Sunday, June 01, 2008

Social Security Disability Residual Functional Capacity Form

On this blog I often mention a concept known as RFC, or residual functional capacity. This basically stands for what a disability claimant can still do, despite the effect of their condition(s) and the limitations imposed by their condition(s).

An RFC is used by a disability examiner to rate a claimant's residual functional capacity. By doing this, a disability examiner can "peg hole" a claimant into a functional category and then go through a process of determining whether or not the claimant can A) return to their past work or, if they can't do their past work, B) perform some type of other work. Claimants who can't return to their past work or do "other work" may be approved for disability.

How does this all work, procedurally? Here's how. The examiner who is assigned to a case will gather the claimant's medical records (this can take weeks or months). Then the examiner will go through the records and discern whether or not the claimant has a listing level impairment (i.e. does the claimant have a condition that is contained in the social security disability list of impairments, and does the claimant's condition satisfy the criteria listed in the book for that particular condition?).

If the claimant has a listing level impairment, they may be approved on the basis of that listing (examples of listings include rheumatoid arthritis, myasthenia gravis, multiple sclerosis, parkinson's disease, etc). If the claimant does not have a listing level impairment, then the examiner will perform sequential evaluation.

What is sequential evaluation? Forget the gobbledygook you get from government websites. Here's what it is. The examiner will rate your RFC based on your medical records. There are variations of RFC ratings, but they basically fall into these categories:

A) Less than sedentary - you really can't do anything (and you'll be approved).

B) Sedentary - you can't do work other than what is considered sedentary, meaning that light, medium, and heavy exertional work is not possible.

C) Light - you can do light work, but can't do more such as medium or heavy work.

D) Medium - You are capable of medium exertion work and can't do anything more than this.

E) Heavy - you can do heavy work - this generally means you are screwed on getting disability unless you have some very highly restrictive physical limitations or a severe mental disability.

What happens after your RFC assessment has been made? The examiner will look at your work history (the jobs you cited when you applied and whatever information the examiner was able to dig up). Using that work history information and your RFC assessment (which was made using your available medical records), the examiner will determine whether you can do your past work or some form of other work.

The process may seem confusing to those who have never processed disability cases, but here's an example of the process (and please bear in mind this is a very simplified one since the evaluative process can involve other issues). Let's say your RFC limits you to light work. If your RFC limits you to light work, then, obviously, you can't do medium or heavy work jobs.

Will you get approved for disability? Well, in one scenario, if the work you did in the past was light work, then social security will probably consider you able to return to your past work. Why? Because you've been given an RFC assessment that has rated you with the ability to do light work, which is the same exertional-level work you performed in the past.

If in a different scenario, however, the work you did in the past was medium (the ability to lift 25lbs frequently and 50lbs occasionally), you obviously won't be able to do this because you've been limited to light work. This situation, as examiners say, "gets you out of past work".

Will you then get approved for disability in this scenario? Well, maybe yes, maybe no. It all comes down to the examiner (or the judge depending on what level your claim is at) deciding on whether or not you can do work that falls into a category known as "other work".

Other work...can potentially mean anything. It includes jobs you've never done and jobs that may not even exist in your state. But as long as they exist in the national economy (example - you live in Florida and there are 2000 positions for a certain job in the country but they are all in Iowa), social security may decide to deny your disability based on your ability to do other work. Whether or not social security will actually deny you on the basis of stating that you can do some form of other work will be based on a number of factors including your age, work skills, education, and your functional limitations, as rated on your residual functional capacity assessment.

At this point in this post you may have realized, it is very important for an applicant to provide a full list of their medical treatment sources and a full listing of their work history. Because both will be needed to properly rate you and determine your eligibility for benefits. It also points out how crucial this thing called RFC, or residual functional capacity really is.

So now to the next part. How does the RFC assessment get made. Basically, the examiner reads your records and then "feels" his or her way toward deciding what your residual functional capacity is (because, remember, disability examiners don't really have medical training, they're only trained to read and interpret records in the context of social security disability guidelines, similar to a disability insurance adjuster).

Once the examiner "comes up with" what he thinks your residual functional capacity is, he visits the doctor who is assigned to his unit. This unit medical consultant will review the examiner's writeup and if he agrees with it (with the RFC that the examiner has given the claimant), the doctor will signoff on the case and, for the most part, the case is done.

Obviously, the social security administration considers it very important that a physician, an M.D., will ultimately decide the residual functional capacity of a disability claimant, instead of just leaving the decision to an examiner who has simply been trained to read medical records and medical terminology (except, of course, for single decision makers). Makes perfect sense to me. When it comes to deciding whether or not a claimant will be approved or denied for disability, a physician should be involved in determining what the claimant's limitations are, i.e. can they do their past work?, can they do some form of other work, or do they need to be put on disability?

