What is Residual Functional Capacity (RFC)?
When you make a claim for Social Security Disability benefits, you are in effect claiming that you can no longer work because of your physical or mental health problems (or a combination of the two). The federal Social Security Administration (“SSA”), acting through a state agency called Disability Determination Services (“DDS”), will evaluate that claim based on their rules for determining whether your evidence proves it to be true.
There are two ways to win a disability claim. One is pretty straightforward and the other can be a little more complicated.
You can receive approval for disability benefits by:
- Proving that you meet one of the SSA’s “Listings” of impairments, which automatically qualifies you as “disabled”
- Proving that your “residual functional capacity” or “RFC” is so limited that no jobs could accommodate all of your impairments.
So, what exactly does “residual functional capacity” mean?
What is Residual Functional Capacity?
Everyone has a “functional capacity.” That term simply means “what you can do.” For a worker without any significant medical problems, their “functional capacity” is virtually unlimited. They can do whatever needs to be done to get and hold a job — things like sitting, standing, walking, talking, carrying objects, using their hands to manipulate things (including a keyboard), and interact appropriately with co-workers.
However, when you have serious medical or mental problems, your functional capacity may be limited by the effects of those problems. Your remaining ability to do things, taking those limitations into account, is your residual functional capacity or “RFC.”
RFC and Disability
In the Social Security disability world, the term RFC has a specific, defined meaning. The SSA says that your RFC “is the most you can still do despite your limitations.”
When DDS makes this determination, they must consider ALL of your severe impairments, but only those that are both “severe” and “medically determinable” as they define those terms. A “severe” impairment is one that has more than a minor effect on your ability to do things. And a “medically determinable” impairment is one that can be proven by medical evidence like test results and medical records. For instance, “pain” is not considered a “medically determinable impairment” — it must be associated with an underlying medical problem like a diagnosed spine issue or other condition. Pain is a symptom, not an impairment.
How is Your RFC Determined by the DDS?
So, how does DDS determine what your RFC is? They turn to two primary sources:
- Your medical records
- The opinions of your doctors
As mentioned above, you must have treatment records from health care providers to prove that you have a “medically determinable impairment.” If you have been suffering from horrible pain or other symptoms but you have not been getting medical care for it, you cannot rely on your own subjective complaints of pain to prove your case, no matter how bad it has been. You MUST have a diagnosis from a doctor or other provider to prove WHY you have the pain. DDS will not put limitations on your RFC without proof from a health care provider that you have a real, diagnosed medical condition.
The same is true for mental health issues. If you want DDS to take your mental health symptoms into account in formulating your RFC, you must get treated by a professional and your treatment must be documented. It is not enough to tell DDS how anxious, depressed or isolated you have been — you must seek professional care and gather the records of that care so they can be submitted to DDS.
Once you have your physical and mental health impairments diagnosed and treated by medical professionals, DDS will look to those professionals for their opinions on how limiting your impairments are. Some doctors and other professionals are willing to give these kinds of opinions, while others are not. If you are fortunate enough to have one or more of your doctors give you a written opinion on your RFC, then DDS will compare it to what your treatment records say.
Sometimes DDS concludes that the medical records they have do not give them enough information to decide your case. This is especially so when your doctors are unwilling or unable to provide DDS with any opinion evidence. In this situation, DDS will sometimes send you to one of their “agency doctors” for an examination and the formulation of opinions on your RFC.
We have discussed these “agency doctors” in another article. In summary, their examinations and reports are often inadequate to give DDS a true picture of your level of impairment. For this reason, we strongly encourage our clients to get as much supporting information as they can from their own treating medical providers and to NOT rely on agency doctors.
Consistency and Supportability
DDS is supposed to evaluate the opinions of your doctors and other health professionals on the principles of “consistency” and “supportability.” There is a misconception out there that once you get a doctor to say that you’re “disabled,” you win your case. That is simply not true.
For example, your doctor’s treatment notes may say that your medical problems are relatively minor, but then that same doctor may give an opinion of your RFC that you can barely do anything. That is an inconsistency that will result in DDS not paying much attention to his or her opinions. The same goes for any doctor’s opinion in support of your claim — it must be consistent with, and supported by, the doctor’s treatment records and the rest of the evidence from other sources.
Once DDS arrives at what they consider to be a true and accurate RFC for you, they will look at your age, your education, and your work history to determine whether there are jobs in the economy that a person as limited as you could perform on a full-time basis. If they answer is “yes” then they will deny your claim; if it is “no” they will approve it.
An experienced North Carolina disability lawyer can help you compile the evidence needed to support your disability claim or appeal. For a FREE consultation with a disability lawyer at Riddle & Brantley, call 1-800-525-7111.
RFC and Disability: The Bottom Line
This is an extremely simplified explanation of residual functional capacity. Every case is unique, and there are exceptions to every rule (and sometimes exceptions to the exception). The determination of your RFC can very often make or break your case, which is why you need the help of an experienced, knowledgeable disability lawyer (especially a Board-Certified Specialist) to help you develop and gather the evidence to support your claim.
For a FREE consultation with an experienced disability lawyer at Riddle & Brantley, please call 1-800-525-7111 or complete the short form below.
There are no upfront costs and you won’t pay any attorney fees unless we win your case and get you the disability benefits you need and deserve.
“I would recommend Riddle & Brantley to anyone who needs help with disability.”
–B. Fields, Riddle & Brantley client
Please call 1-800-525-7111 today and let’s review your disability claim.
We can help with claims concerning all types of disabling conditions, including but not limited to:
- Back problems
- Mental health disorders
- Kidney disease
- Deafness and hearing loss
- Blindness and vision loss
- Heart problems
- Diabetes-related conditions
- Lung disease and breathing problems
Please call 1-800-525-7111 for a FREE, no-obligation consultation concerning your disability claim or appeal.
Don’t wait — we can assist with appeals to the SSA.
Call 1-800-525-7111 today and let’s review your claim.