A Social Security Disability Lawyer Explains the Residual Functional Capacity (RFC) Assessment in SSDI and SSI Claims

 

The RFC You Receive from the Social Security Administration (DDS or the Administrative Law Judge) Often Determines if You Win Your SSDI or SSI Case

 

When deciding if you’re disabled, the Social Security Administration (SSA) wants to know what you can do. Not what you can’t do. 

 

You have the burden of proof for establishing your work capacity. Or, as the SSA calls it, your residual functional capacity (RFC). 

 

Your RFC is the administration’s assessment of how your injuries and diseases and their symptoms (pain, fatigue, etc.) cause physical or mental limitations affecting your capacity to do work-related activities. It is the most you can do with your exertional and non-exertional restrictions, not the least.

 

You need an accurate residual functional capacity that includes all of your exertional (physical) and non-exertional (mental) limitations for two reasons. 

 

First, you must prove you cannot do the easiest (lightest) job you have performed in the last fifteen years that the SSA considers “past relevant work.” A job would qualify as past relevant work if you earned enough money to be considered “substantial gainful activity (SGA)” and did it long enough to develop proficiency. 

 

Second, to show that you cannot do any other job that exists in significant numbers in the national economy if you are under age 50. Those age 50 or older will have an easier time proving that you are disabled under the Social Security Act, though you still need evidence of your RFC. 

 

This article explains how the SSA assesses your RFC and what evidence you need to show your capacity for completing tasks in work situations. 

 

Remember, the more comprehensive and limiting your RFC, the greater the likelihood of getting Social Security Disability benefits. This is because the SSA will compare the RFC to the requirements for your past relevant work and use the RFC assessment to pose hypothetical questions to a vocational expert about other work in the national economy. 

 

Keep reading to learn more.

 

And contact our disability lawyers today for help applying for Social Security Disability or getting SSDI or SSI payments.

 

We have helped thousands of adults and children win their disability hearings before an administrative law judge (ALJ). And we want to help you and your family.

 

Contents hide
1 A Social Security Disability Lawyer Explains the Residual Functional Capacity (RFC) Assessment in SSDI and SSI Claims
1.1 The RFC You Receive from the Social Security Administration (DDS or the Administrative Law Judge) Often Determines if You Win Your SSDI or SSI Case
2 Diagnosis vs. RFC in Disability Claims
3 How Does the Social Security Administration Define Your Residual Functional Capacity?
4 How Does the Social Security Administration Assess Your Residual Functional Capacity?
5 What Evidence Does Social Security Use to Assess Your Residual Functional Capacity?
6 Who is Responsible for Getting the Evidence Needed to Decide Your RFC?
7 What Work Activities Should I Focus on When Describing My Capacity for Employment?
8 Will Social Security Base Your RFC on the Medical Source Opinion from a Treating Physician?
9 Contact One of Virginia’s Best Social Security Disability Application Attorneys

 

Diagnosis vs. RFC in Disability Claims

 

Your exact diagnosis is the starting point in your Social Security Disability claim.

 

You need a diagnosis to prove that you have medically severe impairments at step two of the SSA’s sequential evaluation process

 

But in general, your diagnosis is not that important in proving you qualify for SSDI or SSI benefits.

 

Instead, the limitations resulting from your symptoms and medical treatment are much more critical.

 

Let’s look at how the SSA analyzes your capacity for work.

 

How Does the Social Security Administration Define Your Residual Functional Capacity?

 

Section 416.945 of the Code of Federal Regulations provides that your residual functional capacity is the most you can do in a work setting (physically and mentally) on a regular and continuing basis despite your functional limitations. 

 

The SSA and the United States Court of Appeals for the Fourth Circuit (the court that hears appeals from the federal district courts in Virginia, Maryland, West Virginia, North Carolina, and South Carolina) have defined “regular and continuing basis.”

 

Typically your RFC is the most you can do, working eight hours a day, five days a week, or an equivalent work schedule. 

 

However, there is an exception. 

 

If you have performed part-time work in the past 15 years that was substantial gainful activity and done long enough to constitute past relevant work, the SSA will find you not disabled if you have the RFC to perform that work.

 

How Does the Social Security Administration Assess Your Residual Functional Capacity?

 

Social Security Ruling (SSR) 96-8P states the SSA’s policies for assessing your RFC in claims for disability benefits under Titles II (SSDI) and Title XVI (SSI) of the Social Security Act.

 

This policy interpretation ruling and other SSA statements emphasize that:

 

  • The RFC should only include functional limitations and restrictions resulting from your medically determinable impairments. Even those the SSA does not find “severe.” Though a non-severe impairment alone may not significantly limit your ability to work, combined with limitations from other impairments, it may reduce the range of different work you can still do. 

