FIGURING OUT YOUR RESIDUAL FUNCTIONAL CAPACITY (RFC)

In making disability decisions, Social Security uses "Residual Functional Capacity" or RFC.  It simply means the most that a person is able to do in terms of work-like activity.  It considers such things as:

• How long can a person sit, stand and walk out of an 8-hour day?
• What is the maximum that a person can repetitively lift and carry?
• How often can a person bend, kneel, crouch or crawl?
• What is an individual's restrictions on reaching, handling or feeling? 
• What is the maximum time this person can work without requiring a break?

 Those are only a few of the items considered in a physical Residual Functional Capacity.

For a mental RFC, some questions would include these:

• How long can the individual concentrate and stay on task?
• How often would this individual be able to respond appropriately to co-workers, supervisors or members of the public?
• Can the individual remember, understand and carry out simple instructions?  
• What is the individual's ability to adapt to usual workplace changes?

 There is a 5-Step mandatory process that a Social Security decision maker must use in deciding whether a person is disabled under the rules and regulations.  A Residual Functional Capacity (RFC) must be determined at Step 3 of this sequential process.

Who decides the RFC?  The administrative law judge or other decision maker at Social Security will decide.  However, the claimant's treating physician may greatly influence the RFC determination by providing an opinion concerning what activities the claimant can and cannot perform.  I use a form called a Medical Source Statement (MSS) to get the claimant's physician to estimate the Residual Functional Capacity.  I present the form to the court in hopes that the court will adopt the doctor's RFC.

Once the Residual Functional Capacity (RFC) has been determined, the judge or decision maker will conclude that the claimant is able to engage in work of a certain exertional level:  404.1567 Physical Exertional Levels


SEDENTARY WORK - Sitting up to 6 hours per 8-hour day, lifting no more than 10 pounds occasionally.

LIGHT WORK - Standing or Walking at least 6 hours per 8-hour day and lifting/carying 10 pounds frequently and up to 20 pounds occasionally.

MEDIUM WORK - Standing or Walking at least 6 hours per day and lifting and carrying 25 pounds frequently and up to 50 pounds occasionally. 

HEAVY WORK - Standing or Walking at least 6 hours per day, with lifting and carrying of 50 pounds frequently and up to 100 pounds occasionally.

VERY HEAVY WORK - Standing or Walking at least 6 hours per day with frequent lifting and carrying of up to 50 pounds and lifting/carrying more than 100 pounds occasionally.

In practice, most disability cases are won or lost on the claimant's ability to perform sedentary or light work.  This is especially true with claimants over the age of 50.

 So, the more restricted an individual's RFC is, the more likely the individual cannot sustain full-time work on a "regular and continuing basis," which means 8 hours per day, 5 days per week, or an equivalent schedule. 

If a person's RFC does not permit him or her to perform sedentary work, that person is disabled.  In some cases, even if a person can still perform Light exertion work, a grid rule may still direct a finding of disability.  

Objective medical evidence along with opinion evidence will help decision makers to arrive at a fair Residual Functional Capacity.

Objective evidence includes physical examinations, laboratory tests and imaging studies, such as X-rays, MRIs, CT scans or ultra-sound studies.

Opinion evidence includes a doctor's professional opinion about how a certain medical condition (or combination of conditions) limits or restricts an individual's ability to perform work related activities (such as sitting, standing, walking, bending, kneeling, stooping, lifting, reaching, etc.).

Disability cases are won or lost by getting a fair and accurate Residual Functional Capacity assigned.  You can easily see how an individual who is able to perform the full range of heavy work would not easily be found disabled in the absence of non-exertional impairments.  By contrast, a person limited to less than a full range of sedentary work might easily be found disabled.

A good attorney or advocate will always seek to obtain legitimate objective and opinion evidence that restricts a claimant's work related activity to a reasonable level of exertion.  This can and often will win the case, or lose it, if a reasonable RFC cannot be established in court.
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THE FORSYTHE FIRM
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

SOCIAL SECURITY JUSTICE - WEBSITE 

  "REPRESENTING WITH RESPECT"

WHAT ARE QUARTERS OF COVERAGE AND WHY THEY MATTER

Not everyone is covered by Social Security disability insurance (SSDI).  It covers only workers.  You earn a quarter of coverage for each calendar quarter that work and earn at least $1,360.  For example, if you work January through March and earn at least $1,360 during that period, you have earned one quarter of coverage with Social Security.  (That dollar amount changes each year; it took less earnings in 2018 to earn a quarter of coverage).

