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Residual Functional Capacity in Boston Disability Cases

Social Security Disability Insurance Benefits in Boston

There are essentially two types of disability benefits programs administered by the U.S. Social Security Administration (SSA).  The first is the SSDI program.  SSDI, or Social Security Disability Insurance, is called a Title II program, because the provisions governing this Boston disability benefits program are found in Title II of the Social Security Act.  This is also the section of the Social Security Act that controls the Federal Old-Age Survivors program, of which most people are familiar when they have worked all their lives and reach the age of retirement.

Supplemental Security Income Cases in Boston

Boston SSI casesIn addition to Social Security Disability Insurance, there is also the Supplemental Security Income, or “SSI,” program.  SSI is governed by Title XVI of the Social Security Act.  This program is official called Supplemental Security Income for the Aged, Blind, and Disabled.  The program is designed to provide benefits for Americans who have reached the age of 65, are blind, or are disabled.

The main way in which this program differs from the Social Security old-age and retirement program and the Social Security Disability Insurance program is that the SSI program was designed for people who have never worked or have worked but have not worked long enough to earn enough quarterly credits to have paid into the program.

Whether we are talking about the Social Security Disability Benefits program or the old age retirement program, in order to be eligible for benefits, you must have worked enough quarters prior to applying for benefits. This is like paying a premium on a private long-term disability program or making contributions to a pension fund.  The number of credits you need depends on your age at the time you became disabled. If you do not have enough credits, you will not qualify for benefits.

If you do not have enough quarterly credits for SSDI, you may apply for Supplemental Security Income benefits.  However, as our Boston disability attorneys can explain, SSI is an income sensitive program. This means that it is only available for very low income households. SSA will use a formula to determine the maximum income level that would still allow a claimant to receive benefits.

Proving a claimant is entitled to SSI benefits, as discussed in a recent case from the U.S. Court of Appeals for the Eighth Circuit, requires a showing that claimant satisfies all elements of a five-step process. These five steps are as follows:

  1. The applicant has not engaged in substantial gainful activity;
  2. The applicant has suffered severe impairments;
  3. The medical condition, or set of conditions, meets the severity of one of the listed impairments. These impairments are listed in Part 404 of the Code of Federal Regulations (CFR) pertaining to SSDI cases. It is in step three that the claimant’s residual functioning capacity is assessed;
  4. Whether or not claimant can perform any of his of her past relevant work (PRW); and
  5. With the burden now shifted to SSA, can claimant do any other work in the local or national economies if he or she has RFC.

In this case from the U.S. Eighth Circuit, the administrative law judge (ALJ) determined that claimant had not engaged in any substantial gainful activity.  On the second step, ALJ determined that claimant suffered from various medical conditions including adjustment disorder, anxiety and depression, borderline intellectual functioning, and inherited myelopathy versus conversion disorder.  Here, ALJ did not find these set of conditions met the requirements of the conditions listed in the CFR as discussed above.

Even though step two in the evaluation process was not fully satisfied, he moved on to step three and determined claimant has a residual functioning capacity, and that RFC meant he was able to engage in substantial gainful activity (SGA) according to SSA guidelines.

Residual Functioning Capacity (RFC)

In a Boston SSDI case, RFC evaluation looks at various factors.  The judge actually has a form with check boxes for this purpose, so when we say he or she has to check all the boxes, we are talking literally.

The ALJ must determine, based upon medical records and testimony, how much weight the claimant can occasionally lift, ranging from less than 10 pounds to 100 pounds or more.  After the occasional lifting capacity is determined, ALJ will determine how much the claimant can lift on a frequent basis.

After lifting objects has been established, ALJ must make a determination of how long claimant can stand or walk with the type and duration of breaks given to ordinary employees.  This does not take into account special accommodations. For example, ALJ may determine claimant can stand for less than 2 hours in any given work day. He or she could also determine there is a medical requirement for a hand-held assistive device necessary for ambulation.  This is basically a way of saying claimant needs a cane or walker.

The ALJ will also evaluate whether claimant can sit, push or pull objects, and check off the appropriate boxes.  At this point, ALJ will determine claimant’s ability to balance, climb, stoop, kneel, couch, and crawl.   These are also scored ranging from frequently to occupationally to never.

The next step of the evaluation requires ALJ to determine if claimant has what are known as manipulative limitations.  This involves whether claimant has the limited or unlimited ability to reach in all directions, handle or otherwise manipulate objects, finger objects (fine manipulation) and feel objects.  This last one is a test of the claimant’s skin receptors. There are then evaluations of the claimant’s hearing and speaking abilities and exposure to various environmental factors, such as extreme cold or heat.

Once all the boxes are checked, ALJ will have a numerical value that is the claimant’s alleged RFC.  If the RFC is over a certain value, then he or she will determine claimant has an RFC that allows claimant to work.  ALJ can also ask a so-called vocational expert whether there are any jobs in the local or national economy that allow claimant to work.  As discussed above, this is the fifth step on the disability evaluation process and, at this point, burden shits to SSA to prove claimant cannot work.

However, this is not really as hard for SSA as it sounds, since the whole process is basically set up to benefit SSA.  For this reason, the best thing you can do to increase your chances of obtaining a full and appropriate award of SSI or SSDI benefits is to speak with an experienced Boston disability attorney.  The earlier in the process you do this the better, since it is easier to get things right from the beginning than going back and trying to fix things that have already gone wrong. This doesn’t mean that it is too late to contact to an attorney, but the earlier you do so the better.

If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.

Additional Resources:

Compilation of the Social Security Laws, Social Security Administration

More Blog Entries:

SSDI Appeal Results in Affirmation of Denial, Feb. 15, 2017, Boston SSDI Attorney Blog