What is Residual Functional Capacity (RFC)?

As a Louisiana Social Security disability lawyer, I know one of the most important concepts in evaluating disability claims is Residual Functional Capacity (RFC) also referred to as Residual Functionality.The code of federal regulations describes residual functional capacity as follows:

Your residual functional capacity is the most you can still do despite your limitations.” 20 CFR 404.1545; 20 CFR 416.945.

Your case is not about a diagnosis.

People will talk about how long they have had the diagnosis, what medications they take or have tried, and how they know someone else with the same diagnosis who gets disability.

For most, this misses the point.

While a diagnosis is important, a diagnosis in and of itself will not support your disability.

The diagnosis is the starting point.

The focus of your case is establishing the limitations specifically caused by your medical diagnosis or treatment.

Limitations can range from slight – have to pause slightly when standing up from sitting too long – to more severe – have to lie down most of the day due to pain and medication side effects.

What is Residual Functional Capacity?

Residual Functional Capacity is an evaluation of your remaining ability to do things (work) after taking into account all of the limitations your severe medical conditions cause you.

Think of it as “How much can you do & for how long?”.

What is your ability to work?

The Social Security Administration will look at how your medical condition(s) has affected your ability to exert yourself physically for work-related tasks. These are things like:

• How long can you sit?
• How long can you stand?
• How long can you walk?
• Exert yourself physically for various work-related activities (such as sitting, standing, walking, lifting, carrying, pushing, pulling).
• Can you do manipulative and postural activities (such as reaching, handling large objects, using your fingers, feeling, climbing stairs or ladders, kneeling, crouching, crawling)?
• Can you stoop?
• Can you balance?
• Can you tolerate certain environmental conditions (such as high or low temperature extremes, wetness, humidity, noise, dust, fumes, odors, gases, poor ventilation, vibrations)?
• Can you work in hazardous working conditions like around or with machinery?
• Can you work at heights without any protection?
• Do you have any problems seeing, hearing, and speaking?

These are things from a physical perspective.

Your RFC encompasses your mental faculties as well.

• Can you maintain concentration and attention at work for extended periods of time?
• Can you understand and remember instructions and carry out your duties throughout the day and from day to day?
• Can you get along with people in your workplace or the general public?
• Can you cope with changes in the work setting?
• Can you respond appropriately to supervisors, co-workers, and usual work situations?

For example, let’s assume you have chronic back pain and take narcotic pain medications for treatment. Your doctor has told you that the most you can lift is 20 pounds occasionally and less than 10 pounds frequently. Assume further, as a result of the medication you take to treat your back pain, you experience drowsiness, fatigue and should not operate heavy machinery. You also cannot sit for longer than 1 hour at a time or stand for longer than 30 minutes before you need to rest.

Knowing these limitations, what can you do?

• You can lift 20 pounds occasionally and 10 pounds frequently.
• You can sit for up to 1 hour.
• You can stand for up to 30 minutes at a time.
• You cannot operate heavy machinery.
• Can you do anything else?
• Are you limited in other ways?

There are a number of other factors that should go into your residual functionality, but these are not always clearly explained in the medical records.

When these other factors are not clearly explained in your medical records, Social Security may find that you can perform these tasks.

Some factors that should be considered are the ability to twist, bend, stoop, reach, grasp, handle/finger, kneel, crawl, and climb.

Additionally, other non-exertional factors can play a role in establishing your residual functionality as well. These factors can include things such as the ability to follow directions, maintain concentration, pace, and persistence, ability to get along with co-workers, reliability (do you show up), and a host of other issues.

Your overall residual functional capacity is your remaining physical and mental ability after taking into account your physical and mental limitations.

Oftentimes, the medical records that I review do not discuss a number of factors essential to a proper determination of your RFC.

The reason is that many of these factors are irrelevant to a doctor’s actual treatment of your medical condition.

However, they are important for Social Security Disability claims because SSA’s determination is focused on your functional ability – not your medical history.

Social Security defines residual functional capacity as sedentary, light, medium, or heavy.

If you do not meet a listing, your RFC needs to be at a certain level to qualify you for Social Security disability benefits.

Your RFC needs to prevent you from performing your past relevant work and all other types of work that exist in significant numbers. The specific RFC needed to show that you cannot perform your past relevant work or other types of work is dependent on your age, education, training, and past work history. Your case is about establishing what your limitations are and how these limitations prevent you from working your past job and/or other jobs. A thorough understanding of all of the factors that go into an RFC determination is important if you want to have the best chance of success with your SSDI claim.

