Will Your Claim for Disability be Handled Differently if it is Based on a Physical or Mental Problem?

The answer to this question is yes and no. When we say "no", we mean that the Social security evaluation process used by a disability examiner or a federal administrative law judge will be the same regardless of the condition, or conditions, that your disability claim is being filed for.

When we say "yes", however, we mean that one of the following scenarios will apply:

If the claim involves one or more physical impairments

If your claim is being based on a physical impairment or disorder, then the disability examiner (examiners make decisions when the case is at the level of a reconsideration request, which is the first appeal, or the level of an application for disability) will, after reading and evaluating your medical evidence, consult with a medical doctor who is part of the examiner's case processing unit.

This physician, who is a medical consultant, will also read the same medical records as the examiner and then issue a rating of your functional limitations. This rating is an assessment of your residual functional capacity.

Residual functional capacity is another way of saying "what you are still capable of doing. And this is why an RFC form that is completed by the DDS doctor will indicate how long a person can sit or stand, how much they can lift frequently or ocassionally, as well as indicate whether or not they can crouch, bend, or reach overhead. All of this, of course is a small sampling of the areas that are covered by an RFC assessment; other areas will include the individual's ability to see, hear, smell, balance, and so on.

How a person's limitations are rated on an RFC (residual functional capacity) form will be used by the disability examiner to decide whether or not they can go back to a job that they used to do, or perform some new type of work that relies on their skills and education (and which is not ruled out by their age and functional capabilities).

In cases involving physical impairments, it is also often the case that the claimant will be required to go to a social security medical examination. These exams are known as consultative exams, or CE for short. When a CE is conducted, it is done by an independent physician and, usually, the exam will be little more than a general physical, lasting perhaps ten to fifteen minutes.

If the claim involves one or more mental impairments

If your claim is based at least in part on one or more mental impairments (see Social Security Disability, SSI, Mental Disorders, and Functional Limitations) then everything that was previously mentioned may still apply but with a few differences. After reading and evaluating the medical records, the disability examiner will speak with the other consultant who is part of his case processing unit. This individual will be a psychologist, and, accordingly, this consultant, will use an MRFC (mental residual functional capacity) form to assess how functionally limited you are based on your mental condition (or conditions if you have several, which is often the case).

Just as with a claim based on a physical impairment, the disability examiner may decide to schedule you for a mental consultative exam. This, however, is where things become significantly different. Physical consultative exams are largely conducted simply so that the examiner may obtain some recent medical evidence and then close the case. And, not surpisingly, physical consultative exams tend to be quick. They also seldom have any great effect on the outcome of a Social Security Disability or SSI claim.

Mental consultative exams are different. A mental CE is often a full-fledged psychiatric exam and the information it provides is more detailed. The exam itself takes more time and is more involved. Other types of mental examinations include memory scales, which are designed to test one's memory if memory deficits are part of the claim. Claimants are also often sent to psychological testing, which is another way of saying IQ testing.

Will the results of mental testing have more of an impact on the outcome of a case than a physical consultative exam? Not always, but certainly the potential is there simply because mental testing tends to produce more substantial and detailed information.

To sum up, cases that are filed on the basis of either physical impairments or mental impairments are handled in the same manner. And it is very common for cases to involve a combination of both physical and mental impairments. The only real difference in approaching how to evaluate a mental or physical impairment has to do with A) what types of examinations a claimant may be sent to and B) which unit consultant the disability examiner may need to speak to after reading the medical records.

Related: What can I expect from a Social Security Mental Examination or Evaluation?

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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