 

  • The RFC assessment should not mention age, gender, past work activities, muscularity, body type, constitution, height, or weight (unless obesity is considered a severe medical impairment).

 

  • An RFC finding is insufficient if it states only the exertional level of work the claimant can perform (sedentary, light, medium, heavy, or very heavy). It must also identify the claimant’s functional restrictions and assess work-related abilities on a function-by-function basis.

 

  • In addition to assessing your ability to meet the physical and mental requirements of employment, the RFC will also consider your ability to satisfy a job’s sensory and environmental needs.

 

  • The RFC assessment must include a discussion and analysis of all the evidence in your case, including your complaints of pain and other symptoms.

 

  • An RFC should explain why your testimony about symptom-related functional limitations is or is not consistent with the other evidence.

 

What Evidence Does Social Security Use to Assess Your Residual Functional Capacity?

 

The SSA must base your residual functional capacity on all of the relevant evidence in the case record, such as:

 

  • Attempts to work since the alleged onset date of disability

 

  • Consultative Examination (CE) reports

 

  • Diagnostic imaging studies (x-rays, CT scans, MRIs)

 

  • Effects of treatment on your condition(s)

 

 

  • Function reports completed by you, family, or friends

 

  • Hearing testimony

 

  • Laboratory findings

 

  • Lay testimony and evidence (including written reports)

 

  • Medical (patient) history

 

 

 

  • Observations of home health care professionals or counselors

 

 

  • Operative (surgical) reports

 

 

 

  • Personnel records (including work evaluations and performance statements)

 

  • Pharmacy printouts

 

  • Ratings from the Department of Veterans Affairs (VA)

 

  • Reports of daily living activities

 

  • School records

 

 

  • Side effects of your medication

 

  • Statements from friends, family members, neighbors, clergy, coworkers, and other persons about their observations and what they believe you can and cannot do at work or home

 

  • Whether you need assistance in caring for children or pets

 

  • Whether you require a structured living environment

 

  • Your explanation of your symptoms, what you can and cannot do in a work setting, and why you believe you are disabled. Indeed, SSA examiners must give careful consideration “to any available information about symptoms because subjective descriptions may indicate more severe limitations or restrictions than can be shown by objective medical evidence alone.”

 

Who is Responsible for Getting the Evidence Needed to Decide Your RFC?

 

In general, you are responsible for giving the SSA the evidence it will use to make a finding of your RFC. This responsibility extends to informing the SSA of all evidence known to you relating to whether you are disabled – even if you do not possess it.

 

But the SSA also has responsibilities in developing the medical evidence.

 

Indeed, the Social Security Regulations state the SSA is “responsible for developing your complete medical history, including arranging for a consultative examination(s) if necessary and making every reasonable effort to help you get medical reports from your own medical sources.”

 

What Work Activities Should I Focus on When Describing My Capacity for Employment?

 

We recommend offering specific testimony, medical evidence, and lay witness statements about your exertional and non-exertional capacity. Otherwise, you risk the denial of your application for disability benefits because your answers are too vague.

 

Depending on the medical impairments serving as the basis of your disability claim, you will want to address:

 

  • Walking: How far can you walk without resting or having pain? How many hours can you stand or walk total in an eight-hour working day? Do you need a cane or a crutch? Do you have to wear orthotic devices or specific shoes for comfort? 

 

  • Standing: Can you stand without an assistive device or leaning/resting on an object? How long can you stand without assistance? 

 

  • Sitting: How many hours or minutes can you sit at one time before needing to get up or lay down? Are you able to sit in any chair, or are certain types more comfortable than others? Do you need a seat cushion to relieve symptoms?  

 

  • Changing Positions: How often do you need to change positions between sitting, standing, lying down, and walking? Do you have to do this the entire day?

 

  • Elevating Legs: If you have swelling in your feet or legs, do you need to elevate them to reduce the swelling? And if so, what percentage of time do you lift your legs, and how high do you raise them? What happens if you do not elevate your legs for this amount of time? 

 

  • Lifting/Carrying: What is the most weight you can lift without feeling pain? How much weight can you lift or carry on an occasional or frequent basis (up to 2/3 of the working day)? Do you have increased symptoms after lifting items? Who takes the trash out at your house or does the laundry? 

 

  • Driving: Are you able to drive? If so, how long can you operate a motor vehicle before stopping for a break?  

 

  • Climbing: Are you able to walk up or down the stairs? Have you moved your bedroom to the first floor to avoid the stairs? Do you have motorized equipment to carry you up and down the stairs? Are you able to climb ladders? 