The only problem in all of this: the doctor who works with the disability examiner has never once seen the claimant. He has never treated the claimant. He, in fact, knows nothing more about the claimant than the examiner does from reading the claimant's medical records (though, arguably, being an M.D. he should be able to interpret them better).

Why is this issue important? Because a doctor who has actually provided treatment to a claimant will always know more about that individual (including that individual's limitions and ability or inability to work) than a government-employed doctor who has never once met the claimant.

Obviously, it would make much more sense if the social security administration requested RFC forms from the doctors who treat their patients (these are known as treating physicians).

So, why doesn't the social security administration do this? Very good question. And the answer probably has to do with cost. The cost of printing forms, sending forms out to treating physicians, and the cost, of course, of paying physicians to complete RFC forms for the social security administration (for those who may not be aware, social security pays for the records that are obtained from individual doctor's offices).

However, there is quite possibly another cost: the cost that comes with greater numbers of approved claims which I believe (just my personal opinion) would be the case if the social security administration actually took the time to get detailed statements from the doctors of claimants, versus just getting the medical records which usually say very little about a claimant's functional limitations (very convenient, some would say).

However, just because social security does not send out a residual functional capacity form to its claimants does not mean that a claimant is prevented from doing the same. Disability lawyers, in fact, routinely send out such forms to treating physicians in preparation for a hearing. Why? Because they know that it tends to increase the probability of approval.

Why? Because an RFC form that has been completed by a treating physician will advise a federal administrative law judge as to the functional limitations of a claimant. In other words, it will directly inform the judge as to what the individual is capable of doing and not capable of doing. Can the claimant return to their past work? Can the claimant perform some type of other work? Should the claimant be approved for disability? An RFC form completed by a claimant's treating physician effectively answers these questions for a judge.

Will an RFC form be as effective at the lower levels, i.e. at the initial claim and reconsideration levels? That, unfortunately, may be anyone's guess. The various state agencies that render disability determinations for social security disability and SSI disability claims seem to have a culture of denial that allows them to discount, even ignore, evidence that points to an approval of a claim (I base this statement on my own work experience as a disability examiner, having observed the effects of DDS supervisors on the decision process). Nonethless, submitting an RFC form (completed by a treating physician) at the lower levels may still be a worthwhile component in one's attempt to win disability benefits. In other words, why not give it a shot?

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Social Security Disability List of Impairments
Social Security Disability SSI Status
What does Social Security Disability consider a Mental Impairment?
How many people win Disability Benefits from Social Security?
Social Security Disability Requirements
Will I Qualify for Social Security Disability?
Qualifications for Disability - Social Security (work credits) and SSI
SSI Application for Disability Benefits
Filing for Disability with Fibromyalgia
Qualifying for Disability - How difficult are the Qualifications?
Application for Disability - SSD and SSI applications
Social Security Disability List of Impairments
Application Requirements For SSI Disability
Disability Requirements - The Criteria for Social Security Disability and SSI
How to Qualify for Disability - social security disability or SSI
Are there disability benefits for children?
Social Security Disability Eligibility
Who is eligible for Social Security Disability or SSI Disability?
Correct Steps for Filing a Social Security Disability Claim
Getting Disability - Social Security Disability and SSI
Tips for Filling out a Social Security Disability Application
How Does Social Security Decide Your Disability Claim ?


OpenID katharinakatt said...

This is very helpful and awesome of you to share. I'm downloading mine immediately!

Keep up the great work!

1:44 AM  
Blogger Claribel said...

Thank you very much for this post. Very informative and easy to understand. Will you please write about Quality Reviews of SSD cases. I have been told by examiner that my case (reconsideration) has been decided on May 8 but it was sent to a quality review at NY. They would not tell me the decision or what type of review is being done. I have been out of work since nov. 2005 because of my conditions.

8:28 AM  
Blogger Disability Blogger said...

Thanks katharinakatt. Thanks Claribel (I'll post about quality reviews next).

2:53 AM  
Blogger Richard said...

You have the best "insider's" blog I have seen...I believe Mr. Ginsberg to have the best "outsiders" blog. Between the two of you, I have learned more on your pages, than anywhere else on the net. My wife just received a functional report from DDS to fill out about me. I immediatley came to your page for info. I am not sure, But I really wonder why they are sending her one? They have not sent any to my doctors. Is this a good or bad sign?

8:08 PM  
Blogger Disability Blogger said...

