Want to know how the Social Security Administration (SSA) decides you can’t work for one year due to a disability? Surprisingly, the Residual Functional Capacity (RFC) form holds the most weight in proving that you medically qualify for disability benefits. We’ll explain why this document is crucial for getting your claim for Social Security disability insurance (SSDI) benefits approved.
New Social Security rules went into effect in March 2017 that changed which evidence matters most in getting benefits approved. Previously, you could’ve asked your doctor to write a medical opinion letter detailing your disabling symptoms (both visible and invisible). That letter could outline physical, mental and emotional limitations caused by your condition that fit the SSA’s specific disability definition. You’d include copies of your medical records, along with any non-AMS provider opinions from people that supported your disability claim. (A non-AMS provider is anyone who the SSA doesn’t consider to be an Acceptable Medical Source, such as a group therapist.) Since your treating doctor’s opinion doesn’t count more than a Disability Determination Services (DDS) doctor’s does, what should you do? Keep reading…
What Does “Residual Functional Capacity” Mean?
You’ll need to show the SSA convincing medical evidence that proves your disability prevents you from working for 12 months. First, the SSA needs to know what you currently can or cannot do, specifically as a result of your disability. Before your disability began, you were physically, mentally and emotionally able to work at your full Functional Capacity (FC). Your disability diminished that functional capacity in some way, and that loss could be both invisible and difficult to prove. Your residual functional capacity defines what you’re still capable of doing and what you are no longer able to do. Assessing your residual functional capacity helps the SSA determine if you’re still able to perform certain work duties. It also tells the SSA whether your disability prevents you from any gainful employment for at least 12 months.
First, the disability claim examiner looks at the most recent 15 years of your work history. This tells the SSA what type of jobs you know how to do. Then, the SSA reviews your residual functional capacity assessment to see whether you can go back to work or not. It’s best to have your treating physician complete the mental and physical forms listed below, if at all possible. If you’re seeing a specialist who’s treated you for several months, you’ll greatly increase your odds of winning SSDI benefits.
How the SSA Determines Your Residual Functional Capacity If Your Doctor Doesn’t Fill Out Those Forms
In order to assess your current physical and mental capabilities, a disability claims examiner works alongside a DDS medical consultant. (DDS is a state agency that works for the SSA.) Together, this duo fills out your residual functional capacity forms and then conducts the RFC assessment on your disability claim. The consultant also uses your medical records to determine how much your exertion levels have changed due to your disability. They also look at any restrictions that could limit your job opportunities or specific job-related tasks due to your disability. Once they get the full picture, the final assessment constitutes your residual functional capacity that’s passed along to the SSA.
The reason for having a medical consultant and disability claims examiner complete your RFC assessment at DDS is pretty straightforward. No judge or disability claims examiner can tell what each claimant’s abilities are based on medical records alone. Judges and claim examiners aren’t doctors, so the SSA asks a DDS medical consultant to determine your residual functional capacity. Once that RFC assessment’s complete, the SSA’s disability claims examiner or judge can either approve or deny your benefits application.
RFC Form #1: Measuring Your Physical Limitations
First, the SSA needs to know how much physical activity you can do to assign an exertional work level. That assessment requires a Physical Residual Functional Capacity (PRFC) form. Those work levels may include:
- Sedentary. You can sit, stand, walk and occasionally lift 10 pounds or less as required. Mostly, you’ll sit down all day.
- Light. You can sometimes lift up to 20 pounds, and regularly lift 10 pounds or less. You can frequently walk, stand, push and pull using either your arms or legs as well as sedentary job duties.
- Medium. You can frequently lift or carry 25 pounds or less, and occasionally lift up to 50 pounds. You can also perform light or sedentary job duties.
- Heavy. You can often lift and carry up to 50 pounds, and occasionally lift objects weighing up to 100 pounds. This level also includes all medium, light and sedentary job duties.
- Very heavy. You may sometimes lift objects that weigh more than 100 pounds and frequently lift or carry 50-pound items. You’re also qualified to perform all job duties in the above categories.