 

 

 

  • Handling/Fingering: Can you open jars, operate zippers and buttons, type on a keyboard, write, or move objects without dropping them? A finger or hand injury, carpal tunnel syndrome (CTS), or other neurological condition may reduce your ability to use your hand. 

 

  • Environment: How do you do in hot or cold environments? Can you work outside during the summer? Or perform a job that requires you to stock items in a large refrigeration unit? Can you keep your balance well enough to work on scaffolds or roofs? If you have a pulmonary condition (asthma, COPD, etc.), can you work near dust or chemicals? Can you work near heavy machinery such as forklifts or are you at an increased risk of injury due to your limitations?

 

  • Vision: Do you have trouble reading or viewing a screen?

 

  • Hearing: Can you hear with an assistive device such as a hearing aid?

 

  • Absenteeism: How many days per month will you miss from work because of your medical impairments? Are there days when you do not get out of bed because of pain, depression, or fatigue? Did you call out sick from past jobs because of your health? How often did you leave early due to pain or other symptoms in your past relevant work? Were you disciplined for missing time from work? How many days per month do you attend doctor appointments or physical therapy sessions? 

 

 

  • Instructions: Do you have difficulty following written or oral instructions? 

 

  • Supervision: Do you need reminders from supervisors to stay on task, or can you complete what you set out to do independently?

 

  • Working with Others: Can you get along with coworkers, supervisors, or the public? When was the last time you had a verbal or physical altercation with a stranger in public? Do you have angry outbursts over slight provocations or disrespect? 

 

  • Decisions: Are you decisive, or do you take a long time to make simple decisions? 

 

  • Adaptation: How well do you handle changes in routine? 

 

  • Stress: Are you easily stressed? What happens when you are stressed? Can you work through adversity?

 

  • Breaks: Do you need to take regular breaks when completing tasks? Why do you need to stop? How long do you need to rest before restarting the job? 

 

  • Headaches: What causes your headaches? Can you tell that you are about to have a migraine or headache? Do you need to lie down or find total darkness or a quiet place to get relief?

 

  • Attention: Can you concentrate or focus for extended periods? Are you able to follow the television shows or movies you watch or the books you read?

 

  • Reading: Are you able to read? What types of things can you read and understand if you have difficulty comprehending what you read? 

 

  • Finances: Do you have a checking or savings account with a bank? If so, can you manage your funds, pay your bills, and balance your account? 

 

  • Impulse Control: Can you control urges to spend money, argue, or travel? Or do you have a history of bad decisions? 

 

  • Depression: Do you have crying spells? Are there days you refuse to dress or wash? Do you need reminders about grooming? 

 

  • Panic Attacks: How often do you have panic attacks? What triggers these attacks? For example, can you be in large crowds or near a lot of people? 

 

  • Hallucinations: Do you have audio or visual hallucinations? 

 

  • Sleeping Problems: Do you get a whole night’s sleep? If not, what keeps you up? Do you feel refreshed in the morning? 

 

  • Fatigue: Do you need to take a nap during the day? If so, how many and for how long? Does even minimal physical or mental exertion make you tired? 

 

  • Flashbacks: Do you experience flashbacks of traumatic events that disrupt you during the day? 

 

This is just a sample of the questions you should consider when determining how to present your capacity for work. 

 

Will Social Security Base Your RFC on the Medical Source Opinion from a Treating Physician?

 

Maybe.

 

The disability claim examiner or administrative law judge deciding your application may adopt your doctor’s opinion about your residual functional capacity. But they are not required to do so by law.

 

Instead, they only have to consider the statement and explain why it was not adopted. Indeed, the SSA must provide a narrative description of how it weighed the opinion evidence.

 

You have a better chance of persuading the SSA to adopt a favorable RFC assessment from your doctor if that RFC is detailed and addresses your specific capabilities. A simple statement that you cannot work is not good enough.

 

Contact One of Virginia’s Best Social Security Disability Application Attorneys

 

Our injury law firm helps auto accident victims, injured workers, and persons diagnosed with severe medical conditions qualify for disability benefits through Social Security.

 

And one of the most significant factors in succeeding is making sure that the disability claim examiner or administrative law judge correctly assesses your residual functional capacity. For example, an RFC that overstates what you can do in a work setting will likely find that you are not disabled because you can do past relevant work or other work in the economy given your age, education, and work skills. 

 

Contact us today for help with disability claims in Virginia, Pennsylvania, Maryland, D.C., West Virginia, North Carolina, and South Carolina.

Corey Pollard
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