Monday, February 02, 2009

Social Security Disability and Medium Work

Gordon Gates, a social security disability attorney, practicing in Maine, has a post on his blog (The Social Security Disability Lawyer Blog) titled "Medium Exertional Work".

In the post, he describes a situation with one of his clients who is past age 55 and was given a medium RFC, or residual functional capacity rating by someone at DDS a.k.a. disability determination services. The decision may have been rendered by a disability examiner and a unit medical consultant (the DDS doctor), or, perhaps, the decision was made by just the examiner if the examiner was an SDM, or single decision maker (I've always found this objectionable that social security allows certain cases to be decided without medical consultation).

However, who made the decision is not really relevant. The point of the scenario is that the claimant, due to his age (past age 55) would have been approved if the RFC rating he was given was less than medium, meaning either a light RFC, or less-than-a-full-range-of-medium.

Here is a clear example of why medical record documentation is so important. It establishes not simply a diagnosis, or a prognosis, but also functional limitations. And functional limitations guide residual functional capacity ratings that direct the outcome of social security disability and SSI disability cases.

The scenario also illustrates, in my opinion, how important it is to have a good relationship with your treating physician.

Ideally, you want to have a doctor that has a long (long is always a relative term) and established history of providing medical treatment. This may make it more likely for the doctor to note functional limitations that are associated with your medical or mental condition (or not). It may also make it more likely for the doctor, upon request, to provide a medical source statement or RFC form (different terms for the same thing) that is detailed enough to have a favorable impact on your case.

Now, on the subject of a medium RFC, I have a gripe. And interestingly enough, Gordon Gates has referenced my gripe on his blog which can be found on this following post: 50 pounds.

As I said back in that gripe way back then---doctors who work on SSD and SSI disability cases at disability determination services should be required to have a 50 lb dumbbell beside their desk. Why? To let them know what fifty pounds really is. Because, honestly, I don't think most of them know how much stress having to lift fifty lbs occasionally as part of one's job duties (a medium RFC entails lifting 25 lbs frequently and 50 lbs occasionally) actually puts on the body. A lot of them, I'm sure, would have trouble picking up a 50 pounder even once. And I am fairly certain this would affect how often they dole out medium RFC ratings to claimants with significant back problems such as lumbar degenerative disc disease. that I think of it, there's a larger issue at work here. I've said this before to my spouse who is a former examiner and currently works as a field office CR (claims rep) and her opinion differed. But I tend to be of the mind that the fact that the majority of disability examiners are under 30 (not hard to explain: low pay and lots of turnover) has at least a little to do with the quality of their addition to how easily they "slap a medium RFC" on a writeup (sort of a pre-RFC that's taken in to a consultation with a unit medical consultant who will sign off on the official agency RFC).

Think about it. You can't really feel someone else's pain. No matter how much you hear their expression of it. In fact, it's a psychological phenomenon that the more we hear someone's complaints of pain and discomfort, the more desensitized we become to them.

So, what does this mean for the disability evaluation system? Well, doctors who routinely see patients with painful conditions for which the treatment options are either limited or exhausted tend to become "distanced" (back pain, fibromyalgia, etc). But, also, (in my opinion), disability examiners who tend to be younger individuals probably have less empathy toward many conditions simply because, as a group, their average age precludes having experienced a lot of pain and impairment.

Now, I'm not saying that all disability examiners are subject to this phenomenon. I'm just indicating how the group's (disability examiners in general) inclinations may be subtly affected by their average age as a group. Even using myself as an example, I can safely say that, at the age of 43, I have much more insight into pain and limitation than a younger individual who's been lucky enough to avoid such scenarios thus far. For one thing, I've experienced some pretty awful back pain. However, my "age cohort" of friends and family that are now my age and older are all now more likely to have developed some impairment or worsening of some condition. And their experiences add to my own, and to my perceptions and insight.

Beating around the bush...what am I trying to say? That you, any person, may be more likely to show empathy toward a malady and its limitations if you can relate to the individual's situation in some way. Because that's part of the human condition. We express empathy when we can relate.

Now, some may object to my inference that the disability system is less than objective. But, don't kid yourself, it is a very subjective system, despite the blue book and the grid. If it wasn't then there wouldn't be this huge chasm of disconnect between cases that are denied at the reconsideration level and cases that are later approved at a disability hearing.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Hearings for disability
What are the chances of winning at a disability hearing?
Quality Reviews of SSD Cases
Why does it take so long to get a decision on a Social Security Disability or SSI Disability case?
Will a Disability Lawyer decline taking your disability case ?
Can I win my disability case ?



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