Social Security is a long-term disability program. The individual must have a disabling impairment or combination of impairments that has lasted or is expected to last 12 months or which can be expected to result in death.
Social Security is a total disability program. Unlike the Worker's Compensation system, there is no partial disability or percentage disability. For Social Security purposes an individual is either disabled or not disabled.
The concept of disability is based on the ability to engage in full-time work. Thus, if a person can work 20 hours per week but no more, she would be considered disabled. Additionally, the individual must be able to work in a typical work setting -- such settings do not allow for a person to lie down on occasion during the day, to take frequent or long breaks, or to have other unusual accommodations. The legal requirements of the Americans with Disabilities Act (specifically, those requiring work-place accommodations for people with disabilities) are not considered in determining whether an individual is disabled.
Once a medical impairment has been established, the restrictions in functioning must be determined. Among other things, Social Security will consider the statements of the individual in determining the severity of the symptoms and the degree of functional restriction (e.g., the patient states he cannot stand or walk more than 20 minutes due to low back pain).
The opinion of the treating physician will be given the greatest weight in determining the patient's functional restrictions, provided the opinion is supported. In addition to addressing the medical conditions of the patient, the physician's opinion should include her opinion regarding the functional restrictions caused by the conditions. Conclusory statements such as "Mr. X is disabled by his arthritis" will be given little, if any, consideration.
It is essential that the physician rendering the opinion provide the medical basis for the opinion: reference should be made to the signs and findings supporting the diagnoses; whether the impairments could reasonably be expected to produce the type of symptoms experienced; and, if the symptoms and resulting limitations are greater than what may be expected from the objective findings alone, whether the patients statements about the intensity, persistence and limiting effects of the symptoms are credible. In forming an opinion regarding the functional limitations of the patient, the physician should consider the statements of the patient to the extent the physician believes these statements are credible and the symptoms/restrictions claimed by the patient are of the type which could be caused by the diagnosed condition(s).
1. Does the severity of the individual's medical condition meet the requirements of any impairment listed in the Listing of Impairments (commonly referred to as the "Listings"); if not,
2. What is the individual's "residual functional capacity" (RFC) and, based on that RFC, does the individual have the ability to meet the physical and mental demands of any job he has performed in the past 15 years or any other type of unskilled work. For individual's over age 50, limitations to sedentary or light work may be considered disabling (see below).
The Listing section governing chronic liver disease is included in these materials. The requirements of this particular listing are dependent on medical findings and not the functional effects of the medical condition on the individual.
If the individual's condition does not meet the criteria of any Listing section, then Social Security goes on to consider the individual's RFC.
Once medical impairments are established, the most important evidence in a disability determination can be the treating physician's opinion about the individual's functional capacity. The functional capacity is best expressed in the following terms:
Standing: How long can an individual stand at a single time, and how long in total time over the course of the day.
Walking: How long or how far can an individual walk at a single time and total over the course of an eight hour work day. (Standing and walking can often be combined - though the distinction can be important.)
Sitting: How long can an individual sit at a single time and how long total over the course of the day. This is measuring sitting as required in a typical workplace. If the individual must sit with feet elevated, needs to lean on the arm of a chair or sit in a reclining chair, the capacity for this type of sitting should not be considered in the sitting tolerance or should be specifically noted.
Lifting: The maximum weight a person can frequently lift ("frequently" is defined as up to 2/3 of the day) and the maximum weight a person can occasionally lift (up to 1/3 of the day).
Other limitations: Should be stated as they apply. (E.g., no lifting of any weight above shoulder level, bending should be limited to no more than 1 or 2 times per day, etc.).
Other limitations that generally preclude work: Certain limitations if present, will generally preclude any type of work. These may include the need to lie down during the day, the need to take frequent or long breaks (e.g., use of the bathroom for 15 minutes at a time, several times during the day), the need to use a crutch for any walking, or the need to have frequent absences from work that would exceed the amount of time typically available for sick and vacation leave.
Social Security, in formulating its finding on the individual's functional capacity, should take into account the claimant's statements regarding the intensity, persistence and limiting effects of her symptoms, provided, of course, the statements are credible and could be caused by the diagnosed impairments. Social Security recognizes that pain and other symptoms are very subjective and what may be severe and disabling pain to one person, may not be to another. This is why Social Security requires proof of an impairment that could cause the type of pain or other symptom of which the claimant complains. The persistence and intensity of the symptoms are determined based on the statements of the claimant and third parties, and treating and examining doctors. The physicians' opinions should not be based solely on the laboratory findings and a generic set of limitations associated with the degree of impairment shown in such findings. Unfortunately, many physicians do base their opinions only on the "objective" findings and do not consider the claimant's descriptions of the severity of the symptoms. This is particularly true of doctors who examine the claimant on behalf of Social Security.
Social Security characterizes work as sedentary, light, medium and heavy. The simplified definitions are as follows:
Sedentary: Requires the ability to sit up to six hours in an eight hour work day, lift light objects such as files and paperwork frequently during the day, and objects weighing up to 10 pounds occasionally during the day.
Light: Requires the ability to stand up to six hours in an eight hour work day, lift up to 10 pounds frequently and up to 20 pounds occasionally.
Medium: Requires the ability to stand up to six hours in an eight hour work day, lift up to 25 pounds frequently and 50 pounds occasionally.
Heavy: Same standing as light and medium, lifting heavier than medium.
Once an individual's RFC is established, Social Security will then determine if the person can perform any work. If the person has an RFC compatible with any level of work, depending on the person's age, he or she may be determined to be not disabled. If non-exertional impairments are involved, additional vocational factors will be considered.
Although the following is simplified, and applies only to those claimants whose disability is physical and affects their exertional capacities, it is relatively accurate in most situations.
1. Ages 50 - 55: If the individual is limited to a sedentary RFC (i.e., cannot perform light or medium work) he is disabled unless he has a history in the last 15 years of performing a sedentary job.
2. Ages 55 - 65: If the individual is limited to a sedentary or light RFC, he is disabled unless he has work history in the last 15 years of performing a sedentary or light job.
Issues which are relevant include whether the person would reliably make it to work each day; be able to interact appropriately with co-workers, supervisors, and the public; maintain concentration and memory sufficient to perform simple, unskilled work; exercise appropriate judgment in a work setting; and follow through and complete tasks in a timely manner.
There is no specific RFC for mental impairments that translates into a finding of disability except to the extent the criteria of a specific Listing are satisfied. If the case is not a "Listing level" case, then the determination of disability is based on the severity of the symptoms and interference with work that would result. For example, a person may be found disabled despite the fact his mental impairment does not interfere with his ability to reliably get to work, remember how to perform the functions of work or complete work tasks in a timely manner, but it does cause him to loose his temper and behave aggressively with little or no provocation.