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Author Topic: Cdr Residual functional capacity?  (Read 3664 times)

departed69

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Cdr Residual functional capacity?
« on: July 27, 2022, 10:30:17 am »
When undergoing a Long form cdr does SS ask your physicians to fill out a new RFC report like they may have done at initial approval level? If not then how does Ss decide your new rfc if they they assume one of your conditions has improved? Also I wonder what weight if any ones own statements regarding their daily activities and symptoms on the long form are given. It seems to me they don't really care and that they are just looking for the wrong answer and an excuse to cease benefits. Any insight or answers would be helpful. Thanks

newdawn

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Re: Cdr Residual functional capacity?
« Reply #1 on: July 27, 2022, 11:16:41 am »
When undergoing a Long form cdr does SS ask your physicians to fill out a new RFC report like they may have done at initial approval level? If not then how does Ss decide your new rfc if they they assume one of your conditions has improved? Also I wonder what weight if any ones own statements regarding their daily activities and symptoms on the long form are given. It seems to me they don't really care and that they are just looking for the wrong answer and an excuse to cease benefits. Any insight or answers would be helpful. Thanks

From my understanding, it would be unlikely/unusual that DDS would ever send your doctor an RFC report/form to fill out prior approval or during a CDR. Sometimes attorneys or claimants themselves will have an RFC form they have their doctor fill out but anything in that has to already be backed up by what's written in your medical records.

The only "real" RFC that "counts" is the one filled out by an MC or PC (medical or psychological consultant--some kind of doctor) at DDS that you will never see or have contact with. They look over your medical records and forms you have filled out and determine your official RFC. This is shared with the DDS case worker working on your claim or CDR. That's the RFC that is used.

FWIW, to belabor a point, most people have no issues with a long form CDR. IMO, they're not looking for a wrong answer and an excuse to cease benefits. The statistics seem to back this opinion up. It's different than during the application process where sometimes it seems like they are cherry-picking info from forms and records to look for reasons to deny.

Now, if one's condition truly has significantly improved related to the ability to work or one is not seeking treatment for conditions that require treatment, there could be issues during a CDR.
Location: IL
Age at Application: 31
Disability: Depression, anxiety
Applied: 11/2013
First Denial: 03/2014
Reconsideration Denial: 11/2014
Hearing: 11/13/15 (Friday the 13th!)
ALJ Approval: 01/15/16 Fully Favorable
Back Pay: 02/13/16
Award Letter: 02/17/16
1st monthly benefit: 03/21/16

VET76

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Re: Cdr Residual functional capacity?
« Reply #2 on: July 27, 2022, 01:14:22 pm »
New dawn,
Not to high jack this thread and I believe I had this discussion in an earlier thread. I first agree with you on all the points you made. However, is this not a example for beneficiaries who were approved by an ALJ? My point is, the initial RFC created and given to DDS led to denials in the initial phase and during recon, the ALJ just overturned that decision by giving more weight to the treating physicians and the RFC the claimant turned in. In that sense, the DDS RFC was one of the deciding factors up until the hearing. Now, in my case..I have been seen my LCSW and Psychiatrist twice a month for years, nothing has changed in my treatment plan, including meds etc. I do not see how the internal DDS RFC would change into my favor when I come up for my first CDR. In the decision letter the ALJ specifically pointed out that the Agency's RFC was and I qoute" not reflecting the true impairment of the claimant based on available medical records, and will not be considered in this decision". So I do believe that there is a disadvantage for any beneficiary that had a inot supporting nitial RFC done by DDS. Now I understand that DDS has to prove that you have improved enough to perform SGA, but what is the bar for the RFC? Also, the ALJ who ruled in my favor mentioned that I met I believe 4 listings..does that factor in during a CDR?
Sorry again for the long post, to do it in someone else's thread..but very curious if others can chime in as well?

