TRANSLATING MEDICAL PROBLEMS INTO VOCATIONAL IMPAIRMENTS

For most people, getting disability benefits depends on the fact that you can't work.  By definition, if you can work you aren't disabled.

So, in a Social Security disability claim it is essential to translate medical problems into vocational problems.

For example, you have arthritis in your lumbar spine, knees and other joints.  This causes pain, inflammation and stiffness.  Those are medical conditions.  But how is your ability to do work-like activity restricted?  How does back and knee pain limit your ability to sit, stand and walk?  What restrictions are placed on your ability to lift, push and pull? 

We must realize that back pain is going to have different effects on different jobs.  With significant back pain you may not be able to perform a job with lots of standing, walking, bending and lifting.  But a sedentary job where you can sit most of the time may not be affected the same way.

Many times, back pain can restrict how long an individual can sit.  Sedentary work, the easiest of all work, requires the ability to sit for about 6 hours per day and to stand and/or walk up to 2 hours per day.  If you can show that back pain prevents your ability to sit a total of up to 6 hours in a day, you may be found unable to perform sedentary work.

In a disability hearing, we want to first establish what your medical conditions are:  arthritis, bulging or herniated discs, cervical or lumbar radiculopathy, stenosis, etc.  Next, we want to carefully describe the symptoms caused by these conditions.  Finally, we want to establish how these symptoms interfere with your ability to function in an employment setting:  how long you can sit, stand, walk; how much you can lift, push and pull.

This helps the judge to establish your Residual Functional Capacity (RFC).  This in turn helps the judge decide what kind of questions to ask the vocational expert. 

Here is a typical hypothetical question as it might be asked of the vocational expert in a hearing:

I want you to assume an individual who has the same age, education and past work experience as the claimant.  I want you to further assume an individual who is capable of sustaining work at the light exertion level.  Specifically, she can lift up to 10 pounds frequently and 20 pounds occasionally; can sit for up to 6 hours per 8-hour day, and she can stand and/or walk with usual breaks for up to 6 hours per 8 hour day.  She can frequently stoop, balance and reach.  She can frequently feel, handle and grasp.  She can occasionally climb ramps and stairs but never ropes, ladders or scaffolds.  She should avoid hazards, including but not limited to unprotected height and moving, dangerous machinery.  Given these restrictions, could the individual perform any of her past relevant work or any other work?

This hypothetical is rather unrestricted.  While the judge realizes that there are some medical impairments, he seems convinced that there are no major obstacles to work in the light range of jobs (lifting no more than 20 pounds).  This claim is going to have a difficult time being approved.

What we would like to do is establish more severe limits on standing, walking, reaching, lifting, pushing and pulling, so that the judge includes more restrictions in his hypothetical question.  One way to achieve that is by getting the claimant's doctor to provide a Medical Source Statement, detailing what the doctor believes the claimant's restrictions are.  If the doctor, for example, states that the claimant cannot lift more than 10 pounds, can't stand more than 4 hours per day and can't stand/walk more than 3 hours per day, we have something to work with.

Vocational functionality is one of the many pieces of the puzzle that has to work for a claim to be approved.  I think you can see that it is not enough just to prove that you have arthritis in the back and knees.  The simple question is, "Can you still work, even with some arthritis in the back and knees?"  If Social Security believes that you can, your claim is on its way to a denial.

The first thing I look at in a new case is, "OK, what are the medical conditions?"  Then, "OK, how does this prevent you from doing your past work?"  Third, "How does this prevent you from doing other types of work?"  Knowing the rules and how the judge will apply them is a great advantage.  It helps us to draft a case that uses both medical and vocational evidence to prove that you cannot work 8 hours a day, 5 days a week on a "regular and continuous basis."
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