SSD Claims and Residual Functional Capacity Assessment

When you first apply for Social Security Disability Insurance Benefits (SSI) the Social Security Administration (SSA) will ask you for information on where you have been treated. The SSA will ask you for a list of your current medications. They will then ask you and close family members to fill out forms regarding your activities of daily living to prove that you are unable to function in a work environment. Subsequently, the SSA will request all of your medical records relevant to the case from hospitals and clinics where you have treated. They will take this information and send it to one of the SSA approved doctors who may or may not make an appointment with you for an examination at that time. These doctors will report back to the SSA their findings. After the SSA receives all of the information mentioned above, they will issue a determination in your claim.

Ultimately, there may be another SSA physician who you will be asked to see. The SSA will want this SSA physician to fill out a form called a Residual Functional Capacity Assessment (RFC). The SSA almost always requires the RFC for all physical claims as well as mental claims to properly assess the individual situation. Thereafter, an Administrative Law Judge (ALJ) in your case, if it reaches that level, will put great weight on what these SSA physicians say. Your greatest weapon against your claim being decided based upon opinions of these SSA physicians who don’t know your history is to provide reports of those that do.

I personally ask every client that comes into my office to take with them my own version of the RFC to their next visit with their regular treating physician.  I have noticed that often your regular treating physician’s opinion portrays a more accurate picture of your impairments over a long period of time than the opinion of an SSA physician who has only recently met you. Generally, an ALJ is compelled to give your regular treating physician’s opinion greater weight as long as that opinion is supported by your medical records as a whole.

In other words, if the SSA physician says you can lift 50lbs but your regular treating physician says you can lift less than 10lbs, customarily; your regular treating physician’s assessment will undermine the SSA physician’s opinion. However, even though the rules call on the ALJ to grant greater weight to the opinions of the regular treating physician, they can still make the determination that your regular treating physician’s opinion on an RFC assessment is inconsistent with the rest of your medical records and could not be accurate given the weight of the other evidence. This happens on occasion. In conclusion, do not let the SSA physician be the only deciding factor in your case. Be aware that you have the right to have your regular treating physician who knows you best weigh in on your situation.

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