Understanding the Role of Your RFC in Disability Determination

Your Residual Functional Capacity (RFC) acts as a bridge between your medical conditions and the workplace. It translates your medical restrictions into practical terms that employers and decision-makers can understand. For instance, while an average employer may not grasp the full impact of peripheral neuropathy, they will understand if it causes you to drop small objects or requires you to elevate your legs to reduce pain.

Evaluation of Past Relevant Work

Social Security begins by comparing your RFC to the demands of your past work. This involves reviewing your work history from the past five years and assessing whether your current limitations align with those job requirements. For example, if your work history includes sedentary jobs and your RFC supports sedentary work, you might be expected to return to those roles unless there are specific non-exertional restrictions, such as memory issues.

However, if your previous roles were physically demanding, like those of an auto mechanic or mail carrier, and your RFC limits you to sedentary tasks, Social Security would not expect you to return to such occupations.

Assessing Other Work Opportunities

If it’s determined that you can’t return to your past jobs, the next step is to see if you could transition to other work, given your current RFC. This evaluation considers various factors such as age, education, and skills acquired from past employment. Generally, claimants over 50 have an easier time proving they can’t switch to other jobs, while those under 50 must demonstrate an inability to perform even the least demanding jobs full-time.

By understanding these processes and effectively communicating your limitations, you can strengthen your case and improve your chances of a favorable outcome with your SSDI claim.

Assessing Your Functional Activity Level

Determining your level of functional activity is crucial for understanding your capabilities and limitations, especially if you’re evaluating your work readiness or applying for benefits. In this context, the Social Security Administration (SSA) uses something called the exertional level to frame your abilities within the workplace.

Understanding Exertional Levels

Your exertional level outlines how long you can stand and the weight you can handle, impacting your Residual Functional Capacity (RFC). It’s essentially a scale that helps classify the physical demands you can meet.

Types of Exertional Levels

1. Sedentary Work
   • Weight Handling: Limited to lifting no more than 10 pounds.
   • Activity Requirements: Primarily seated tasks with occasional walking and standing.
2. Light Work
   • Weight Handling: Lift up to 20 pounds occasionally; frequent handling of items up to 10 pounds.
   • Activity Requirements: Requires plenty of walking and standing, plus some ability to use arms and legs for pushing and pulling.
3. Medium Work
   • Weight Handling: Lift as much as 50 pounds at times and frequently manage 25-pound loads.
   • Activity Requirements: Includes the ability to do light and sedentary work tasks.
4. Heavy Work
   • Weight Handling: Capable of lifting up to 100 pounds; frequently handle loads around 50 pounds.
   • Activity Requirements: Covers tasks ranging from medium to sedentary duties.
5. Very Heavy Work
   • Weight Handling: Lifting more than 100 pounds is required, with frequent handling of 50 pounds or more.
   • Activity Requirements: Encompasses all lower exertional tasks.

An Example in Practice

Imagine you’re advised by your healthcare provider to limit walking and standing to no more than two hours daily. In this scenario, you’d likely fall under the category of sedentary work. It’s a classification that helps tailor roles to fit your abilities without causing undue strain.

By understanding these exertional levels, you can better gauge where you stand in terms of functional activity and make informed decisions about your employment capabilities and applicable benefits.

Who Determines Your Residual Functional Capacity?

Your Residual Functional Capacity (RFC) is primarily determined by a team that includes Social Security claims examiners and judges. These professionals assess your ability to work by evaluating medical evidence, but they don’t make this decision in isolation.

Medical Input

To accurately gauge your limitations, these officials rely heavily on insights from medical professionals affiliated with Social Security. These specialists, known as medical consultants, examine your medical records to understand how your health conditions might restrict your daily activities.

Role of Medical Experts

In some cases, during disability hearings, additional insights are provided by medical experts. These are doctors who present their evaluations of your file, offering essential testimony to clarify what tasks you can undertake without causing undue pain or exacerbating your condition.

Determination Process

Together, these medical professionals analyze documentation from your healthcare providers to identify the specific activities you can handle. They recommend an RFC that outlines the type of work you’re able to do, ensuring it aligns with your current health status and any documented restrictions. This collaborative assessment helps guide the claims examiner or judge in making a fair decision regarding your work capabilities.

Understanding When Your Residual Functional Capacity is Determined

The determination of your Residual Functional Capacity (RFC) is a pivotal step in the process of applying for disability benefits. This assessment evaluates what you can still do despite your impairments and plays a critical role in deciding your eligibility for benefits.

Initial Application Stage:

When you first apply for disability benefits, your RFC is evaluated by a claims examiner. These examiners are part of your state’s Disability Determination Services (DDS), an agency that collaborates closely with the Social Security Administration at the federal level. The examiner will assess your physical and mental capabilities based on the medical evidence provided.

