Social
Security disability is awarded base on a claimant's limited ability to
function. It is not awarded based on diseases, but on functional
limitations.
The
primary way Social Security evaluates your functional ability is by a
detailed questionnaire that they refer to as "the ADL (Activities of
Daily Living) questionnaire. The official name of the document is the
"Function Report."
The Function Report is an 9-page document with Sections A-D and it contains approximately 60 questions.
I
understand the temptation to ignore this form (just not bother with it)
or to fly through it quickly because you feel it is a waste of time.
This is a crucial mistake. You should spend a lot of time with this
form. In fact, this form should be your constant companion for a couple
of days until it is completed lovingly, comprehensively, thoughtfully
and very, very completely.
The Function Report will ask you things like:
- Do you cook your own food? How long does it take you? What do you cook?
- Do you spend time with others?
- What are your hobbies? How often do you do them?
- Do you go places on a regular basis?
- When you go out, how do you travel?
- Do you get along well with others?
- Do you need help caring for others or pets?
- Do you need help with bathing, getting dressed, or feeding yourself?
- How do your illnesses, injuries conditions affect your sleep?
- Are there things you used to do that your disability now stops you from doing?
Social
Security will use your answers to these questions to determine (a) how
your illness or injury affects your activities of daily living, and (b)
are your allegations of symptoms consistent and credible.
If
your application is denied (about 70% will be), the judge who hearings
your appeal with use this same Function Report to evaluate consistencies
in your symptoms and the credibility of your complaints. This Function
Report literally stays with you from the day your file your claim until
the appeal is decided, perhaps 24 months later in some cases.
If
you are unable to understand or complete the Function Report in loving,
comprehensive detail--get someone who can help you: a relative, your
pastor, a friend, etc. If you are represented by an attorney or
advocate, he/she will understand this form and help you complete it
correctly. But for heavens sake, do not ignore the form or (just as
bad) fly through it checking boxes just to say you finished it. (That's
how I used to do my homework, with equally dismal results, I might
add).
There are 2 types of medical evidence in a disability claim: objective medical evidence and opinion medical evidence.
Objective medical evidence consists of things like X-rays, laboratory tests, MRIs or CAT scans. These are found in your doctor's records.
Opinion evidence is quite different. Opinion evidence is where your doctor or professional renders an opinion on how your medical condition affects your ability to perform certain functions.
For example, an MRI may show that you have 2 herniated discs in your lumbar spine. This is objective evidence. It is what it is. The doctor may then give an opinion as to how long you can sit, stand or walk. That is opinion evidence. If your doctor states: "The patient would be limited to lifting no more than 10 pounds occasionally, sitting no longer than 30 minutes, standing no longer than 15 minutes at a time, or walking no more than 300 feet," that is opinion evidence.
Opinion evidence is used to form "residual functional capacities," that is, what is the most work like activity that an individual can perform on a sustained basis? This will be use by decision makers to determine what type of jobs, if any, the claimant would be able to perform. This, in turn, will determine whether the claimant meets the rules for Social Security disability benefits.
We should note here that broad, general conclusions by doctors are not useful. For example, the statement, "It is my opinion that this patient is not able to perform any type of work and is totally disabled," is not useful. This conclusion is reserved solely to the Commissioner of Social Security under the federal regulations (20 CFR 404.1527(d); SSR 06-03(p); SSR 96-6(p), etc.).
A doctor's statement that addresses the patient's ability to sit,stand, walk, lift, carry, push, pull, concentrate, make decisions or perform other specific work related functions can be very useful opinion evidence.
5 THINGS THAT WILL WIN SOCIAL SECURITY DISABILITY BENEFITS:
1) Admissible objective medical evidence from acceptable medical sources.
2) Admissible opinion evidence from acceptable medical sources.
3) Proper use of the Medical-Vocational Guidelines from 20 CFR 404, Subpart P, Appendix II, the "Grid Rules."
4) Elimination of the potential for past relevant work, considering the most recent 15 years of your work history.
5) Elimination of the potential for "other work" as it exists in the national labor force.
Winning Social Security disability cases involves strategic use of combined medical and vocational evidence. A claimant cannot just submit his medical records, tell his story and trust to luck that he will be approved. Not with the average national award rate at 42 percent.
