What's in a Definition?

A small paragraph can hold a lot of legal content.  Take for instance SOCIAL SECURITY DISABILITY CLAIMS and the definition of disability.

This is basically one definition of disability, but it is modified when dealing with children.

Definition of Disability adult worker (with sufficient paid quarters to get disability insurance) - means the “inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months...42 USC 423(d)(1)(A)

There is also a modification to the definition for adult children.  Disabled Adult Children (Title II only) – An adult child may be eligible for social security disability benefits if he or she has an (1) AND INSURED DECEASED PARENT OR (2) AN INSURED LIVING PARENT WHO IS RECEIVING SOCIAL SECURITY BENEFITS FOR RETIREMENT, DISABILITY OR BLINDNESS, and the onset of disability for the adult child precedes her/his 22^nd birthday.

Similarly,there is a modification to the definition for a disabled child. The Personal Responsibility and Work Opportunity Act of 1966 changed the statutory definition of disability or SSI eligible disabled children, requiring that for a condition to be considered disabling it must impose MARKED AND SEVERE FUNCTIONAL LIMITATIONS.  The regulations issued as a result of Sullivan v Zebley, 493 US 521, 110 S.Ct 885 (1990).

For this entry, I am only focusing on the adult definition, i.e. the “inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months...42 USC 423(d)(1)(A)

Inability to engage in any substantial gainful activity.  This is a mouthful.  It does not mean as a lot of client’s understand, to be a replacement for unemployment.  The fact that a claimant is not working, or claims to have an impairment that prevents his/her employment, or any job that could be worked produces much less then my prior job, or “The job is below someone with my work history”,  means very little to the process.

It doesn’t matter that you can no longer do your prior employment, if you can do another job, within your function capacity, i.e. you can’t be a security guard, but you could work bench assembly.  It doesn’t matter that you consider such a job below you, or that it does not produce the income your prior job produced.

If there is a job out there that could pay you over $1,100.00 per month and it is within your functional capacity, like it or not, you have the ability to be engage in substantial gainful activity.

Sadly, social security doesn’t need to prove the job(s) that it finds that you can do even still exist in the economy, or where the jobs are.  You cannot argue, if the job is out there  show me where and prove it will hire me, if you are finding me not disabled.  The material upon which social security relies upon to identify jobs is not the most current information on the market.  As a matter of fact, a major part of the job evidence is over ten years old.

What is residual functional capacity?  What does it assess?  RFC is the term used by SSA to denote what a claimant can still do despite his or her limitations.  It must be based on consideration of all impairments, and all relevant evidence, including a claimant’s own statements.  20 CFR § 404.1545(a), 416.945(a).

Residual Functional Capacity include items such as:  The ability to understand, carry out and remember instructions, and the ability to respond appropriately to supervision, co-workers, and work pressures in a work setting. Again the nature and the severity of any mental, emotional, or intellectual limitation will determine the extent to which the capacity to work is impaired.  THE CENTRAL QUESTION IN ASSESSING AN INDIVIDUAL’S MENTAL CAPACITY IS WHETHER THE PERSON CAN PERFORM WORK ON A SUSTAINED, ON GOING, INDEPENDENT AND APPROPRIATE BASIS.  POMS DI 24510.085(A);  SSR 85-15

The inability to be engaged in substantial gainful activity must be because the claimant suffers  a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

The first question is what is a determinable physical or mental impairment?  Is it only impairments for which objective medical evidence exists that show the impairment?  If it is, then people with chronic pain, somatoform disorders etc. would never qualify.  If the definition includes such problems, how do you prove that claimant is suffering?

Consider a claim for benefits based upon disabling pain - :  An individual’s  statement as to pain or other symptoms shall not alone be conclusive evidence of disability…; there must  be medical signs and findings, established by medically acceptable clinical or laboratory diagnostic techniques which show the existence of a medical impairment that results  from anatomical, physiological or psychological abnormalities which could reasonably be expected to produce the pain or other symptoms alleged and which, when considered with all evidence required to be furnished under this paragraph.(including statements of the individual or his physician as to the intensity and persistence of such pain or other symptoms which may reasonably be accepted as consistent with the medical signs and findings)  would lead to a conclusion that the individual is under a disability. 

Consider a mental disorder - :  The mere existence of a mental impairment is not per se disabling.  There must be evidence of significant functional restrictions in areas such as activities of daily living, maintaining social functioning, deficiencies of concentration, persistence or pace, deterioration or decomposition in a work-like setting, or the ability to sustain mental activities necessary to the performance of sustained work activity.

If that is not confusing enough, there is nothing in the foregoing that says the Judge cannot find claimant’s evidence, i.e. his doctor reports, claimant’s statements, lacking in credibility.

The impairment must result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

What if there are multiple impairments claimed to cause disability, but one or more occurred at different times, i.e. one impairment existed on filing, another was occurred at a later date and the first healed, but the second did not and at the end of the 12 months the second impairment is all that remains.  You cannot add impairments together to establish the twelve month period.  You can be disabled from multiple impairments if the combined effect lasts the required period of time.