In Social Security Disability and SSI claims, the main focus almost always is proving the Claimant's residual functional capacity (RFC) is such that he or she qualifies for disability under the Social Security Administration's regulations. Last week, I discussed showing limitations through lay testimony and this week the focus will be on proving a claimant's RFC through medical or other evidence.
Treating or examining physicians are generally afforded greater weight, but it depends on certain factors. It is useful to get information about the physicians' specializations and qualifications.
Consider sending RFC assessments or source statements to treating physicians. Watch out for vague or undefined terms such as prolonged, long, etc. If utilizing an assessment, use terms familiar to the SSA. If you cannot obtain an assessment, see if the claimant's physicians will at least write a letter describing the impairments in relation to engaging in full-time employment. PCPs are usually most willing to do this. A short paragraph of two from a treating physician can lend a lot of credibility to the testimony of the claimant. Keep in mind SSR 96-5p provides that medical statements stating that a claimant is disabled, unable to work, permanently and totally disabled, or unable to return to past work are administrative findings reserved to the Commissioner. At the very least, if the claimant uses an assistive device such as a cane, have the provider write on a prescription pad that the device is medically necessary.
If a physician refuses to complete an assessment because he "is not a disability doctor", ask the physician if he would adopt the findings of an FCE and then consider sending the client to an FCE with a trusted physical therapist.
Was there a workers' compensation case? If so, there will be medical and vocational evidence such as out-of-work slips, IME's, vocational evaluations, depositions detailing restrictions, and/or functional capacity evaluations (FCE's).
If the worker is a veteran and has been to the VA for medical treatment, be sure to order all of those medical records. Additionally, if VA has granted service-connected disability, get the rating decision.
Is the claimant receiving long-term disability? Physicians and employers will have to fill out restriction forms in order for an employee to qualify for long-term disability.
A last option would be an IME paid for by the claimant.