How Does A Social Security Disability Examiner Determine a Person's Functional Limitations?

Social Security Disability examiners must make a medical determination that involves ascertaining an individual's 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 individual's health, they have to get information about how the person's 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 individual's impairment affected their work performance.

For instance, did the disabled individual's 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 individual's 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 person's 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.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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