"Without evidence of a limited Residual Function Capacity (RFC), you don't have a disability case."
Unfortunately, Social Security disability law is filled with technical terms that people don't understand, yet they are critical in the successful outcome of a disability claim.
One of those terms is Residual Function Capacity (RFC).
I hate to belabor this but let me try to explain what the RFC is and why it can make or break your Social Security disability claim. This is critical to understand if you plan to handle your own case.
What is residual function capacity? Simply put, it is the maximum you are able to do with regard to work-related activities, such as standing, walking, lifting and carrying, pushing and pulling, bending, stooping, remembering, concentrating, making decisions, etc. Those are all job functions. Capacity is the measurement of where your limits are.
Where does the RFC come from? The residual function capacity (RFC) comes out of the medical records. While a decision maker can take your testimony or statements into account, your statements must be supported by objective medical evidence. What is most helpful is when your doctor will complete a form that defines your RFC. This is why I ask my client's doctors to complete a form that states, Mr. X can lift so many pounds, stand or walk for so many minutes, etc. If your doctor does not complete an RFC form, the judge or other decision maker at Social Security will develop their own RFC. That can cause problems.
What are the terms Social Security will use to put limits on my functional capacity? Social Security will use terms such as:
- Constant - There are no limitations on this ability.
- Frequent - This function can be performed up to two-thirds of an 8-hour workday.
- Occasional - This function can be performed from very little up to one-third of a workday.
- Never - This function can never be performed and must be avoided.
One of the best things a claimant can do before a disability hearing is to scour the medical records to develop a proper set of qualifying limitations of his/her functional abilities. For example:
- I would be limited to lifting and carrying no more than ___ pounds based on records from Dr. A.
- I would be unable to sit more than 1 hour at a time or 3 hours in an 8-hour workday, based on records from Dr. B.
- I can only occasionally stoop, kneel, crouch and crawl, based on my medical impairments treated by Dr. C.
- I would never be able to climb, operate machinery, or be exposed to unprotected heights, based on conditions treated by Dr. D.
- Dr. D and Dr. E both say that I would be absent more than 2 days per month because of ----------------.
Frankly, this is the type of thing I do all day, nearly everyday. I scour medical records to justify functional limitations that prove my client is not able to perform past relevant work, or any other work. When I get paid a fee, it is not because I went to a 45-minute hearing with my client. Rather, it is because I spent hour upon hour reading the medical files to find objective medical evidence that proves that my client has a limited residual function capacity (RFC). Without that limited RFC, you do not have a disability case.
When Social Security denies a disability claim you must request a hearing before a US administrative law judge (ALJ). Here are a few critical things you must know about the hearing process if you are to win your disability benefits.
The ALJ will deal only in facts. If it is not in your medical record, it did not happen.
The ALJ will need specifics. Generalities will not suffice. Avoid terms like "not very often, not very much, every now and then, or a whole lot." You will need to provide answers in terms of minutes, hours, yards, feet, pounds, etc.
Winning requires a limited residual functional capacity. A residual functional capacity (RFC) is the most you are able to do in terms of work-like activities, such as sitting, standing, walking, lifting, bending, concentrating, staying on task, etc. The RFC must come from the medical records. You need to provide evidence that will help the judge develop a properly limited RFC, or else you may lose your case. (This is so important that I plan to write a separate post just on the RFC itself).
The burden of proof is on you until you reach Step 5. In parts 1-4 of the sequential evaluation process, Social Security does not have to prove anything. They assume you are NOT disabled unless you can prove otherwise. They do not have to prove that you are not working now. They do not have to prove that you do not have a severe impairment. They do not have to prove that you don't meet a Listing. They don't have to prove that you can perform some of your past relevant work. The burden of proof with all these facts rests with you, the claimant. Failing to establish proof will lose the case.
The Burden of proof shifts at Step 5. At the last part of the hearing, "Step 5," the burden of proof shifts, at least partially, from the claimant to Social Security. In this final consideration, Social Security must prove that there exists a significant number of jobs in the US economy that you could perform, considering your age, education, residual functional capacity and previous relevant work experience. They will attempt to prove this using testimony from a vocational expert. Unless you can challenge the testimony of the vocational expert there is a high probability that you will lose your case.
Social Security Hearings are Technical and Complex. They are legal proceedings. The claimant is the only participant in the hearing who is not a trained professional. You will be dealing with alleged onset date, significant gainful activity, residual functional capacity, listings from Appendix I, medical-vocational guidelines from Appendix II and many other technical issues from the Social Security rules and regulations. Most claimants will need help to protect their own best interests during these hearings.
Don't be misled by the statement that these hearings are "informal" or "semi-formal." All this means is that Social Security will not have an attorney arguing against you. However, the administrative law judge has a law degree. The vocational witness usually has a masters or doctorate degree. If there is a medical expert present, he or she will have an MD degree and a license to practice medicine. Why would you not want an advocate who argues your side of things?
When you file a Social Security disability claim or file an appeal on a denied claim, it is vital that you focus on the key issue. The key issue is "Why I am disabled."
The Social Security Act does not concern itself with the question "Why I Can't Get a Job." One is a disability issue; the other is an employment issue.
A disability claim must focus on severe functional limitations that can be proven with medical evidence. By "functional limitations," I mean the inability to perform one or more work-related activities. Functional limitations may be divided into two broad categories, and I have given a few examples for illustration:
Exertional Limitations
- I cannot lift and carry more than 10 pounds.
- I cannot walk more than 25 yards without resting.
- I can't use my upper extremities to push/pull.
Non-exertional Limitations
- I have a severe hearing disorder.
- I am unable to remember, understand or carry out simple instructions.
- I am not able to focus or concentrate long enough to do work activities.
Too often, disability claimants get side tracked into non-productive areas like, "No one will hire me because...." This line of thought will never prove successful in Social Security disability applications or appeals. The correct approach would be, "I am not able to work because..." Those may sound like very subtle differences but to Social Security decision makers, they are huge differences.
