Is Your Patient “Disabled” Under Social Security Law?
Doctors with patients who have been inured or have Social Security disability claims are usually asked to provide evidence. But what do the Social Security people mean by “disability”? And what kind of evidence do they need from doctors?
There is no universal definition of “disability.” It depends on who is defining it – Veterans administration, Worker’s Compensation, ADA , Social Security, etc.
Your cannot depend on common sense to tell you who is disabled under the Social Security law. Examples:
A 48 year-old construction worker has done heavy, unskilled labor since age 16. He has a 4th grade education and a “low/normal” I.Q. He can read only basic things, like inventory lists and simple instructions. His heart condition limits him to sedentary work. He is not disabled under Social Security law unless he has an additional limitation.
A 38 year-old machine operator has done unskilled, medium exertion factory work since graduating from high school. A cardiovascular impairment limits him to sedentary work, and a permanent injury of the right hand limits him to work not requiring bi-manual dexterity. He is disabled under Social Security law.
A 61 year-old truck driver has been driving trucks all his life. But during a downturn in the trucking industry ten yeas ago he worked 18 months at a sedentary office job for his brother-in-law. Now a pulmonary impairment limits him to sedentary work. He is not disabled under Social Security law because he is still capable of doing the office job.
The Social Security Administration (SSA) defines disability as:
“Inability to perform substantial gainful activity by reason of a medically determinable physical or mental impairment, or combination of impairments, which has lasted or is expected to last at least 12 consecutive months, or end in death, taking into account the individual’s age, education and work history.”
To determine if a person is disabled, the SSA uses a five-step “sequential evaluation:”
Step 1. Is the applicant working?
Step 2. Is the condition “severe?” – that is, does it limit ability to do some basic work activity, physical or mental or both?
Step 3. Does the applicant “meet” or “equal” one of the impairments listed in the SSA disability law?
Step 4. Is the applicant able to return to past relevant work (work performed within the last 15 years)?
Step 5. Can the applicant perform any other work in the national economy, considering his/her age, education and past work?
The applicant can be bumped at any step. For example, if working, he will not get past Step 1. Information from the treating doctor is important under Steps 2, 3, 4, and 5.
A “severe” condition limits basic work activity due to a medical (physical or mental) impairment. Basic physical work activities are sitting, standing, walking, bending, stooping, lifting, carrying, etc. Basic mental work activities are following instructions, accepting supervision, getting along with co-workers and supervisors, maintaining attention and concentration for extended periods of time, and behaving appropriately in the work place, etc.
Under Step 3, the treating physician’s medical records are critical. The SSA listings of impairments are organized by body system. They identify most common impairments. For a condition to be found disabling, the records must show test results that meet or exceed the medical criteria set forth in the listings.
An individual may also be found disabled, even if the condition is not listed, if appropriate tests show the individual’s condition to be equally severe.
The treating physician is the key source of medical data. Your records are vital to determining if your patient’s condition meets or equals a listing. This office would be happy to provide a copy of the pertinent listing, if you have a patient encountering difficulty with a Social Security disability claim. Fax, mail or phone your request to June Rich (541-772-9850; Fax: 541-779-7430).
In Steps 4 and 5, the physician’s role changes from identifying the medical condition to providing information on the claimant’s physical or mental capacity for work. The Judge does not want a doctor’s opinion on whether the claimant is “disabled.” Rather, the Judge wants evidence of what the claimant can and cannot do.
After considering evidence from doctors and others, of what the claimant can now do on a sustained basis and the demands of past relevant work in the last 15 years, the Judge decides if the individual can return to any former work.
What an individual can still do, despite impairment-related limitations, is his/her residual functional capacity “RFC”. Under Step 5, the Judge will look at the individual’s RFC, age, skill level, and education and determine whether the person can do any work in the national economy.
If the impairment is fully or partially exertional, it is measured against medical/vocational regulations called the GRID. Pain and other subjective complaints may result from exertion or exist independent of exertion. If related to exertion, the limitation imposed may be supported by the proper GRID table. Physicians may obtain a copy of a pertinent “GRID” table from us as well.
Claimants will be denied if they fail, without good cause, to follow a treatment their treating doctor has prescribed to restore their ability to work.
If you or a patient have questions about qualifying for disability under SSA, please call our for a free consultation.
This article was prepared by Robert Webber.