If your condition does not meet the requirements of the SSA's Blue Book of Impairments, you may still be awarded Social Security Disability Insurance based upon your functional limitations.
The Social Security Disability Insurance is a federal program run by the Social Security Administration that offers monthly payments to people with severe conditions or impairments affecting their daily functioning levels. The SSA does have an official impairment listing for each of the condition it offers a disability benefits allowance for. The Blue Book of Impairments is a complete guide of every possible symptom or condition that it may consider while evaluating for SSDI benefits.
How does SSA view Residual Functional Limitations?
If the SSA does not find symptoms or conditions mentioned in the Blue Book of Impairments, it may reject your SSDI application right away. However, the SSA 'is' required to look further into a person's symptoms if their given condition is not listed clearly in the Blue Book – before rejecting your SSDI application for benefits.
To qualify for SSDI benefits, you must prove that you have a severe, medically determinable impairment that matches the criteria of a condition listed in the Social Security's Blue Book of Impairment, or match symptoms under one of its categories, for instance, severe depression under mental impairments. Many people believe that they have to qualify for exactly the same symptoms or conditions listed in the Blue Book in order to be eligible for SSDI benefits. However, that is not the case for all.
In fact, almost 50% of all approved disability cases do not meet the impairment listings – where other half of the applicant who qualified actually did so based on their limitations, work history, age, education and the fact that their condition was severe enough to prevent them from performing substantial gainful activity (SGA). According to a survey, only 38% of applicants won SSDI benefits because their impairments match the Blue Book's listing exactly, while the other 6% won benefits because their symptoms were considered equivalent to an impairment listing.
What happens when a listing is not met?
IF your medical condition does not meet the impairment listing in the Blue Book, then your disability examiner (DE) will look for the symptoms or residual functional limitations that your condition has over your daily life. The DE at Disability Determination Services (DDS) will assess what level of exertion you are capable of and which physical restrictions limit the jobs you can uptake. This also holds true for mental and neurological claims, the DE will evaluate the symptoms based on how they limit your functionality.
What Residual Limitations win an SSDI case?
To meet the requirements of an SSDI application, you must be able to prove that your residual functional limitations are severe enough to prevent you from working to earn a substantial income.
Some ways the disability examiner may assess you are your medical records and functional medical evidence.
Your disability examiner (DE) is more likely to believe your condition is disabling if your medical case is documented better with good medical records. For instance, if you have severe acute back pain disabling your work life, but you only visits your medical doctor only twice a year, then your DE might probably think your condition is not disabling enough. Note that it is almost impossible to win a disability case if your medical treatment is infrequent.
Functional Medical Evidence
The Social Security Administration (SSA) makes decisions on an SSDI case based on medical or physical 'functional' evidence, that is, your residual functional limitations. Examples of functional evidence can be the 'straight-leg test' in a Degenerative Disk Disorder (DDD) or exercise stress tests such as ECG, ETT for heart disorders, CT scans or MRI scans for ADHD, PTSD symptoms etc. Some other instances of functional limitations may involve an inability to stand-up from a seated position with ease, bend down, stoop to pick up something or to balance while standing, or, for mental claims the results of memory tests or intelligence or clinical psychiatric tests.
In some cases, statements from employers, caregivers, relatives or friends may not mean so much as much as statements of physicians about your functional limitations do. A physician's statements should point out to the disability claims examiner (or the judge in that case) exactly what your symptoms are and how they are disabling to you.
What do RFC symptoms explained by physicians mean?
Your physician's statement must be detailed, preferably in the form of an RFC form (residual functional capacity form). Having your physician list out your symptoms in detail is the single-most important document you can have at your disposal as a leverage to increase your chances to win a disability case. However, eventually your disability examiner does need to look at an RFC form backed by medical evidence (hence the need for good medical records).
Physical RFC Forms
Your disability examiner will look for medical evidence in your SSDI application file. Then, on the RFC form, the physician will rate the claimant's residual functional capacity—an assessment of your ability to engage in normal daily activities, taking into accounts your physical condition. For instance, physical RFC forms will include tests to evaluate your physical strengths for daily functioning such as how long you can sit, stand, walk, crouch, and stoop. The physical RFC will also give the medical consultant's opinion regarding how much you can lift (in pounds) on an occasional or frequent basis, and how well you can grasp, manipulate, and reach overhead.
Mental RFC Form
A mental RFC form, completed by a DDS psychologist or psychiatrist, will make reference to a your mental symptoms (for example, poor memory, decreased energy, illogical thinking, and so on). The mental RFC will also indicate your ability to persist in the areas of concentration and attention, as well as your ability to interact socially in work settings, assimilate new information, and successfully engage in simple, routine, repetitive tasks (SRRTs).
Unfortunately, RFC forms completed by DDS doctors are rarely of any benefit to claimants. At DDS, RFC forms are used to facilitate denials significantly more often than approvals. That's why it's important to get your own treating doctor (whom you frequently visit for treatment for the condition you are filing SSDI for) to fill out an RFC form you.
Also, your doctor's statements are superior to a short statement or a letter written on behalf of a claimant (you) stating that your condition is severe enough to affect your work capability. This could include testimonials of your doctor stating your functional limitations such as strength, range of motion, mobility and so on.
If you need help submitting an SSDI claim or look for disability guidance for your Appeal's process with RFC symptoms, you can seek counsel of expert disability attorneys at Law Office of Irene Ruzin for help.