Novel ideas for reforming social security disability - the dumbbell approach

August 6, 11:36 PMRaleigh Disability ExaminerTim Moore

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The disability benefit programs operated by the social security administration have tons of problems these days, chiefly in the form of backlogs. However, backlogs are not the only issues hampering the proper delivery of social security disability and SSI disability benefits. Some of the disability system's problems are actually inherent to the way the system operates.

Anyone who has ever worked at Disability Determination Services as a claims examiner knows this basic fact: when it comes to physical impairments a large percentage of denied claimants are given a medium RFC.

What is meant by RFC? RFC stands for residual functional capactity and it essentially means "what a claimant is still capable of doing (residually) in spite of the limitations imposed by their impairment or impairments".

RFC determinations are made for every disability claim that proceeds through the SSA evaluative system and the process for determining a particular claimant's RFC is simply this:

1. A disability examiner gathers a claimant's medical records.

2. The examiner reads the claimant's medical records and does a writeup. This writeup is basically a preliminary version of the RFC determination that will be made for the claim in question.

3. The examiner takes the writeup to their unit physician (aka the medical consultant aka the dds doctor). Often, this person is located right down the hall from them.

4. The unit physician either agrees or disagrees with the disability examiner's assessment. But, in either case, the DDS doctor completes his or her own assessment which becomes the official RFC determination for the case, resulting in an approval or denial of social security disability or SSI disability benefits for the claimant.

This is how claims at the initial and reconsideration levels have been decided and, most likely, this is how the system will continue to operate for many years ahead.

And, on the face of it, this approach to evaluating claims would seem entirely sound and reasonable...if not for the simple fact that a large and considerable chunk of evaluations fall into the medium exertion category. In other words, too many claimants who get denied are judged to be capable of medium-level work.

What is medium work and what is a medium RFC? A medium RFC basically means this: after a careful review of a disability claimant's medical records, the conclusion is made that the claimant is capable of lifting fifty lbs occasionally and twenty-five lbs frequently. That's not all there is to a medium RFC rating, of course, but that's the basic gist of it.

Now, how heavy those amounts sound to someone may depend on their point of view. And perhaps to some, lifting fifty pounds on an occasional basis would not seem overly burdensome. But consider this: an older model 25 inch tube television typically weighs in the neighborhood of fifty pounds. Would anyone reasonably expect a person with severe neck or back pain (or carpal tunnel syndrome or emphysema or heart problems, etc, etc) to lift and carry a 25 inch tv occasionally, perhaps more than once each day? Probably not.

Why, then, does the social security administration so routinely make such determinations?

One possible part of the answer may be that DDS physicians, i.e. social security doctors, have no real idea how fifty pounds really feels, and, as a result, have very little understanding (or empathy) as to how medium-level work might affect a person with a severe physical impairment.

Thus, this suggestion: every DDS medical consultant should be required to keep a 50 lb dumbell beside their desk. And each time a DDS unit medical consultant reviews a claimant's medical records and decides to write up a medium RFC, they should be required to pick up this weight.

What would a DDS doctor "feel" upon picking up such a heavy weight? Stress in the finger joints and wrist for one thing. However, for a claimant with carpal tunnel syndrome and poor grip strength, this may only serve to further weaken their handling ability.

The DDS doctor would also find that the lifting of a fifty pound weight would introduce significant stress to the back muscles and probably require the use of the lumbar spine area as a fulcrum. This is something that a person with lumbar degenerative disc disease would be cautioned not to do--certainly not "occasionally"--at the risk of worsening their back condition.

The DDS physician would also find that lifting this weight would make a significant demand on the neck and shoulder muscles. However, for a claimant with cervical degenerative disc problems or bone spurs in their neck, this would probably lead to pain, muscle strain, and a worsening of their neck condition.

Giving every doctor who works as a DDS unit physician a 50 lb dumbell and requiring them to lift it at least once each and every day might add a bit more reality to the RFC forms these non-practicing physicians (remember: DDS doctors are typically not engaged in medical practice as well as being only vicarious assessors of disability claimants, i.e. they never actually meet them) dole out daily.

And since every human being is, inevitably, subject to some form of musculoskeletal complaint, for the doctor who lifts his weight on the day he himself has suffered an injury to his own back, it might possibly introduce a modicum of empathy for the claimant...whose condition is not temporary but long-lasting and perhaps even permanent.