Hearing Level Assessment:

If your claim progresses to the hearing stage, an administrative law judge will reassess your RFC. This judge operates independently within the Social Security Administration. It’s not uncommon for judges to have differing opinions from the initial DDS assessment, potentially resulting in a favorable outcome for you.

Key Points to Remember:

• Medical Evidence: Your RFC determination heavily relies on medical records and evaluations from your healthcare providers.
• Ongoing Evaluation: Each stage of the process allows for a fresh assessment, ensuring all aspects of your condition are considered.
• Appeal Options: If you disagree with the initial determination, you have the right to appeal, leading to the judge’s independent review.

This multifaceted evaluation process ensures that your RFC is accurately determined, reflecting your current functional abilities.

The Impact of a Doctor’s Treating Source Statement on Your RFC Determination

A doctor’s treating source statement can significantly influence your Residual Functional Capacity (RFC) evaluation. Here’s how:

Understanding RFC

Your RFC assessment plays a crucial role in Social Security disability claims. It evaluates your ability to perform work-related activities despite your medical condition.

The Role of a Treating Source Statement

1. Credibility and Insight:A treating source statement comes from a doctor who knows your medical history well. This statement holds weight because it reflects a detailed understanding of your condition over time.
2. Objective Evaluation:Doctors who see you regularly can provide comprehensive insights into how your health issues specifically limit your capabilities. They can highlight limitations in physical activities, mental functions, or both.
3. Detailed Documentation:A thorough statement outlines the extent of your medical conditions and their impact on daily activities. Such documentation can support your claim by providing clear, firsthand evidence of your limitations.

Boosting Your Claim

• Proactive Measures:Ask your doctor to complete an RFC form accompanying their statement. This form explains how particular medical conditions cause specific limitations.
• Enhanced Claim Success:A well-documented treating source statement, combined with an RFC form, increases the likelihood of a favorable outcome in your disability claim.

Incorporating a detailed treating source statement into your Social Security claim not only strengthens your case but also ensures that your doctor’s expert opinion is fully considered in the RFC determination process.

Challenges in Getting a Doctor to Complete an RFC Form

Getting a doctor to fill out a Residual Functional Capacity (RFC) form can be challenging for several reasons:

1. Time Constraints:Doctors often have busy schedules, making it difficult for them to allocate additional time to fill out these detailed forms. Their primary focus is patient care, which can make administrative tasks like form completion a low priority.

2. Clinic Policies:Some hospitals or clinics have specific policies that restrict or discourage physicians from completing outside forms. These policies are often in place to streamline operations and ensure that doctors concentrate on their medical responsibilities.

3. Weight of Medical Opinion:Not all doctors’ opinions are valued equally by Social Security. It’s important to discern which medical opinions are most likely to impact your case positively.

4. Complexity of Forms:The RFC form can be complex and may require comprehensive details about a patient’s limitations. Doctors may need guidance or encouragement to complete these forms accurately.

Overcoming These Challenges

Hiring an experienced disability attorney can significantly alleviate these challenges. Here’s how they can assist:

• Policy Navigation: Attorneys can help you understand the specific policies of your clinic or hospital regarding form completion.
• Strategic Decision-Making: They can advise on which doctor’s opinion might be more persuasive to Social Security based on your medical history and case specifics.
• Direct Requests: Lawyers can formally request that your doctor complete the form and ensure it is submitted correctly to Social Security.
• Educational Support: Providing your doctors with the necessary forms and clear instructions can simplify the process for them, reducing their hesitation to assist.

By addressing these challenges directly, you increase your chances of having a complete and compelling RFC form submitted on your behalf.

A thorough understanding of all of the factors that go into an RFC determination is important if you want to have the best chance of success with your SSDI claim.

As a Social Security disability attorney helping clients nationwide, I can help you understand the residual functionality you will have to prove in order to give your disability case the best chance of success. Here’s how I can assist you in navigating the RFC process:

• Evaluating Medical Opinions: We will identify which of your doctors’ opinions will carry more weight with Social Security, maximizing the impact of their assessments.
• Facilitating Form Completion: I’ll handle the request for your doctors to complete an RFC form and ensure its submission to Social Security on your behalf.
• Providing Accurate Instructions: Your doctors will receive the appropriate RFC form along with detailed instructions, ensuring the form is completed accurately and effectively.

By leveraging my expertise in this field, we can streamline the process and enhance the likelihood of a favorable outcome for your disability claim.

Give me a call at 985-240-9773.