The Inside Scoop on Applying for Disability Benefits
By Kristen Lavoie
Whether you’re a patient, caregiver, or
physician who wants to learn more about
disability benefits—you’ll want to read this.
A helpful tool is the residual functional capacity (RFC) evaluation process: When applying for disability, the following may serve as helpful information for both the applicant and their treating physicians, either past or present.
In order to improve an applicant’s chances of getting disability benefits from the Social Security Administration, one particularly helpful tip involves making sure your physician has the most effective, proper documentation in your medical records.
Although this process isn’t mentioned on the official Social Security website, it may serve as a vital tool in making sure your disability claim is adequate enough to warrant you the benefits you need.
An important responsibility of both the applicant AND their medical team is to prove what potential occupational activities the patient is capable of performing and what his or her limitations are. When a claims examiner contacts the physicians listed on the patient’s disability application, those physicians must be able to provide very specific documentation about their patient’s limitations. (Note: It is most helpful for a patient to list physicians on their disability application who have regularly and most recently treated them; and for those physicians to prepare and compile specific documentation—verses a physician who saw the applicant once years ago).
A physician can help significantly to ensure that a patient acquires disability benefits by conducting a residual functional capacity (RFC) assessment. You can read more about the RFC assessment here. A patient’s RFC refers to a patient’s remaining abilities despite any limitations from his or her impairment. The RFC evaluation assesses a patient’s capacity to do work-related physical and mental tasks on a regular and continuing basis—which means eight hours a day, five days a week.
Your doctor’s RFC form may be the most
important part of your disability case.
As the RFC assessment is performed, the physician should document very specific details of a patient’s limitations on the RFC form. The patient should work with their physician when completing this form by reviewing it alongside their physician to resolve any difference in opinion. You can request the RFC form from your local Social Security office or you can download it here.
One of many websites that discusses this helpful form, Disability Secrets, says: “Your doctor’s RFC form may be the most important part of your disability case.” Read more about that here.
Defining and Determining Disability:
It is important to understand the Social Security Office’s definition of disability, as well as what kind of evidence is needed. The meaning of the term “disability,” is largely dependent on who is defining it. For instance, the Veterans Administration, Worker’s Compensation, and the ADA (the Americans with Disabilities Act) vary in their definition. This is why meticulously documenting the impact a disease or illness has on a patient’s normal daily living (NDL) on the RFC is important.
The Social Security Administration (SSA) defines disability as:
“Inability to perform substantial gainful activity by reason of a medically determinable physical or mental impairment, or combination of impairments, which has lasted or is expected to last at least 12 consecutive months, or end in death, taking into account the individual’s age, education and work history.”
In order for an individual to qualify as disabled by the SSA, his or her impairments must “meet” or “equal” the specific list of requirements found in the Social Security Blue Book. This list identifies the physical and mental conditions that the SSA considers severe enough to result in an automatic disability finding. If an impairment does not meet or equal the Blue Book listing requirements, the patient may still be determined disabled under the following stipulation: if he or she is unable to perform work he or she did in the past 15 years; and if he or she is unable to do any other type of work considering residual functional capacity, age, education, and work experience.
An adequate functional capacity evaluation assesses the following categories: physical abilities, mental limitations, and other non-exertional impairments and restrictions.
It is important to note ALL of a patient’s impairments that correlate with medical records in the functional capacity evaluation—even those which may not be considered severe, since the combination of impairments may greatly affect the patient’s ability to work. To better understand these three categories, here is a break down:
Physical Abilities: This section of the functional capacity evaluation should describe the patient’s physical limitations. All potential activities that might be required in an occupational setting, such as sitting, standing, walking, lifting, carrying, bending, squatting, crawling, climbing, reaching, stooping, kneeling—the patient’s ability to do repetitive motions, etc.—should all be addressed. Any necessary physical restrictions should be assessed and listed. For example, what is the maximum number of pounds a patient can lift, and how often can the patient engage in such activity?
Mental Limitations: This part of the evaluation should detail the patient’s limitations in comprehending, remembering, and following through on instructions. Any limitations the patient has with respect to appropriate responses in an occupational setting should be noted, such as the ability to handle work pressure, receive supervision, or relate to coworkers, etc.
