The current SSA guidelines for determining disability focus heavily on the overt signs and symptoms of mental impairments but do not focus on cognitive impairment. Proposed new rules would deemphasize the signs and symptoms, but there is no evidence of concern about cognitive impairment in schizophrenia and other psychiatric disorders in the proposed rules. The actual vocational disability that results from these disorders is often unrelated to delusions, hallucinations, sadness, or anxiety. Our patients, even when their symptoms have remitted, are left with cognitive impairments that interfere with concentration, attention, visuospatial function, language, memory, and executive function. These are the enduring and disabling features of serious mental illness. There is no good way to demonstrate these impairments unless you test for them.