The Importance of a functional capacity assessment in support of a Social Security disability claim.
Claims for Social Security disability benefits succeed, for the most part, on the state of the medical documentation contained in the claim file. There should be a clearly stated list of diagnoses provided by the treating physicians that interfere with full-time work activity. The record should contain medical test results that support the diagnoses. Social Security regulations refer to these as “medically acceptable objective, clinical and laboratory findings”. A person alleging back pain should be able to provide x-ray evidence of some level of disc degeneration. Someone suffering from rheumatoid arthritis can have blood studies consistent with that diagnosis. This might include positive ANA or “antinuclear antibodies”. Heart conditions that cause chest pain may demonstrate lack of oxygen to the heart (ischemia) through stress treadmill tests or EKG’s.
Regardless of the diagnosis, there should be some supporting documentation of a condition that can reasonably result in a condition that can cause the reported symptoms. This combination of symptoms and medical documentation of a condition that can cause those symptoms is only part of the equation however.
Once it is established that medical conditions exist that can reasonably cause the symptoms presented by the patient, the question as to whether the diagnosed impairments would prevent “substantial gainful activity” or full-time competitive work needs to be addressed. This is best accomplished through the completion of a “Residual Functional Capacity Assessment” (RFC) by the treating physician. Basically, this form identifies the diagnoses, provides the objective, clinical or laboratory findings that support the diagnoses. In addition, the form indicates the limitations that result in the patient’s ability to perform work related activities such as sitting, standing, walking and lifting. The doctor indicates what degree of time limitations would be involved in these activities due to the severity of the medical conditions.
The typical RFC assessment allows the doctor to indicate how many hours the patient can tolerate sitting, standing or walking at one time and how much of these activities can be tolerated in total in an eight hour work day. A physical functional capacity form can be as simple as the following:
How many hours in an 8 hour day can the patient?
1. Stand/walk (In and 8 hour workday)? ______hours. Stand/Walk (continuous without rest);______ hours. (use fractions if necessary)
2. Sit (in an 8 hour day)? ______hours (continuous); Sit (continuous without changing position) _____ hours.
3. The patient is limited in lifting/carry objects weighing
Less than 10 pounds _________ (check one)
Up to 10 pounds _______
20 pounds _______
25 pounds ________
50 pounds _________
4. Is it reasonable to expect that claimant will, because of claimant's impairments, need to LIE DOWN and rest intermittently during an 8 hour work day?
YES ______ NO_____
5. Is it reasonable to expect that claimant will, need to ALTERNATE STANDING AND SITTING to accommodate and relieve pain in order to complete an 8 hour work day?
YES____ NO____
If the total number of hours the person can sit, stand and walk is less than 8 hours in an 8 hour work day, based on the medically determinable impairments, a finding of eligibility is appropriate. In other words, if the doctor states that’s based on the medical conditions verified by the appropriate tests the patient cannot tolerate working 8 hours per day, 40 hours per week on a consistent basis the claim should be granted.
It is interesting to note that the RFC forms developed by SSA are for the completion by the state agency doctor assigned to review the medical file after the medical records have been collected. This doctor never has the opportunity to examine the claimant before completing the RFC form. The findings are strictly based on the medical records alone. Yet, case after case is denied based on this cursory assessment.
Of greater importance is that the state agency doctor must answer a question on the form that asks, 1. Is there an RFC completed by the treating physician; and
2. Is your assessment different than that of the treating physician; and
3. Explain why the assessment by the treating doctor should be given less weight.
This shows the importance of obtaining a Residual Functional Capacity Assessment from the treating physician. If the state agency physician is denying your claim, a justification of why the treating physician’s assessment is not more reliable is required. This is fairly difficult to explain for a doctor who has never met the patient.
Paul Proto
President – Federal Benefits Advisory Group
http://ssa-disability.tripod.com
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