As an attorney who limits his practice to representing those individuals seeking Social Security Disability Benefits and Supplemental Security Income, I recognize that there are many common misunderstandings as to exactly how the Social Security system works. My clients often ask me exactly what type of medical evidence is needed to help prove a disability claim. Often they will show me a letter or medical record from a doctor stating that they are "100% disabled" or "permanently and totally disabled," and they can't understand why the Social Security Administration keeps turning them down for benefits.
Just how can you prove that you are entitled to Social Security Disability benefits?
The claimant (person seeking disability status) must produce medical evidence from an acceptable medical source that shows they meet the Social Security Administration's definition of disability. The Administration's definition of disability is that a person be "unable to engage in substantial activity because of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of at least 12 months."
To evaluate whether or not the claimant meets this definition, the Social Security Administration has developed a 5-Step sequential evaluation process. Though an in-depth discussion of the 5 steps is beyond the scope of this article, I would like to talk about 2 vital elements of the sequence that all your medical evidence should address:
- medical signs and findings and
- your residual functional capacity (RFC).
Making sure your medical reports address these two elements will assist you a great deal in proving your claim for benefits.
Medical signs and findings - what are they?
Medical signs are things such as tenderness, swelling, muscle loss, reflex changes, reduced range of motion, and sensory loss in the instance of a musculoskeletal impairment or injury. Findings, more aptly called clinical findings, are those signs which are clinically confirmed through tests. Examples include an MRI or myelogram showing a herniated disc, a nerve study showing carpel tunnel syndrome, or even a simple tape measure showing muscle loss in a limb.
Sometimes a person can be found disabled based on meeting listed criteria for medical signs and findings alone. Under the Social Security Law this is known as the "Listings" and occurs at Step 3 of the evaluation process. It is, therefore, vital that the treating physician detail the medical signs and findings in all medical reports. A well-meaning physician may conclude in the medical report that the patient is "permanently and totally disabled", but fail to detail the signs of the disability in a manner that meets the Social Security Administration's listed criteria. Medical evidence must also address one's residual functional capacity (RFC). The RFC is simply a statement from the physician concerning what a person can and cannot do. Elements entering into consideration for RFC might be one's ability to sit down, stand up, stoop, bend and walk. Lifting and carrying abilities must also be addressed.
Once a doctor determines the residual functional capacity of the patient, I compare it to the person's past work and to other jobs under Social Security Law. This comparison process comprises Steps 4 and 5 of the evaluation process and can be quite complicated. Many doctors and claimants will show me medical records that show the claimant has a 10%, 25% or even 100% disability rating of the whole person. However, since this percentage-type rating is not based on the Social Security Administration guidelines (which are based on residual functional capacity), it is of limited value in proving disability.
In my practice I have developed specialized forms that deal with a person's RFC, and I usually provide these forms to a client's physician and ask the doctor to complete them. I realize that many physicians who are accustomed to percentage ratings for personal injury matters question the relevance of such forms; however, we have found that these forms are the very foundation upon which a Social Security Disability case can be built.
If you are seeking disability benefits, you can assist your physician in developing medical evidence that addresses your medical signs and findings and residual functional capacity. Be sure to inform your physician about all of your symptoms and give your physician examples of how your activities are limited to assist him in preparing reports for your claim. As an attorney, when I am able to obtain medical evidence that addresses these two vital elements, we take a giant leap toward proving a disability case and obtaining a successful result.