In order to know whether you can perform your occupation (or any other work in the economy), the disability claims handler deciding your long-term disability claim or Social Security Disability claim needs to determine your residual functional capacity (RFC). This is accomplished by having a doctor perform a residual functional capacity assessment and complete an RFC form. This form is also known as an Attending Physician Statement or a Medical Source Statement. We’ll use these terms interchangeably throughout this article.
What Is a Residual Functional Capacity Assessment?
A residual functional capacity assessment is an evaluation of your impairment(s), and any related symptoms, such as pain, which may cause physical and mental limitations that affect what you can do in a work setting. Your RFC is the most you can still do despite your limitations.
Why RFC Forms Are Better Than Your Records
Many claimants think: “Well if my medical evidence is strong, why should I need to get an RFC form completed?” Your records very rarely specify opinions or conclusions regarding the patient’s ability to work or not. The claims examiner’s at DDS and disability insurance companies are not doctors, so they cannot easily translate medical findings into specific work-related impairments. Submitting completed RFC forms:
- Make the claims handler’s job easier;
- Allows a claimant to present a professional interpretation of the medical evidence, as opposed to simply presenting the evidence by itself;
- Is far superior to a short statement or letter from a doctor on behalf of a claimant. (Such letters rarely, if ever, help to win a case.); and
- Allows the physician to specifically comment on a claimant’s limitations with respect to exertional ability, postural limitations, strength, range of motion, mobility, etc.
This is why it is important for a physician to “bridge the gap” between your medical diagnoses and your work-related impairments with an RFC form. Every disability applicant should submit a completed RFC form unless they absolutely cannot obtain one. If you see multiple doctors, you should try to obtain a statement from each doctor.
What Form Does My Doctor Need to Fill Out for Disability?
You can download a generic mental RFC form or physical RFC form for free from our website. However, keep in mind that the same forms are used for every claimant, regardless of that individual’s specific impairments. A custom form makes it easier for your doctor to identify physical or mental limitations that only apply to specific medical conditions.
Since each medical condition results in specific impairments we have created custom forms for a multitude of medical impairments. We have physical RFC forms for neck, back, heart, lung, shoulder, knee, hip, foot, fibromyalgia, and migraine headaches. This list is not complete: we literally have dozens of forms, including less common medical conditions like dysautonomia and Lyme disease. We also have mental RFC forms for conditions like bipolar disorder and PTSD.
Who Can Fill Out an RFC Form?
A doctor who submits a residual functional capacity form should be a treating physician. A treating physician is qualified to perform an evaluation as to the claimant’s medical condition and how the condition affects the claimant because the doctor has a history with the claimant.
What Should the RFC Form Say?
Medical opinions only carry weight if they are specific enough to indicate the patient’s specific limitations and why the physician believes that his or her patient is disabled and unable to work. For these reasons, an RFC form should contain the following elements:
- It should identify the claimant’s diagnosed condition or conditions;
- It should indicate the date of the diagnosis;
- It should indicate the prognosis (or future outlook) for the condition(s); and
- Most importantly, it should identify all the various ways in which the claimant is functionally limited (which evidences how and why the claimant would be unable to sustain full-time work activities).
Regarding item number 4 above: it is usually most helpful for a doctor to complete a check-off style form that allows the doctor to address the claimant’s level of impairment. For physical impairments, the doctor may opine as to the claimant’s physical strength level, their range of motion, their postural or ambulatory limitations (sitting, standing, walking, bending, crouching, reaching, balancing), their ability to lift and carry weight on an occasional or frequent basis, their deficits with regard to their senses (seeing, hearing, feeling, grasping, manipulating), and any other physical short-comings the claimant may have.
If the claimant’s disabling condition is mental, the treating psychiatrist or psychologist should indicate which cognitive deficits they have. For example, do they have trouble retaining information, learning information, concentrating, getting along with supervisors or co-workers, etc.? Does the patent have a poor memory, decreased energy, illogical thinking, and so on? The mental RFC may also indicate the patient’s ability to persist in the areas of concentration and attention, as well as the patient’s ability to interact socially in work settings, assimilate new information, and successfully engage in SRRTs (simple, routine, repetitive tasks).
Can a Doctor Write a Letter for Disability?
A statement from your doctor can often make the difference between winning or losing your disability claim, but that does not mean any statement will be helpful. The statement should not be too brief to be of any use or too conclusory. I cannot tell you how many times our office has received a call from an excited client and the client says the doctor wrote them a statement that will win the case. It is an extremely brief note on a prescription pad that says little more than “My patient is completely disabled and unable to work”. Unfortunately, this type of statement is useless to the disability claims examiner.
RFC In Long Term Disability Claims
To learn what your limitations are, the insurance company may ask for you to take an Attending Physician’s Statement (APS) form to your doctor. If the insurance company claims handler does not believe the APS is sufficient, the adjuster may schedule you an appointment to attend an “Independent Medical Examination” by a doctor hired by the insurance company to obtain an independent RFC assessment.
If your claim is still within the “own occupation” period, the LTD disability claims examiner will first use your RFC to determine if you can be expected to do your own job. For example, if your prior occupation was sedentary and your RFC is for sedentary work (or higher), the claims examiner will likely find you should be able to return to your job unless your RFC identifies further non-exertional restrictions (non-exertional impairments may include mental or emotional limitations, such as memory problems from a psychiatric or neurological disorder, or an inability to concentrate). If your claim is within the “any occupation” period, then the claims examiner will review your RFC to determine whether you could return to any occupation in the economy.
RFC In Social Security Disability Claims
Per the Social Security Administration (SSA), a claimant’s RFC is assessed using all relevant evidence in the record. This evidence may include medical records, observations of treating physicians and others, and the claimant’s own descriptions of his or her limitations.
During the processing of a Social Security claim, an examiner at the Disability Determination Services (DDS) office will have one of the DDS physicians and/or psychological consultants review the evidence in the claimant’s file and give an assessment as to the claimant’s RFC, taking into account the claimant’s conditions and how such conditions affect the claimant’s ability to work. The Physician will then fill out an RFC form for your SSA file.
When issuing a decision on a Social Security Disability benefits claim, the Disability Determination Services examiner will explain the reasoning behind his or her decision to approve or deny the claim before sending it back to your local Social Security Administration office. One of the key pieces of evidence in the evaluation of a Social Security disability case is always the exertional level indicated on the RFC form. You can also ask your treating doctor to fill out an RFC form to support your claim for Social Security Disability benefits.
The SSA gives substantial weight to the opinions of a disability claimant’s treating physician. They have a history of treating your condition. They likely have first-hand knowledge of your condition and prognosis. As such, your treating physician is in a better and more informed position to give an opinion as to your medical impairments.
For these reasons, claims examiners at DDS and the judges at the SSA hearing offices are to give “substantial weight” to the opinions of treating physicians, especially when those opinions are backed up by the medical evidence and when those opinions are properly documented in detailed RFC forms.
How An Attorney Can Assist You with RFC Forms
A competent and experienced disability lawyer will nearly always try to get a doctor to fill out RFC forms. Every client that we represent in a long term disability or Social Security Disability claim receives an RFC form that has been customized to their specific medical condition(s). This is because an RFC form can often “turn the tide” in a case and effectively win disability benefits.
We offer a free consultation if 1) your long term disability claim has been denied or terminated or 2) you are filing a disability application or appeal for Social Security Disability benefits (up to a hearing before an Administrative Law Judge). Mr. Ortiz is a Board Certified Social Security Disability attorney. Call (888) 321-8131 today to schedule your free consultation.
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