HOW MUCH MEDICAL EVIDENCE IS NEEDED?
If you feel you are disabled and are considering a Social Security disability claim (SSDI), you should consider how much medical evidence you have. A successful SSDI claim these days requires substantial medical proof.
Let me use the example of an individual with back pain as an illustration. The claimant is 44 years old and suffers regular pain in the mid to low back. He describes the pain as 8 on a 0 to 10 pain scale. It is made worse by sitting, standing, walking, bending or lifting. The pain often wakes him up at night. This man has been to the emergency room several times where doctors have diagnosed "chronic back pain" and prescribed muscle relaxers and pain pills. He has stopped working for now.
Social Security will have problems with this claim because:
1) The cause of the back pain is not known. There have been no X-rays or MRIs to see if there is a disc or spine problem. The pain could be caused by a herniated disc but it might also be a muscle problem. Therefore, there is no "medically determinable impairment." Social Security will not award benefits for unexplained back pain (no known medical cause).
2) There is no evidence that this claimant will meet the duration requirement. Social Security requires that a disabling impairment must last for at least 12 consecutive months OR end in death. Without knowing the cause of the back pain there is no way to determine if it can be expected to last for 12 consecutive months.
3) Since this person is a younger individual at age 44, he would also have to prove that there is no kind of work in the national economy that he could perform because of his limited residual functional capacity. Without more medical evidence, it is impossible to determine his residual functional capacity.** Social Security will likely assume that he can perform sedentary work or perhaps light work. That would be cause for denial of benefits.
What This individual Needs
This person needs more medical evaluation, including an MRI on the back, if possible. If he is found to have severe degenerative disc disease, then he meets at least the first 2 steps of the 5 steps necessary to get benefits.
After a proper diagnosis has been made, he needs to be followed by a regular physician, placed on proper medication and other appropriate treatment--to see if the pain is resolved or reduced to manageable levels. Emergency rooms are fine for urgent needs; however, Social Security prefers evidence from the same doctor who has seen the claimant over a longer period of time--with an opportunity to observe and treat with various methods.
Finally, this claimant would benefit from a doctor's written opinion, often called a treating source statement. Such a statement will specify the doctor's opinion as to the patient's limitations in such areas as sitting, standing, walking, lifting, stooping, reaching, kneeling, crouching, handling, etc. This statement is very useful in deciding the claimant's Residual Functional Capacity (RFC).**
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**RFC - We constantly use the term Residual Functional Capacity or RFC. What does it mean? It simply means the most a person can do in terms of work activity, in spite of his or her impairments. There are 5 exertion levels, given here from easiest to hardest: (1) sedentary (2) light (3) medium (4) heavy (5) very heavy.
Example: An individual who can lift and carry no more than 10 pounds occasionally and who can stand and walk for at least 2 hours per day is capable of sedentary work.
A person who can lift and carry 10 pounds frequently and up to 20 pounds occasionally and who can stand and walk up to 6 hours per day can perform light work, etc.
THE FORSYTHE FIRM
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
"Across From Bridge Street"
PH (256) 799-0297
FREE CONSULTATIONS. NEVER PAY UNLESS YOU WIN. KEEP ALL YOUR MONTHLY CHECKS.
Let me use the example of an individual with back pain as an illustration. The claimant is 44 years old and suffers regular pain in the mid to low back. He describes the pain as 8 on a 0 to 10 pain scale. It is made worse by sitting, standing, walking, bending or lifting. The pain often wakes him up at night. This man has been to the emergency room several times where doctors have diagnosed "chronic back pain" and prescribed muscle relaxers and pain pills. He has stopped working for now.
Social Security will have problems with this claim because:
1) The cause of the back pain is not known. There have been no X-rays or MRIs to see if there is a disc or spine problem. The pain could be caused by a herniated disc but it might also be a muscle problem. Therefore, there is no "medically determinable impairment." Social Security will not award benefits for unexplained back pain (no known medical cause).
2) There is no evidence that this claimant will meet the duration requirement. Social Security requires that a disabling impairment must last for at least 12 consecutive months OR end in death. Without knowing the cause of the back pain there is no way to determine if it can be expected to last for 12 consecutive months.
3) Since this person is a younger individual at age 44, he would also have to prove that there is no kind of work in the national economy that he could perform because of his limited residual functional capacity. Without more medical evidence, it is impossible to determine his residual functional capacity.** Social Security will likely assume that he can perform sedentary work or perhaps light work. That would be cause for denial of benefits.
What This individual Needs
This person needs more medical evaluation, including an MRI on the back, if possible. If he is found to have severe degenerative disc disease, then he meets at least the first 2 steps of the 5 steps necessary to get benefits.
After a proper diagnosis has been made, he needs to be followed by a regular physician, placed on proper medication and other appropriate treatment--to see if the pain is resolved or reduced to manageable levels. Emergency rooms are fine for urgent needs; however, Social Security prefers evidence from the same doctor who has seen the claimant over a longer period of time--with an opportunity to observe and treat with various methods.
Finally, this claimant would benefit from a doctor's written opinion, often called a treating source statement. Such a statement will specify the doctor's opinion as to the patient's limitations in such areas as sitting, standing, walking, lifting, stooping, reaching, kneeling, crouching, handling, etc. This statement is very useful in deciding the claimant's Residual Functional Capacity (RFC).**
- - - - - - - - - - -
**RFC - We constantly use the term Residual Functional Capacity or RFC. What does it mean? It simply means the most a person can do in terms of work activity, in spite of his or her impairments. There are 5 exertion levels, given here from easiest to hardest: (1) sedentary (2) light (3) medium (4) heavy (5) very heavy.
Example: An individual who can lift and carry no more than 10 pounds occasionally and who can stand and walk for at least 2 hours per day is capable of sedentary work.
A person who can lift and carry 10 pounds frequently and up to 20 pounds occasionally and who can stand and walk up to 6 hours per day can perform light work, etc.
THE FORSYTHE FIRM
7027 Old Madison Pike - Suite 108
Huntsville, AL 35806
"Across From Bridge Street"
PH (256) 799-0297
FREE CONSULTATIONS. NEVER PAY UNLESS YOU WIN. KEEP ALL YOUR MONTHLY CHECKS.
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