Richard, if its a questionaire regarding activities of daily living, then this is completely normal. Social Security will typically inquire about ADLs to gain more understanding regarding your residual functional capacity (what you can still do despite your impairment). And, very often, they'll contact a third party. Third parties can include neighbors, friends, work associates, and relatives. Your doctor wouldn't receive an ADL questionaire. However, SSA really should send an RFC (residual functional capacity) assessment form to a claimant's treating physician and they don't. I suspect cost is the issue there.

11:37 AM  
Blogger seething said...

You know, it will sound completely disingenuous to say this, but reading about the hurdles and pains of getting help is... depressing.

I know that I can do things but I also know that I am slipping further. Does the disarray of your finances count for much? It just seems so difficult to prove anything. I'm not a vegetable, i just can't stay afloat.

It seems to me from all the reading that I've done that the SSA is not denying so much out of a mindset of disbelief but really because they, like everyone else, is panicking about funding.

And since mental illness is such a pervasive problem in America, they have the attitude that you are not sick unless you can provide overwhelming evidence to the contrary.

6:43 AM  
Blogger Disability Blogger said...

ocdgirl2000, since your comment was long, I went ahead and addressed it on a new post. Here it is along with your original comment:

Social Security Disability Claim Reviewed After Seven Years

7:15 PM  
Blogger Sarkie said...

What do you do when your Dr leaves, moves to another state before he rec'd the forms to fill out.His PCP has been following my husband for over 5yrs & recently dx'd with Sarcoidosis in 2007 he knows everything from the beginning for this terminal mystery disease & I don't think it's fair for another dr who has never treated my husband to fill out the forms. The lawyer we hired I feel is at fault, they've known for 2mo before the hearing May 29th. I called them to make an appt with & the asst said that if they need anything they'll contact us, never happened. They sent us the forms to give to his dr, the lawyer waited too long to get his dr the paperwork, now my husband is screwed with his case....Any help is greatly appreciated, like I said we're only 3wks away. My husband has several dx'd problems, DM II extremely high sugars (last night his sugar was HI),HTN, Sarcoidosis of the lungs,liver & spleen, fevers, fatigued,SOB, coughing, sleep apnea, depression & has dx'd by SSI dr that he is also Bi-polar.Thanks again for your help.
Sarkie's wife

7:20 PM  
Blogger Disability Blogger said...

I apologize for the delay, I've addressed your comment in this post: Problems in Getting Disability Forms Completed by a Doctor

3:25 PM  
Blogger MrIndependent said...

I think almost all people whom deal with the Social Security Administration know how much of a scam they, and their process are, but I'm thankful for the time and consideration you afford us in this blog. Your help is kindly appreciated believe me.
Dave :)

2:31 PM  
Blogger Hinterland Harmony said...

Thank you so much for all the wonderful info that is so helpful. I wish I'd seen this before I started the process. I was wondering if you could make availble the RFC forms in PDF format as my computer only has word perfect and cannot download them. If not I will understand.

Thank you again, Kirsten :)

11:33 AM  
Blogger toolin66 said...

Very Informative post. My issue is that I found work and my job positions changed due to new diagnosis in addition to my original claim. I have continued to work and times the Doctor treating me took me off for complications related to new dx. I am in position that I make more than SGA and not really able to continue with the work schedule I currently have. Would your opinion be that this will be my denial, end of story even with RFC?

9:53 PM  
Blogger Disability Blogger said...

Toolin66, I posted a response to your question here: Social Security Disability and Continuing to Work

6:29 PM  
Blogger paul said...

I certainly would never accuse any of the bloggers here of their legitimate claimes or needs to recieve benefits, but this system is also very suseptable to fraudulant claims. My ex-wife works out at the gym, teaches art as a volunteer, is a leader in a girlscout troop amoung other activities yet she has successfully recieved benefits for 15 years. because she knows how to use the system that most of you all need to survive. The dificulties in obtaining SSDI benefits are certainly in place to prevent frauds from abusing the system. Good luck to all of you who are truely deserving of your benefits.

7:08 PM  
Blogger Disability Blogger said...

Paul, I addressed your comments here:
Can you Get Disability if you can do Some Normal Daily Activities?

10:11 AM  
Anonymous Anonymous said...

I was trying to locate the RFC forms on the bottom of the homepage. I'm sure its just me but I couldn't find them anywhere. Can you tell me again where they are?

My son is autistic. He has his own neurologist, pediatrician, speech therapists, occupational therapists, physical therapists, and ABA therapists. All of them are aware of the claim and have no problems completing the paperwork for us. None of them have received any requests for paperwork from the SSA. Yet for some reason the disability board sent us an appointment for a special evaluation and a "mental exam" by a weight loss doctor that sells herbal pills on his official website. Needless to say... I'm confused and not a whole lot hopeful. Cry...

2:28 PM  

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