Wednesday, December 19, 2007

Medically Disabled for Social Security Versus the Definition of Disability

A statement from a forum: "Doctors usually don't understand the fact that there is real difference between being medically diagnosed as "disabled", and the government's legal definition of disability".

Actually, there's a lot of truth in this statement. Over the years, I've encountered numerous physicians who seemed to think that if they simply give their patient a piece of paper stating "patient is disabled and unable to work" then the social security administration would roll over and issue a disability approval.

Obviously, it doesn't work that way, but what is a bit amazing is the fact that any physician would actually think for one moment that it does, and that the issuance of a short statement that says nothing about a claimant's functional limitations would be enough to win a disability case.

Let me clarify a couple of points. The social security administration makes decisions on disability cases by reviewing and evaluating medical evidence. And this includes statements from physicians. However, the type of evidence that both disability examiners and administrative law judges (hearings are held and decided by these federally appointed judges) are looking for and need is documentation that indicates a claimant's level of severity and level of functional limitation.

So, when a doctor submits a statement that says "my patient is 100% disabled", what does that mean, really? In actuality, it means nothing to someone making a decision on a disability case. Why? Because in order for social security disability or SSI disability benefits to be approved, it must be clear that a claimant cannot perform work activity that earns more than substantial gainful activity while engaging in either their past work or in some form of other work.

And the only way to arrive at such a determination is by first assessing what a claimant can or cannot do, i.e. their residual functional capacity. By doing this, a disability examiner or disability judge can determine whether or not a claimant return to their past work, or perform some other type of work.

So, what type of medical record documentation helps a disability adjudicator the most? Obviously, detailed documentation that makes reference to what a patient can or cannot do. For example, the ability or inability to: sit, stand, crouch, stoop, reach, lift, walk, hear, see, etc, etc.

Unfortunately, this is not the type of approach that most doctors take when it comes to compiling their treatment notes. And, in fact, sometimes, it is extremely difficult for an adjudicator to find anything in the medical records that even hints of a patient's functional limitations.

However, when a doctor submits a statement to social security on behalf of a patient, they have opportunity to rectify this by citing their patient's residual functional capacity (translation - what they are still capable of doing despite the effects of their impairment or impairments).

Therefore, if you plan to obtain a statement from a physician in support of your case, try to make it clear to the physician that the statement needs to be detailed in the sense of providing commentary regarding your functional capacity and limitations; otherwise, the doctor's statement may be next to useless.

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