This is the second in a two-part series on how people with conditions which are not among those listed and described in that portion of the Social Security regulations known as “the Listings” may still be regarded as legally disabled
If your disabled patient’s condition does not meet or equal one of the medical conditions described in “the Listings, ” he/she may still be entitled to Social Security disability benefits if his/her “Residual Functional Capacity” (RFC) precludes performing any work.
A Social Security disability claimant’s RFC is what the claimant can still do despite his or her limitations. Medical evidence is critical to determining the RFC – which, in turn, is used to determine whether the claimant is capable of performing past relevant work or any other employment, which ultimately determines whether the claimant is legally disabled.
The doctor’s role does not concern what jobs the patient has had in the past and may or may not be able to do in the future. The doctor’s role is to provide a medical basis for deciding what the patient is capable of doing in a sustained and productive manner as would be called for in a work setting. To determine RFC all specific work-related limitations must be known.
To address what a patient can do, it is important first to consider which of the recognized types of impairments may be limiting your patient. Non-exertion limitations include mental, sensory and skin impairments, as well as postural limitations such as kneeling, bending and stooping. Non-exertion limitations also include environmental restrictions, such as an intolerance of dust or fumes.
Exertion limitations are familiar to any doctor who has seen a Physical Capacities Evaluation form. How much weight can the patient lift? carry? how far? How long can he/she stand? walk? sit? … at a stretch? … in the course of an eight hour work day? Can the patient work a full day? If so, what restrictions or limitations may be necessary? Does the claimed disabling condition allow for this person to put in full weeks of full days of work, week in and week out? That is, could the patient maintain a steady work schedule or will the condition probably cause a certain amount of absenteeism?
These questions of endurance and capacity for sustained functioning on the job) may relate to non-exertion limitations as well. Mental conditions, as well as conditions which produce chronic pain or fatigue, may not impair a patient in ways measured by range of motion and muscle strength tests. But they may affect a patient’s ability to focus on a task or sustain even minimal exertion for the course of a work day (day in and day out, week in and week out). Does your patient’s condition require time to recover from a full day or two of work?
If your patient is afflicted with more than one condition, which impairs his/her capacity for work, please remember that the Social Security Administration is required to consider the combined effect of all impairing conditions. So, it would help your client if you took into account all conditions (which may include conditions that you have not treated) when evaluating your patient’s capacity for work.
For example, a patient with heart and lung impairments may be limited in lifting, carrying, walking and repetitive bending, but also may not be able to work in a dusty or fume-laden environment. Likewise, a person with a back condition and psychological limitations may suffer both postural limitations and inability to keep focussed on a task or work with people.
Social Security has a form (SSA-4734-U8) which its medical consultants use to evaluate functional capacity based on their review of a claimant’s medical records. Here is a summary of guidelines and questions from this form which may help you as you prepare notes on your patients:
– Medical conclusions must be based on clinical and laboratory findings, symptoms, observations, knowledge of daily activities, etc. and must be explained in terms of these evidentiary bases.
– Medical consultants are required to request and consider treating and examining doctors’ statements and conclusions concerning the patient’s capacities. – Medical consultants must assess any “alleged limitations imposed by symptoms (pain, fatigue, etc.)” and judge whether they are attributable to a medically determinable impairment.
– Exertional limitations: frequently (one-third to two-thirds of an 8-hour workday; cumulative – not continuous) or occasionally (very little, up to one-third) lift and/or carry____ pounds; stand and/or walk _____ hours/work day; sit _____ hours/work day; need to alternate sitting and standing to relieve pain/discomfort? push /pull limitations in upper or lower extremities?
– Postural Limitations: as to climbing (ramp/stairs? ladder/rope/scaffolds?), balancing, stooping, kneeling, crouching, and crawling – frequently, occasionally or never?
– Manipulative Limitations: reaching (all directions, including overhead), handling (gross), fingering (fine), feeling (skin receptors).
– Environmental Limitations: Extreme cold; extreme heat; wetness; humidity; noise; vibration; fumes, odors, dusts, gases, poor ventilation; hazards (machinery, heights). Options: avoid concentrated exposure? … moderate exposure? … all exposure? or no limitations.
– Symptoms claimed to produce physical limitations: attributable to a medically determinable impairment?
– Visual and Communicative Limitations: Visual: near and far acuity, depth, accommodation, color and field. Communicative: hearing and speaking.
Determining mental RFC calls for an evaluation of understanding and memory; sustained concentration and persistence (carrying out instructions, maintaining attention for extended periods, distractable by others, decision-making, and maintaining work throughout day and week without interruption by symptoms); social interaction (interactions with co-workers and public, asking for assistance, behavior and attire); and adaptation (responding to changes, setting goals, etc.).
Your reports should state whether your patient’s potentially disabling condition is controlled or uncontrolled.
Whatever conclusions you draw concerning your patient’s limitations and capacity for work, they are most likely to help determine his/her Social Security disability status if they are supported by clinical findings which are objective and subject to confirmation (are reproducible and verifiable), that is, “medically acceptable clinical and laboratory diagnostic techniques.”
Finally, it is important to keep in mind that while you are providing, necessary information on your patient’s impairment(s), the final decision as to whether your patient is legally “disabled” is made by the SS people taking also into account factors such as age, education and past work experience.
This article was prepared by Arthur W. Stevens, III