Why Functional Limitations Matter More Than Medical Diagnoses in Social Security Disability and Alabama Workers’ Compensation Cases

Why Functional Limitations Matter More Than Medical Diagnoses in Social Security Disability and Alabama Workers’ Compensation Cases

Why Two People with the Same Diagnosis May Receive Very Different Legal Outcomes

Throughout this series, we have discussed several mental abilities that are essential to maintaining employment.  We have examined the ability to:

• understand, remember, and carry out instructions;
• maintain concentration, persistence, and pace;
• interact appropriately with supervisors, coworkers, and the public;
• adapt to changes in the workplace; and
• sustain competitive employment on a regular and continuing basis.

These abilities are evaluated every day by physicians, psychologists, vocational experts, Administrative Law Judges, and courts.

Perhaps the most important lesson from this series is this:

Disability claims are not decided simply by the name of a medical diagnosis. They are decided by how that medical condition affects your ability to function in the workplace.

Understanding that principle helps explain why two individuals with the same diagnosis may receive very different legal outcomes.

Recommended Reading: Isn’t My Diagnosis Enough to Qualify for Disability Benefits

A Diagnosis Begins the Analysis—It Does Not End It

Many people believe that once they receive a diagnosis such as:

• degenerative disc disease;
• PTSD;
• depression;
• fibromyalgia;
• traumatic brain injury;
• multiple sclerosis;
• chronic pain syndrome; or
• anxiety disorder,

their disability claim should automatically be approved, and that is somewhat understandable.  After all, receiving a serious diagnosis often changes a person’s life.

Legally, however, a diagnosis is only the beginning of the analysis.  The more important question is:

What limitations does that condition produce?

For example: Two people may both suffer from lumbar degenerative disc disease.  One experiences occasional pain but continues working full-time.  The other cannot sit longer than twenty minutes, requires narcotic pain medication, sleeps poorly, struggles to concentrate, and must lie down several times each day.

Although their MRI findings may appear similar, their ability to maintain employment is dramatically different.

Disability law recognizes that difference.

Recommended Reading: Why Your Restrictions are More Important than a Diagnosis

Social Security Evaluates Functional Capacity

The Social Security Administration evaluates disability through a five-step sequential evaluation process found in 20 C.F.R. §§ 404.1520 and 416.920.

As part of that process, Social Security determines the claimant’s Residual Functional Capacity (RFC).

Under 20 C.F.R. §§ 404.1545 and 416.945, RFC represents the most an individual can still do despite medically determinable impairments.

Importantly, RFC includes both:

Physical limitations, such as:

• lifting;
• carrying;
• standing;
• walking;
• sitting;
• reaching; and
• postural activities.

and

Mental limitations, including:

• understanding and remembering instructions;
• maintaining concentration;
• making work-related decisions;
• responding appropriately to supervision;
• adapting to workplace changes; and
• sustaining work activities over time.

Social Security evaluates the combined effect of all of these limitations when determining whether an individual can perform past work or adjust to other work.

Recommended Reading:Why Work Classifications Matter in Alabama Workers’ Compensation,  Social Security Disability Cases and The Five-Step Sequential Evaluation Process and What is My Residual Functional Capacity?

Medical Evidence Must Translate into Functional Limitations

One reason disability claims become difficult is that medical records often describe diagnoses rather than limitations.  For example, an MRI may reveal:

• disc herniations;
• spinal stenosis;
• degenerative arthritis; or
• nerve compression.

Those findings are certainly important; however, the MRI does not answer questions such as:

• How long can the individual sit?
• Can the person stand throughout a workday?
• Does pain interrupt concentration?
• Does medication impair alertness?
• How often must the individual rest?
• Can the person maintain regular attendance?

Those questions are answered through medical opinions, treatment records, Functional Capacity Evaluations (FCEs), psychological testing, vocational evidence, and the claimant’s own testimony regarding daily functioning.

The diagnosis explains what the medical condition is.

Functional evidence explains what the condition prevents the individual from doing.

Recommended Reading: What is a Functional Capacities Evaluation?

