Proving Functional Limitations and why this is Important on a Disability Case

You're not likely to hear the term "functional limitation" when you file a disability claim at the social security office. And even if you later speak to a disability examiner over the phone (examiners often contact claimants to ask them about their medical treatment, past jobs, and normal activities of daily living, or ADLs), the term probably won't make it into the conversation. However, functional limitations are a huge part of the Social Security Disability and SSI evaluation process.

What is a functional limitation?

The phrase "Functional limitation" is another way of what you are not able to do any longer because of your medical impairment. Functional limitations can be physical or mental and they are simply any way in which your condition has limited you. A disability examiner, or Administrative law judge for a hearing, will be paying attention to your medical record evidence to determine 1. how you are limited and 2. how your limitations reduce your ability to work.

Physical and Mental limitations

For a physical condition, a person could have ambulatory limitations that restrict how long they can stand, or walk, or sit, or move around. Back conditions and osteoarthritic conditions often have such effects. Physical limitations can also include a reduced ability to see, hear, feel, smell, balance, tolerate heights, pick up objects, and engage in physical movements such as bending over or crouching down. To use another example, for individuals with shoulder problems raising an arm up to a certain level to open a cabinet can present a problem.

For a mental condition, a person might have reduced cognition, meaning less of an ability to comprehend. Or they might have an impaired ability to remember new information, recall old information, or pay attention, or concentrate. Disability claims based on mental conditions include organic brain conditions and injuries such as closed head injuries and TBI (traumatic brain injury).

They also include varying degrees of mental retardation, anxiety-related conditions (such as panic attacks and agoraphobia), and affective disorders such as depression and bipolar disorder. And, of course, all of these conditions generally have the effect of limiting an individual in some fashion due to their effects.

Functional limitations often have the effect of inhibiting the things that a person can, on a daily basis, do. This is exactly why the social security administration will ask a claimant about their normal daily routine, and will often contact whoever the claimant listed as their third-party contact person (usually a friend, neighbor, or relative) to ask that individual about their daily activities.

By asking whether or not a claimant has difficulty putting on clothes, or preparing meals, or making shopping lists, or using a vaccuum cleaner, a disability examiner who is trying to evaluate a case can get a better idea of A) what limitations a person has and B) how pervasive those limitations are.

A disability examiner will use a combination of the medical evidence and questionaires, as well as over-the-phone interviews, to get a better picture of a claimant's functional limitations. Phone calls and questionaires might not be so necessary; however, they are used as an information technique because medical records normally say very little about what a person can, and cannot, do. This is understandable because doctors simply record measurements, diagnoses, and the most basic facts in their records and are not in the habit of commenting as to physical or mental function and capability.

After a disability examiner has reviewed the medical records and has gotten an idea of how the claimant is physically and/or mental limited, this will be reflected on an RFC, or residual functional capacity, form. This form is mainly a check-off style form that indicates the claimant's limitations. It gets specific enough to indicate how much the claimant can lift on a regular basis, whether or not the claimant has difficulty with memory or comprehension and to what degree, and so forth.

The disability examiner completes the RFC form, or MRFC form (mental residual functional capacity form) if the impairment is of a mental nature, and then the examiner has a short consultation with a medical doctor or a psychologist who is attached to his case unit. This is done to ensure that the examiner does not misinterpret the medical evidence and to lend validity to the examiner's decision since the examiner is not a doctor or psychologist and, in actuality, has no real medical training.

How does rating a person's limitations on an RFC or MRFC form help a decision on a disability case get made? By determining just how limited a claimant is as a result of their condition, a disability examiner can then compare this to the demands of the claimant's relevant past jobs (for the most part, the jobs they have done in the fifteen year period prior to becoming disabled).

This is done to see if the claimant might still possess the ability to go back to their last job, or go back to some other prior job. If it is determined that the claimant cannot return to a past job, then the process advances to the next step, which means the examiner will try to determine if the claimant has enough education and work skills to switch to some new type of employment.

The more education a person has, and the higher their level of skills, the more likely they are to be denied on the basis they can do other work, even if it is decided that they cannot go back to their old job.

In this type of scenario, it certainly helps a person's case by making sure that the disability examiner is fully aware of all of the claimant's functional limitations, as well as the degree to which they exist. Because the more severe a person's limitations are, the more likely it will be that they will be found to be unable to go back to a past job, but also unable to switch to some new form of work.

For these reasons, a claimant should never minimize their complaints or their symptoms. If they are sent to a consultative medical exam by social security, they should not attempt to play down their condition (believe it or not, some individuals do this because they do not want to be perceived as trying to exaggerate their condition).

Also, when the time comes, a claimant whose case is scheduled to be heard at a hearing by a judge may want to review their own records to see how their doctor has commented in their records about their condition (and it may be the case that the doctor has said nothing, but has only recorded the most basic office notes).

At that point, if the claimant has a disability attorney and the attorney is considering obtaining a medical source statement from the doctor (which is basically an RFC form), the claimant may wish to personally take this form to their doctor and speak candidly about their case as many doctors do not realize how important it is for the social security administration to have a clear idea of their various limitations (in order for a case to be approved and for a disability benefit award to be made).

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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