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Social Security Disability Sequential Evaluation Steps

Step Four of the Five Step Sequential Evaluation Process Disability Examiners Use to Allow or Deny Your Application for SSI and Social Security Disability Benefits...


 

  Here's a little graphic of the five step sequential evaluation process

4. Can you do any work that you have previously done in the last 15 years?

So, at this point it has been established that you are not currently earning over $860 a month, you do have a severe impairment that affects your ability to work, but your condition is not exactly like or equal in severity to any of the ones listed in the SSA blue book. So, after the medical records have been read, then the DE must now summarize your medical condition on a Residual Functional Capacity (RFC) form (for physical impairments) and/or a Mental Residual Functional Capacity (MRFC) form (for mental impairments). If a mental impairment proves to be “more than non severe”, then a Psychiatric Review Technique Form (PRTF) must also be written up by the examiner.

These forms—now containing a summary of all the pertinent findings in your medical records written by the disability examiner—are then forwarded to in-house medical consultants (medical doctors and psychologists) who will review the summary and agree or disagree on whether the disability examiner reached the right conclusion as to how your impairments affect your remaining functioning capacity.

So here you can see that it really does not matter what the name of your condition is because if it is not listed in the blue book, it is now a matter of whether you still have the functioning ability to do any that you have previously performed in the last 15 years.

In some cases, the medical consultant will review the summary and ask the examiner to attempt to get more medical records from the treating physician, if feasible, or will request that the claimant be sent to a consultative examination (CE) so that the needed additional information can be secured in order to reach a good decision. Reaching a good decision is not based on whether or not you are allowed benefits, but based on whether or not your functional limitations are documented and appropriate limitations have been assigned on these forms based on your current medical conditions.

For instance, sometimes examiners will conclude in their summaries of a case that the claimant is still able to do “medium level work” despite their impairments, while the medical consultant will conclude—on the same case--that the claimant can only do “light work” given the extend of their impairments and medical limitations. Such distinctions will prove important as the claimant’s case moves on to the next final steps in the sequential evaluation process.

Also, in some cases, the doctor will note that even though the claimant’s condition is very severe right now, that it can be expected to “resolve to non-severe” within a 12 month period. Of course, if this distinction is made, it means the claimant will be denied benefits at this point since the rules require that the condition be expected to linger for a year or more.

(Editor’s note: as an aside, and as an ex-DE, it should be understood that it is at this point in the evaluation process that many errors are made. For example, if you have an experienced disability examiner working on your claim, then s/he will know what information must be included in the summary which will allow the medical consultant to reach a valid conclusion regarding the residual functional limitations that a claimant has despite his impairments, but if an examiner is not experienced or does not understand a particular body system very well and has not consulted his Blue Book, then s/he may unknowingly or inadvertently leave out pertinent information that could mean the difference between the medical consultant agreeing that the claimant could do “light work” versus “sedentary work” versus any kind of work. Again, such distinctions will come into play in the last two steps of the sequential evaluation process so it is vital that the summaries of your medical records as documented on the RFC/MRFC/PRTF assessment forms be accurate if a good decision is to be rendered.

Another problem at this stage of the evaluation process can occur in some states due to the way that they manage or fail to manage who actually write summaries of your medical records.

In one state an examiner will write up all cases, despite the level of complexity. By this I mean that there are claims which can go either way. They will be allowances or denials based on certain interpretations.

In states where examiners write up all case summaries, there appears to be a greater possibility of error, especially if the examiner is an inexperienced one.

However, in some states, examiners only write up cases where they have a good grasp of the impairments the claimant suffers from and consequently, they can write fairly accurate summaries. If the examiner does not feel that s/he knows enough about a claimant’s condition to write a good summary, she can request that the medical consultant write up the case summary and issue the conclusion.

This system seems fairer to claimants because an actual doctor is reviewing all of their medical records in complex cases, and is able to reach a better decision. End note.)

So now we come to the purpose of completing the RFC and the MRFC forms. The forms are used to document/summarize the objective findings in your medical records and to have a medical doctor or psychological doctor judge how these medical conditions impact your work ability.

It is to determine if you can do any of your past work. You may have read in my previous disability newsletter about how important it is to list exactly what you did on your work history forms. It is at this step in the evaluation process that the examiner will be looking at your work history form, the one you have completed which tells how much sitting and standing and stooping and bending and twisting and crawling you did.

This information will be compared with the information on the RFC form which will also have a place for the in-house medical consultant to list how much standing, sitting, stooping, bending, crawling, twisting, etc. that you can still be expected to do, given your current level of functioning.

So if you were a “domestic technician” i.e. a maid, who cleaned rooms for 25 years and you used a vacuum cleaning, and you listed that you only lifted 20 lbs in this job, such a job could conceivably be considered light work by your DE. However, an experience DE will recognize that working as a maid is in most cases “medium level work” due to the strenuous activity that is associated with it, such as having to climb stairs, having to constantly bend, stand and stoop, etc.

The other example would be that of a truck driver who did not do any lifting in his job, but merely drives a truck to and from destinations while others load and unload the cargo. Such a position is still considered to be “medium level work” because of the exertion that is required in pulling and pushing and getting in and out of the cab and climbing, etc.

If your completed RFC and MRFC forms indicate that you can return to your past work based on what you say you did or based on what the dictionary of occupational titles says the exertional level of work is for the type of work you did, then if you can return to this level of work, your claim will be denied at this fourth step.

If however, you can no longer do your past work, your claim will move on to the next and final sequential evaluation step.

Social Security Administration Information on the Five Step Sequential Evaluation Process  l More Technical Stuff here

Tags: sequential evaluation social security disability disability benefit Ddisability claim disability determination advocate question representative attorney disablity insurance disablity dissability

 
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