Your physical RFC level combined with your prior work history plays a big role in your claim’s approval or denial. If your physical RFC level matches your job’s physical demands, the SSA assumes you can return to work. However, your physical RFC form may list other issues that limit your work abilities. If the SSA decides you can still work in some capacity, they’ll explain what types of jobs you can do. The claim examiner also considers non-exertional restrictions, including:
- Postural limitations (stooping, kneeling)
- Manipulative limitations (sensory and gross/fine motor skills)
- Visual limitations
- Communicative limitations (hearing, speaking)
- Environmental limitations
RFC Form #2: Measuring Your Mental Health-Related Limitations
If you’re filing a claim for an emotional or mental condition, the SSA is required to investigate your reported symptoms. If they’re severe enough, you’ll have to submit a Mental Residual Functional Capacity (MRFC) form.
The grid rule system works fine for measuring your physical RFC (i.e., you can or cannot lift, push, carry, pull). Unfortunately, assessing your true mental residual functional capacity is much harder. For a mental RFC determination, the SSA looks at current job opportunities across the U.S. They do this to find less mentally demanding jobs that you may be able to do. If you’re incapable of doing even simple, unskilled jobs, you may qualify as disabled and therefore approved for SSDI benefits. But first, the SSA needs a thorough understanding of your mental and physical residual functional capacity levels.
A mental RFC assessment measures (but isn’t limited to) your ability to:
- Understand, remember, and follow instructions
- Remember locations, work procedures, and routine job tasks
- Pay attention and concentrate on tasks for prolonged periods of time
- Meet scheduled deadlines
- Be punctual
- Work with others or in close proximity without becoming distracted
- Interact appropriately with the public
- Respond appropriately to your manager’s direction and feedback
- Follow socially acceptable standards of neatness and cleanliness
- Adapt to changes in the workplace
- Notice standard workplace hazards and respond appropriately
- Tolerate normally expected stress levels
- Drive yourself to and from work, or use public transportation
- Set realistic goals/make plans without needing assistance
Why Your Treating Physician Should Fill Out Your Residual Functional Capacity (RFC) Form
Some conditions can include mental or emotional symptoms that qualify you for disability benefits but aren’t obvious to other people. If you’re diagnosed with an invisible or hard-to-prove disabling condition, have your doctor fill out your residual functional capacity forms. Here are a few examples that help illustrate this point:
- You come home from work and realize you’ve been robbed. After a few days, you go to the doctor because you’re having panic attacks. Your doctor diagnoses PTSD and prescribes medication. Due to your PTSD, you have difficulty leaving the house to wait tables during your night shifts and get fired. You may qualify for monthly disability — if you can prove it.
- You got rear-ended. When you go to work, you have difficulty typing for more than a few minutes. Your hands are shaking, and after an X-ray, your doctor says you need physical therapy. Except for a few bruises, you look fine — but you cannot sit and type. So, you may qualify for SSDI.
- While moving, you hurt your back carrying furniture. You pop a Tylenol and hope it gets better in a few days, but it doesn’t. Finally, you cave and ask your doctor for pain medication. After your exam, the doctor warns you not to lift anything due to a pinched nerve. You work for a package delivery service and bartend at night, but can’t do either due to back pain. Proving you’re eligible for SSDI may be harder than you think.
Have your treating physician fill out both RFC forms explaining how and why your condition meets the SSA’s disability requirements. A specialist is ideal, but the person treating you understands your condition far better than the DDS medical consultant could.
You May Qualify for Legal Assistance
Unless you’re able to consistently work full-time and be productive without frequent rest breaks, you’ll probably qualify for SSDI benefits. However, the DDS claim examiner may decide you can learn another job (that matches your RFC, age, education, and skills). If this happens, the SSA may train you to do another job instead of approving your SSDI claim.
To ensure you’re submitting accurate, well-supported claim paperwork and medical evidence, talk to a disability advocate who understands what you’re going through. They can answer any additional questions you may have about residual functional capacity and help you file your disability claim. If you’ve already received a denial letter from the SSA, an advocate may help you win benefits on appeal.
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