So, we see that an individual may earn up to 4 quarters of coverage per year.  Over 10 years, up to 40 quarters of coverage can be earned.

Most individuals need at least 20 quarters of coverage to have "insured status" for Social Security disability.  Stated another way, you need to have worked at least 5 years out of the most recent 10-year period.  (Very young workers have different rules).

When a person stops working, he or she stops earning quarters of coverage.  Gradually, the required number of work quarters begins to slip away.  About 5 years after you stop working you become uninsured for purposes of SSDI benefits.  When this "Date Last Insured" or DLI rolls around, you are no longer insured for new disability claims.

We have individuals call us quite frequently who have real disabilities.  They worked for years but stopped working several years ago and didn't file for SSDI benefits.  Now, they find that they have waited too long to file and are no longer insured by Social Security.  So, the simple point I'm trying to make here is this:  When a person stops working, his/her disability coverage with Social Security eventually disappears. This affects the ability to file a new claim after the "Date Last Insured" (DLI).

If you have stopped working because of a medical condition, consider filing for SSDI benefits right away.  Waiting too long to file can result in severe disappointment if you find that your insured status has slipped away.
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 Charles W. Forsythe
The Forsythe Firm
7027 Old Madison Pike, Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

SOCIAL SECURITY JUSTICE (WEBSITE) 

WHY VETERANS HAVE AN ADVANTAGE WITH SSDI

Disabled veterans may find that they can get Social Security disability benefits in addition to their VA or military benefits.  Here are some of the things working for the Veteran at Social Security:

1.  Veterans have excellent medical records.  The military documents everything in duplicate.  If you were sick or injured while on active duty, there is a medical record of it, for sure.

2.  If you have a high VA disability rating, you have already been through the government's disability determination process and been approved.  It's true that Social Security has their own process which is different from the VA process.  Yet, there are enough similarities in the two programs that the VA disability rating increases the odds of approval by Social Security.

3.  If a veteran has a 100 percent permanent and total disability rating, Social Security will expedite the process and provide a quicker decision.

One word of caution is in order:  Even disabled veterans get denied by Social Security.  An appeal and hearing is often required to get approved.  Persistence is what pays off.  So, file the appeal within 60 days of your denial.

We are seeing more and more veterans with severe physical impairments--but also with depression, anxiety and PTSD symptoms.  These can certainly be disabling.

The Forsythe Firm in Huntsville is proud of our reputation of serving disabled veterans over the years.  If you need assistance with getting the government benefits you deserve, we would be honored to have you contact us.
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The Forsythe Firm
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

SOCIAL SECURITY JUSTICE WEBSITE 

WAYS TO HELP GET APPROVED FOR DISABILITY BENEFITS

Discovering that you have a long-term disability and may never work again can be devastating.  Financially, it turns your world upside down.  Survival becomes paramount.

For most people in this situation, Social Security disability benefits are the only lifeline.  This government program can pay up to $2,800 per month, plus Medicare health insurance.  However, the difficulty in getting approved for SSDI benefits is well known.  And, it takes a long time.  

Because of the mandatory 5-month waiting period, no SSDI benefits can be paid for 5 months after you are found to be disabled. So if Social Security determines that you became disabled on June 15th, for example, your first benefit would be due in December.  And since they pay one month in the arrears, the check won't actually arrive until January.

There are things you can do, however, to help yourself with a Social Security disability claim.  As an advocate who has pleaded thousands of SSDI cases, I've found that the following things definitely help your case:

1.  See your doctor regularly.  SSDI decision makers want to see continuing medical treatment and recent medical records from your doctor(s).

2.  Comply with medical treatment to the extent possible.  Take your medicine.  Let the doctor adjust your medications and dosage as required.

