Tim Moore, who has answers to almost any question you can imagine regarding disability at his site, The Social Security and Disability Resource Center, has kindly written a guest blog post for us on a topic that's of particular interest to me and I know is also applicable for at least some of my readers:
What if you go to a disability hearing with complicated or not fully diagnosed health issues?
This is actually not an uncommon scenario. Very many hearings take place in which A) the claimant's condition is not specifically and concretely tied to one condition or B) the medical evidence does not yield clear lines between the cause of illness and the resulting effects. Fortunately, however, the social security administration's approach to deciding social security disability and SSI claims does not focus on the identification of an impairment, but, rather, on the functional limitations that result from a condition, or set of conditions.
In all social security disability and SSI claims that are filed with the social security administration, the claimant's medical records will be gathered, read, and reviewed. The disability examiner (if the claim is pending at the disability application or reconsideration appeal level) or the the administrative law judge (if the claim is pending at the hearing level) will attempt to discern what the claimant's RFC is, based on the available medical record documentation.
RFC stands for residual functional capacity and it is simply a measurement of what a person is still able to do, despite their illness. Knowing what a person's residual functional capacity is, i.e. knowing what they are still residually capable of doing, can allow the decision-maker on a claim to determine if the individual is capable of returning to their past work, or if the individual is capable of performing some type of other work. If the medical record indicates that the claimant can do neither, then the case will be approved.
So, does it really matter what a person's specific illness is when they go to a disability hearing? Well, it is true that the clearer a case is, the easier it may be for an adjudicator to discern what the claimant's functional limitations may be. And, in certain instances, having a specific and clearly diagnosed impairment can lead to an approval based on meeting or equaling a listing in the impairment listing manual (This is a listing of impairments for which approvals can be made so long as the medical record substantiates specific criteria. Known as the blue book, it is published under title "Disability Evaluation under Social Security"). However, in most cases, the identification of an illness in the medical records will do nothing for a case if those same medical records do not support the existence of functional limitations that are severe enough to prevent a person from engaging in work activity that is substantial and gainful.
This is actually the single area in which disability representation may be the most helpful. An experienced and insightful representative should be capable of assembling a presentation of the case that highlights physical or mental limitations that preclude both the claimant's prior work activity, as well as preclude the ability of the claimant to switch to form of other work that, otherwise, might be logical based on the claimant's work skills and education.
How does a good representative accomplish this? Two ways. First, by knowing which information in the medical record to focus on (for example, evidence of the ability or inability to engage in normal daily activities that involve basic tasks such as standing, sitting, reaching, stooping, lifting, memory, learning, maintaining attention and concentration, etc). Secondly, by working to obtain qualified and objective statements from a claimant's treating physician or physicians.
The author of this article is Tim Moore, a former medicaid-disability caseworker and a former disability claims examiner for the social security administration's DDS, or disability determination services. Tim Moore is the publisher of The Social Security and Disability Resource Center.
If you're in the application or appeal process seeking Social Security Disability, I strongly recommend you browse Tim's site, which is full of helpful, informative articles on the entire process, from initial application through final appeal.
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