Residual Functional Capacity

A Residual Functional Capacity Form (RFC) assesses the most amount of work that you can do despite the limitations from your disability.

This RFC form will be filled out at the request of the DDS examiner by a DDS physician or psychiatrist who reviews the medical evidence in your file to gather information. The DDS physician will rate the residual functional capacity after taking into account the medical condition and how it affects the person’s ability to work. The form will make reference to how long a person can sit, stand, walk, etc. Or, in the case of a mental claim, how the person would handle a work environment if they have a poor memory, rational thinking problems, etc.

You may ask your own treating physician(s) to complete an RFC form which can be included with your application. Your medical records are written to keep a record of what your symptoms are at a given time and describe your pain. They are not written in a way that would note your ability to work or your prognosis for returning to work, but this is the information that the DDS physician must use to complete your RFC form. Your own doctor knows you and can shed the best light on how your condition will affect your return to work. An RFC form completed by your doctor can be much more beneficial to you than a form completed by a DDS examiner physician.

If you do choose to ask your doctor to complete an RFC form, you should do it early in your application process. Let your doctor know that you intend to apply for disability and that you would like him/her to complete the form. The RFC form is long, so don’t expect your doctor to quickly fill it out and hand it back to you. If your doctor does not return the form within a few weeks, politely follow up to see if it has been finished.

What is a Consultative Exam?

A Consultative Exam (CE) is a medical examination. Some people who have applied for social security disability benefits are asked to have a consultative exam by the DDS examiner who is handling their claim. You will receive a letter asking for a consultative exam if one is needed.

If your medical records do not have enough documentation, if your application is missing a recent x-ray, or if you have not been seen by your doctor recently, then the DDS examiner may ask for a CE. This is his/her way of gathering more information regarding your condition and limitations which will further help in determining your case.

The CE will not be performed by your own doctor but by a doctor who is contracted by the Social Security Administration. The DDS examiner will request the information or tests that are needed from the physician. Your exam may include a physical, psychiatric or psychological evaluation and may or may not include blood work, x-rays or an eye exam. The examining physician will not prescribe any medication or treatment for you.

Be sure that you attend the CE if you are asked to go. If you do not attend, it may give the examiner a reason to dismiss your claim. If you are unable to attend a scheduled exam, contact your DDS examiner or the CE physician to reschedule as soon as you know you will not be able to make your appointment.

DDS Examiner

The Disability Determination Services employs examiners whose job is to determine whether the claimant is considered blind or disabled according to the law.

The examiner uses an RFC form (Residual Functional Capacity) and fills it out according to the medical information provided by the claimant in their disability application. There are also five criteria that must be met in order for your claim to be approved at this level. If the examiner believes all these criteria are met, then your claim should be approved.

What is Disability Determination Services?

The office of Disability Determination Services is often referred to as the DDS.

DDS is the department that decides whether a person is medically eligible – whether physically or mentally – to qualify for disability benefits.

Before an application is sent to the DDS, it is looked over and non-medical facts (such as age, employment, marital status, etc.) are checked. After that information is verified, the file is sent to the Disability Determination Services where it will be assigned to an examiner who will decide if your case meets the criteria for you to be considered disabled.

If your initial case is denied, the DDS office will also handle the reconsideration claim.

The Steps to your Initial Disability Determination

Once your application arrives at the Disability Determination Services (DDS), your case is assigned to an examiner. The DDS examiners job is to use the information provided in your application to see if you meet the criteria for disability benefits. These criteria are:

1. Are you working at Substantial Gainful Activity (SGA)? Even being able to work a small amount does not disqualify you from claiming disability. If you are found to be able to support yourself by working, you will be denied benefits. If your impairment keeps you from earning enough money to support yourself, then you pass this step.

2. Is your condition(s) severe enough to prevent you from doing basic work?

3. Does your condition(s) “meet or medically equal” the definition in the list of impairments? If you can prove that you have met a listing, or if your conditions combined create problems which equal the listed conditions, then you will continue on to the next step. If your condition does not meet or equal a listing, you could be denied.

4. Are you able to perform your past line of work? If you can return to your line of work, you will not be given benefits. If you are found unable to return to your previous line of work, you will go to the last step.

5. Do your condition(s) and abilities allow you to do a different line of work? This is somewhat up to the SSA and their experts to determine whether there is another line of work that you are able to do. Rather than only going on your medical records, they must speculate about other jobs you can perform.

If more medical information is needed before a decision can be reached, you may be asked to have a Consultative Exam (CE). This is an exam performed by a doctor assigned by the state which is intended to fill in any gaps in your medical information. The Social Security Administration (SSA) pays for this exam. Once enough medical information is gathered your initial application will either be approved or denied.

Your application will be returned to the SSA who will continue with the appropriate action. If you have been found to be disabled, then the SSA will calculate the benefit amount and pay benefits. If you are found not to be disabled, your file will be kept in the field office in case you decide to appeal your claim. This is called a Reconsideration Appeal.

Initial Disability Application

There are several different steps that your initial disability application will go through. It is important to be specific and completely fill out the application before it is submitted. The application forms will ask you to describe your disability (physical or mental), treatments you have received, medications you have or are currently taking, treating doctors and their contact information, as well as how your impairment(s) affect your ability to work. You will also be asked your marital status and if you have minor children living at home.

Once your application for disability benefits has been submitted, the application will be quickly reviewed to make sure it is complete, meets basic requirements and to look at any current work history. Your application will then be sent to the local Disability Determination Services (DDS) in your state.

The state office (or the office nearest you in your state, if you live in a large state) will assign a DDS examiner to your case. This person will use the medical information provided in your file to complete a Residual Functional Capacity (RFC) form and also to evaluate whether you meet disability criteria.

Once enough medical information has been gathered, the DDS will make an initial disability determination. Your case is returned to the SSA who will continue with the appropriate action. If you have been found to be disabled, then the SSA will calculate the benefit amount and pay benefits. If you are found not disabled, your file will be kept in the field office in case you decide to appeal your claim.