3.  Tell your doctor about all your symptoms. Get it on the record! I often go before judges with claimants and the judge says, "I don't see where the claimant complained about headaches or back pain to Dr. So-and-So."  If it isn't in the medical record, it didn't happen, according to Social Security.  So, tell the doctor where it hurts and about all your symptoms.

4. Try to see a specialist if appropriate.  If you have a heart condition, see a cardiologist.  For depression or anxiety, go to a psychiatrist. For back pain, see an orthopedic doctor.  If you have fibromyalgia, try to see a rheumatologist.  Doctors have "pecking order" with Social Security.  A specialist carries more weight than a family practitioner.  And nurse practitioners, who are not doctors, carry the least weight.  Try for an MD or DO (a doctor), not a nurse practitioner for your medical care.

5.  Try to get imaging studies:  X-rays, MRIs, ultra-sounds, etc.  A picture really is worth a thousand words.

 
 6. Don't wait too long to fire your Social Security claim.  Most people don't know it, but SSDI benefits expire over time.  When you stop working, a thing called your Date Last Insured (DLI) begins to creep up on you.  Once that date rolls around, it becomes difficult to file a new SSDI claim.  Your disability coverage with Social Security will expire one day after you stop working.  File a claim before that happens.  

7.  Realize that nearly everyone gets denied and has to file an appeal to get approved.  The odds are about 80/20 that you will be denied at the application level.  And you must file the appeal within 60 days of your denial date.  After that, the claim dies deader than yesterday's road kill.

8.  Consider representation (attorney/advocate), especially at the appeal stage.  The appeal really is a legally complex procedure and your case must be proven.  Individuals sometime think they will represent themselves and keep 100 percent of their back pay.  The problem is that 100 percent of 0 is 0.  I believe most of my clients believe that my fee was worth it.  That's most of them tell me.  And there is never a fee unless you have won and got back pay from the government.  

9.  Get an attorney before the last minute.  This may surprise you, but an attorney who works on your case for two years will probably earn the same money as one you hire 2 weeks before your hearing.  The one you hire 2 weeks before your hearing just won't be as well prepared.  It takes time to prepare a good (winning) disability case. A losing case can be prepared with no effort.  But that isn't what you want, of course.

My firm, like most others, will give you a free consultation and case evaluation.  We can answer a lot of your questions over the phone.  Discussing your potential claim or appeal is always at no cost.  All you need to do is call.
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The Forsythe Firm
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
PHONE (256) 799-0297

https://forsythefirm.wixsite.com/website

                                                             Representing with Respect

 

YOU MAY QUALIFY FOR DISABIILTY BENEFITS.....IF

You may qualify for disability payments from Social Security if.....

• You are currently unable to work a full-time job (not working now or earning less than $1,120 per month).
• You have a severe medical condition which will keep you off work for at least a total of 12 straight months.
• You have worked long enough, and recently enough, to be covered by Social Security disability program.  Not everyone has earned enough "work credits" to be covered.
• There is recent objective medical evidence and records to prove the severity of your disabling impairment.
• You have not yet reached full retirement age.  (If so, you may receive Social Security retirement benefits without proving disability).

If you believe you meet all of the above requirements, the process of being approved is still rigorous and challenging. Proving disability eligibility is usually a fight.  This is because Social Security's rules are so strict, narrowly defined and complex.

Up to 80 percent of individuals who file an application can expect to be denied.  The reason is always:  "You are not disabled according to our rules."

This is really the beginning of the right for your benefits.  Next, you file and appeal (within 60 days) and move to the next step of the process.  Below, I will give you the steps you should expect in your long, complicated fight for SSDI benefits:

STEP 1:  File and application with an 80% chance of denial.

STEP 2:  Beginning September 2019, ask for Reconsideration.  The same agency which denied your claim will "reconsider it."  There is a 98% chance of another denial.  This step can take 6 months.

STEP 3:  File an appeal and request a hearing before a US Administrative Law Judge (ALJ).  This hearing will be your best chance for approval, especially if you have adequate legal counsel at the hearing (and to prepare for it).

STEP 4:  If denied at the hearing, you may file another appeal with the Appeals Council in Falls Church, Virginia.  You will not have a hearing and will not actually go to Virginia.  A group of judges will give you a paper review.  Odds of winning benefits at this stage are very low.