Symptoms Rarely Exist Alone

Another important principle is that impairments seldom occur in isolation.  Consider someone suffering from severe chronic back pain.  The individual may also experience:

• sleep disturbance;
• fatigue;
• depression;
• anxiety;
• reduced concentration;
• medication side effects;
• memory difficulties; and
• decreased stress tolerance.

Each limitation affects the others.  Pain reduces sleep.  Poor sleep increases fatigue.  Fatigue reduces concentration.  Reduced concentration increases mistakes.  Mistakes increase stress.  Stress often worsens pain.

This cycle may substantially reduce a person’s ability to maintain employment even when no single symptom appears completely disabling by itself.  Social Security recognizes this principle by requiring consideration of the combined effects of all medically determinable impairments.

How Social Security Evaluates Symptoms

Another important point is that Social Security does not evaluate symptoms based solely upon whether an MRI or laboratory test proves the degree of pain a claimant experiences.

Instead, SSR 16-3p explains how the agency evaluates the intensity, persistence, and limiting effects of an individual’s symptoms.

The ruling directs adjudicators to consider the entire record, including:

• objective medical evidence;
• treatment history;
• medications;
• daily activities;
• factors that worsen symptoms;
• efforts to obtain relief; and
• the consistency of the evidence as a whole.

The focus remains the same: How do these symptoms affect the person’s ability to function in a work environment?

Functional Limitations Also Drive Alabama Workers’ Compensation Cases

The same practical principle applies in Alabama workers’ compensation cases, although the legal standards differ.

For body-as-a-whole injuries, Alabama law focuses upon vocational disability and loss of earning capacity rather than simply assigning a medical impairment rating.

A physician may assign a relatively modest permanent impairment rating, yet the employee’s actual vocational disability may be significantly greater.  Why?

Because courts and vocational experts consider factors such as:

• age;
• education;
• work history;
• transferable skills;
• permanent work restrictions;
• chronic pain;
• medication side effects;
• cognitive limitations; and
• the practical ability to obtain and maintain reasonably suitable employment.

For example, a forty-five-year-old accountant and a forty-five-year-old construction laborer may receive identical permanent impairment ratings following the same knee injury.  Nevertheless, the effect upon their earning capacity may be dramatically different because their occupations place very different physical demands upon them.

Likewise, chronic pain, PTSD, or medication side effects may substantially reduce employability even when the physician’s impairment rating appears relatively modest.

Recommended Reading: What Do Permanent Work Restrictions Mean?, and What Do Sedentary, Light, Medium, Heavy, and Very Heavy Work Really Mean?

Why Physicians, Vocational Experts, and Judges Focus on Function

Physicians diagnose disease.

Vocational experts evaluate employability.

Administrative Law Judges determine disability under the Social Security Act.

Judges hearing Alabama workers’ compensation cases determine vocational disability under Alabama law.

Although each professional serves a different role, they often ask remarkably similar questions.

Can this person:

• work consistently?
• maintain attendance?
• remain productive?
• learn new tasks?
• interact appropriately with others?
• adapt to workplace changes?
• complete a normal workday?
• safely perform required job duties?

Those are functional questions, and they frequently determine the outcome of disability claims.

The Bottom Line

Medical diagnoses matter.  Without a medically determinable impairment, there can be no disability claim, but diagnoses alone rarely determine the outcome.

What matters most is how those medical conditions affect your ability to function in the real world.

Can you remain on task?

Can you remember instructions?

Can you interact appropriately with others?

Can you adapt to workplace changes?

Can you sustain competitive employment eight hours a day, five days a week?

Those are the questions that physicians, vocational experts, Administrative Law Judges, and courts answer every day.

Ultimately, disability law is not simply about identifying disease.  It is about understanding how disease, injury, pain, and their consequences affect a person’s ability to earn a living.

Coming Next…

In our next series, we’ll examine an issue that affects thousands of disability claimants but is frequently misunderstood:

The Hidden Effects of Chronic Pain: Why Pain Changes Much More Than Your Ability to Lift, Stand, or Walk

We’ll explore how chronic pain affects concentration, memory, sleep, fatigue, emotional well-being, medication use, attendance, productivity, and overall employability—and why understanding these hidden effects is often essential to proving both Social Security Disability and Alabama workers’ compensation claims.