Non-Exertional Impairments: This part of the evaluation should address remaining factors that may affect the patient, such as physical pain, environmental restrictions, the need for rest breaks, and any side effects of medication. In regard to physical pain—any objective signs of pain, the degree of pain, and the frequency of pain experienced by the patient must be noted. Detailed information on whether the patient will need unscheduled breaks due to pain, time off, or may experience medication side effects should also be noted.
Potential environmental restrictions should also be included in this section. For example, should the patient avoid exposure to sunlight, dust, fragrances, fumes, extreme weather conditions, or smoke? Can he or she tolerate stairs, heights, etc.?
All limitations should be fully described as they will affect the patient’s ability to work.
Again, keep in mind that physicians must be as specific as possible when documenting the patient’s occupational limitations. This may even include additional information not requested on the forms. It is important to note that just because a symptom or illness is documented, it doesn’t necessarily equate to functional impairment.
For example: For patients with multiple sclerosis, an MRI that reports lesions on the brain does not necessarily mean the patient is physically impaired; the doctor must provide an explanation of what those findings actually mean for the patient and how it specifically affects them. In other words, the Social Security Administration evaluators never assume the effects that a documented medical condition has on a patient unless the physician explains the connection between the diagnosis and its effects. Additional examples include the following:
- A 49-year-old construction worker has been diagnosed with a heart condition that now limits him to sedentary work. Since he has a 5th grade education and a “low/normal” I.Q., he has done heavy, unskilled labor since age 16 and can only do basic things such as inventory lists and simple instructions. Although he is now restricted to sedentary work, he is not disabled under Social Security law unless he has an additional limitation.
- A 36-year-old machine operator has only done unskilled, medium-exertion factory work since graduating from high school, and a permanent hand injury limits him to work that doesn’t require bimanual dexterity. He has recently been diagnosed with a cardiovascular impairment that limits him to sedentary work. He is disabled under Social Security law.
- A 62-year-old truck driver has been driving trucks most of his life, but when the trucking industry took a downturn 10 years ago he worked 18 months at a sedentary office job. He now has a recent pulmonary impairment that limits him to sedentary work. Since he is still capable of doing an office job, he is not disabled under Social Security law.
The ultimate decision regarding a
patient’s residual functional capacity
rests with the SSA.
The SSA may even request that their own team of medical professionals perform a functional capacity evaluation on the applicant. Regardless, the functional capacity evaluation performed by the patient’s treating physician must not be underestimated, since that physician is considered to be the most knowledgeable about the patient’s condition and any resulting occupational limitations. The RFC assessment and documentation serves as a key factor in helping someone get the disability benefits he or she desperately needs.
General Information on Applying for Disability:
The following information can also be found on the official Social Security Administration’s website:
There are three ways you can apply for disability benefits:
- From the convenience of your own home online.
- Via phone by calling 1-800-772-1213 to make an appointment and avoid any loss of benefits (applicants who are deaf or hard of hearing can call a toll-free TTY number, 1‑800‑325-0778. Representatives are available weekdays from 7 a.m. to 7 p.m (ET). Upon calling, tell the representative you wish to apply for disability benefits. For applicants calling from outside the United States and its territories, contact the nearest U.S. Social Security office, U.S. Embassy or consulate: http://www.socialsecurity.gov/foreign/.
- In person at a local Social Security office. http://www.socialsecurity.gov/info/isba/otherways.htm.
Who can apply? In order to apply for benefits online, the official Social Security Administration states:
The applicant must be 18 years old or older; not currently receiving benefits on their own Social Security record; unable to work because of a medical condition that is expected to last at least 12 months or result in death, and he or she must not have not been denied disability benefits in the last 60 days. If your application was recently denied for medical reasons, the Internet Appeal is a starting point to request a review of the medical determination made.
What basic information is needed? The official SSA website provides a checklist to help gather information needed to complete the application. To review this checklist, click here.
The website also states, “Applying for disability is a multi-step process that may take between one to two hours to complete depending on your situation.”
One of the benefits of applying online is that you can save the application as you go,
allowing you to take a break at any time.
To begin an online application process, click here.
To check on the status of your application once completed click here.
For complete information on applying for disability, visit: http://www.ssa.gov/applyfordisability/