STEP 5:  if denied by the Appeals Council, you may a lawsuit  against the Commissioner of Social Security in Federal District Court.  

Most claimants will only need to go through Steps 1 - 3.  However, nearly all claimants will need the Step 3 hearing in order to be approved.

So, a few claimants may get a quick, easy decision just by filing an application.  But most claimants will need an appeal and a hearing before being approved.

At the hearing level, it is imperative to have adequate legal representation.  Remember, of all the 5 steps available, the hearing level is the absolute BEST chance of being approved.  By far the best chance.
________________
Charles W. Forsythe
The Forsythe Firm
7027 Old Madison Pike NW, Suite 108
Huntsville, AL 35806
"Across from Bridge Street"
(256) 799-0297

SOCIAL SECURITY JUSTICE (WEBSITE)

WHAT DETERMINES IF YOU QUALIFY FOR SOCIAL SECURITY DISABILITY PAYMENTS?

Nearly every American worker earns work credits which eventually insure him or her for potential Social Security disability benefits (SSDI).  But what factors determine whether you can actually receive an SSDI benefit?

• Age
• Residual Functional Capacity (How much exertional activity you are able to tolerate)
• Type of Past Work You Have Done
• Medical Evidence
• How long your impairment has/is expected to last

Workers under age 50 have the highest, most difficult burden.  They must prove that no full-time job exists in the national economy that they are able to perform.  Thus, if they are found able to perform the easiest job in America, they will be denied.

At age 50, the rules change.  Now, all the claimant may have to prove is that he/she cannot perform past relevant work and has learned no transferable skills. This can still be difficult if the claimant has performed sedentary (easy) work during the past fifteen years.

At age 55, the rules are even more relaxed because a person is now in the "advanced age" category.  The grid rules will dictate a finding of 'disabled,' even in situations where a younger person would be denied.

In a nutshell, here are the basic tests a person must meet for a Social Security disability benefit:

• Must not currently be working at substantial gainful activity (SGA) - which in 2019 means earning at least $1,220 per month in gross wages or self-employment income.
• Must have worked long enough, and recently enough, to have insured status with Social Security.  In short, the claimant must have paid enough into the system to have coverage.  Not everyone has.
• Must have a severe medical condition which has lasted or is expected to last for at least 12 straight months and which is severe enough to prevent working a full-time job.  Short term disabiity (less than 12 months) is not covered by Social Security.
•  Finally, there must be objective medical evidence to prove the severity, duration and functional limitations of the alleged impairment.  This means a history of recent medical tests and treatment to evaluate and verify the medical condition(s) being alleged.

Finally, claimants should not expect to be approved just by filing an application.  Persons with certain catastrophic illnesses or amputations, or those who are legally blind in both eyes, may be approved with just an application.  Most others will be denied and will require a hearing to be approved.

The time limit for filing an appeal is a very strict 60 days from the date on the denial letter.  If you wait past the 60 days, you must file a new claim and start over (spinning your wheels).

Since the Social Security application and appeal process is so complex, most claimants find it helpful to appoint an attorney or other qualified advocate to represent them and help them.  It is a fact that the administrative law judge who hear disability appeals prefer dealing with attorney-representatives rather than with unrepresented claimants.  And your odds of being approved are much enhanced by having a legal representative who knows the law and the procedures of the Social Security Administration.

CAN YOU AFFORD A GOOD ATTORNEY OR REPRESENTATIVE?  Yes.  The law is set up so that attorney/representatives may not charge you any fee until after you have won your case and been approved for back pay from the government.  Any attorney fee must come out of this back pay.  Therefore, there is no financial risk to you, the claimant.  You do not pay any expenses, fees or other money upfront.

My firm spends all of our time on just one thing:  the practice of Social Security disability advocacy.  With us, it is not a sideline, it's something we do for a living.  We have helped thousands of people get their disability benefits from the Government.  Why not call us for a free consultation and case evaluation?

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The Forsythe Firm

Social Security Disability Counselors

7027 Old Madison Pike - Suite 108

Huntsville, AL 35806

PHONE (256) 799-0297

"Across from Bridge Street"

SOCIAL SECURITY JUSTICE (WEBSITE)