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How Does A Social Security Disability Examiner Determine a Personís Functional Limitations?

Social Security disability examiners must make a medical determination that involves ascertaining an individualís currently level of physical and/or mental functioning. Since disability claims are largely determined on the basis of what a person is no longer capable of doing (i.e. work activity), this really means determining the individual's functional limitations.

Functional limitations, from the standpoint of the Social Security Administration, may be exertional, such as the ability or inability to sit, stand, lift, or carry. They may also be non-exertional and involve the degree to which a person can, or cannot, reach, bend, hear, see, smell, concentrate, remember, interact with other individuals in a work setting, etc.

Determining a claimant's functional limitations is crucial to the outcome of a disability case because if a case is not approved on the basis of a Social Security Disability listing (the majority of cases are not), then the only means of approving a disability claim will be to determine that the claimant has funtional limitations that:

A) rule out their ability to do their past work and

B) contribute to an overall medical-vocational profile that makes it impossible for the individual to switch to some type of other work.

How does a disability examiner determine a claimant's functional limitations?

Disability examiners begin the process by requesting medical treatment records from all the medical sources provided by the person at their disability interview (conducted by a CR, or claims representative, at a Social Security office).

When filing for disability, claimants do not have to provide their actual medical records themselves (though it is possible for a claimant to personally deliver their medical records at the time of application--which can have the effect of speeding up the disability case) just the names of their treating medical sources, i.e. the various clinics, hospitals, and doctor's offices where they have received treatment.

This is because medical records are paid for by the state disability agency that makes disability claim decisions for the social security administration. This agency is known in most states as DDS, or disability determination services.

It is at DDS that a person's case is assigned to a disability examiner. Typically, the very first action performed on a case will be for the examiner to request the claimant's medical records.

Note: This is why it is crucial for a claimant to supply a detailed list of their medical treatment sources, to enable the examiner to obtain the records quickly but also to ensure that the examiner actually can obtain the records (correct names and addresses of treatment sources is vital).

The examiner will need to obtain current medical records to document that the claimant is presently disabled, but will also need to obtain older medical records to verify the claimant's onset date which can impact how much the claimant may receive in disability back pay.

Once the disability examiner reviews the disability claim file, they can determine if there seems to be enough medical information to make their disability determination.

Note: Medical records must include medical records that are not more than ninety days old in order for the disability examiner to make a decision.

Not only does the disability examiner have to get medical information about the state of an individualís health, they have to get information about how the personís ability to perform routine activities of daily living (including work activity) is affected by their disabling condition or conditions.

They get this kind of information from questionnaires provided to the disability applicant and their third party contact person (this person is provided by the applicant at the time of application), or through phone contact with the disability applicant and/or their third party person. They may even contact past employers to garner information about how an individualís impairment affected their work performance.

For instance, did the disabled individualís employer give them special considerations that helped them keep their employment (i.e. rest periods, more time off, less expectation with regard to production, etc). Or did their employer have to terminate their employment because of the limitations their disability imposed upon them.

There are many ways a disability examiner can determine an individualís state of health and their residual functional capacity. If the disability examiner determines that their residual functional capacity is so restrictive that is not only prevents the performance of any of the personís past work but also rules out the ability to perform any other type of work, the person may be approved to receive disability benefits from Social Security.

  • What medical conditions will get you approved for disability?

  • What kind of Mental Problems Qualify for Disability?

  • Which conditions will social security recognize as a disability?

  • Tips for getting Social Security Disability or SSI benefits approved

  • SSDRC Homepage:

    Social Security Disability and SSI Resource Center

    The Most Basic questions about Getting Disability Benefits

    Social Security Disability SSI and whether or not you can work

    Common Mistakes to avoid after being denied for Disability

    Social Security Disability SSI Questions and Answers

    More Social Security Disability SSI Questions and Answers

    Common Questions about Social Security Disability and SSI

    Winning Social Security Disability or SSI Benefits

    The SSI Disability Benefits Program

    Social Security Disability SSI and Doctors - Yours and Theirs

    Social Security Disability and SSI Claim Reviews

    Social Security Disability SSI System and Benefits for Children

    Denials, Appeals, and Getting a Disability Lawyer or Representative

    What you should know about Social Security Disability and SSI Denials

    Questions about Disability Lawyers and Hiring a Disability Attorney

    Various Types of Benefits including SSI, Mental, and Child benefits

    Social Security and SSI based on Mental Disability

    Social Security Disability or SSI Benefits for Children

    Disability Benefits through Social Security

    Filing for Social Security Disability or SSI Benefits

    Social Security Disability SSI: Medical Evidence and Records

    Filing your claim for disability benefits

    Eligibility for receiving disability benefits

    Resources on this site

    Social Security Disability, SSI Terms and Definitions

    Previously answered questions regarding SSD and SSI

    The SSDRC Disability Blog

    For Individuals living in North Carolina

    Disability in North Carolina

    North Carolina Disability Lawyer

    Getting disability in North Carolina

    Related pages:

    Denied Social Security disability Appeal
    Getting Disability and Trying to work
    How many times can I appeal my Social Security Disability or SSI?
    How Does A Social Security Disability Examiner Determine a Personís Functional Limitations?
    How does Social Security determine if I am disabled or not?
    How are medical records and work history used to determine a social security disability claim?
    How will Social Security Determine if you get Disability Benefits?
    If I die on Social Security Disability, will my wife receive anything?
    How much will it cost to hire a disability attorney in Pennsylvania?
    Why does it take so long to get a decision on a disability case in Pennsylvania?

    Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

    Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI

    These pages answer some of the most basic questions for individuals who are considering filing a claim.

    Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
    How to Apply for Disability - What medical conditions can you apply and qualify for?
    Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
    What happens if I file a disability application and it is denied by a disability examiner or Judge?
    How to Prove you are disabled and qualify to win disability benefits
    How do you prove your disability case if you have a mental condition or impairment?
    Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
    Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria