, with symptoms or signs currently attenuated by medication or psychosocial support, and one of the following:
1. Repeated episodes of decompensation, each of extended duration;
2. A residual disease process that has resulted in such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate; or
3. Current history of 1 or more years' inability to function outside a highly supportive living arrangement, with an indication of continued need for such an arrangement.
Dr. Borrego has documented that the claimant's symptoms include anhedonia, sleep disturbance, decreased energy, feelings of guilt or worthlessness, difficulty concentrating or thinking, thoughts of suicide, hallucinations, and paranoid thinking, and opined that these symptoms result in extreme restrictions of activities of daily living, extreme difficulties in maintaining social functioning, and extreme difficulties in maintaining concentration, persistence, and pace (Exhibit 21F.)
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