newdawn

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Re: Cdr Residual functional capacity?
« Reply #3 on: July 27, 2022, 07:04:09 pm »
New dawn,
Not to high jack this thread and I believe I had this discussion in an earlier thread. I first agree with you on all the points you made. However, is this not a example for beneficiaries who were approved by an ALJ? My point is, the initial RFC created and given to DDS led to denials in the initial phase and during recon, the ALJ just overturned that decision by giving more weight to the treating physicians and the RFC the claimant turned in. In that sense, the DDS RFC was one of the deciding factors up until the hearing. Now, in my case..I have been seen my LCSW and Psychiatrist twice a month for years, nothing has changed in my treatment plan, including meds etc. I do not see how the internal DDS RFC would change into my favor when I come up for my first CDR. In the decision letter the ALJ specifically pointed out that the Agency's RFC was and I qoute" not reflecting the true impairment of the claimant based on available medical records, and will not be considered in this decision". So I do believe that there is a disadvantage for any beneficiary that had a inot supporting nitial RFC done by DDS. Now I understand that DDS has to prove that you have improved enough to perform SGA, but what is the bar for the RFC? Also, the ALJ who ruled in my favor mentioned that I met I believe 4 listings..does that factor in during a CDR?
Sorry again for the long post, to do it in someone else's thread..but very curious if others can chime in as well?

The ALJ assesses RFC at the hearing level (for those who do not meet/equal a listing). Then the earlier internal DDS RFCs become irrelevant going forward. Your approval letter gives the rationale for your approval. During a future CDR, the DDS caseworker cannot substitute his/her judgement for the prior CPD*, which is the ALJ's approval if it's your first longform CDR.

During the CPD review, the CDR adjudicator must not substitute his or her judgment for that of the prior adjudicator by:

-re-adjudicating the case, or
-reviewing the CPD evidence with the intent to find error in the CPD medical determination.

[see link below, "Discussion of the 8-step CDR Eval process)

For those approved by meeting/equaling a listing, it bypasses the RFC thing since the listings are short cuts in a way, i.e. if you can prove you meet/equal a listing, it is agreed upon by everyone that you are officially "disabled" according to the disability rules/laws. For example, there's really no point in going to all the bother of determining RFC for someone (for example) that has ESRD (end stage renal disease--one listing). Same goes for a CDR, if you still meet/equal a listing, they don't bother to assess RFC and your benefits just get continued (see 8-step process as mentioned already and linked to below).

"The Listing of Impairments describes, for each major body system, impairments considered severe enough to prevent an individual from doing any gainful activity (or in the case of children under age 18 applying for SSI, severe enough to cause marked and severe functional limitations)."

https://www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm

Also, just to back up my "short cuts" comment regarding the listings (I'm tired so "short cuts" is perhaps not the best description)...

The Listings serve as a screening tool at the initial decision stage to expedite the identification of individuals whose impairments clearly more than equal the level of severity that defines disability in the Social Security Act. Quick identification of obvious cases deserving benefits permits the Social Security Administration (SSA) to avoid a time-consuming and resource-intensive inquiry into all of the case facts. Using the Listings as an administrative expedient, SSA is able to process more cases more quickly and cost effectively than it would otherwise. As SSA explained in a February 10, 1994, final regulation, Revised Medical Criteria for Determination of Disability, Cardiovascular System (59 FR 6468):

"The listings are intended to be a screening device by which we can identify and allow claims filed by the most obviously disabled individuals; they are not an all-inclusive list of disabilities under which all individuals must be found disabled."


Also, "In addition to efficiency, the Listings are intended to ensure that there is a medical basis for the disability and that all applicants receive equal treatment" and "In addition to providing equal treatment for all applicants, the Listings were intended to ensure adjudicative consistency".

There's a history of how the Listings came into being if you scroll down the link below which is the source of the material quoted above:
https://www.ncbi.nlm.nih.gov/books/NBK332903/

Adult CDR Process Summary Chart (8-step evaluation process):
https://secure.ssa.gov/apps10/poms.nsf/lnx/0428005010

Discussion Of The 8-Step CDR Evaluation Process (gives more detail than the chart):
https://secure.ssa.gov/apps10/poms.nsf/lnx/0428005015

*CPD defined: https://secure.ssa.gov/poms.nsf/lnx/0428010105
Location: IL
Age at Application: 31
Disability: Depression, anxiety
Applied: 11/2013
First Denial: 03/2014
Reconsideration Denial: 11/2014
Hearing: 11/13/15 (Friday the 13th!)
ALJ Approval: 01/15/16 Fully Favorable
Back Pay: 02/13/16
Award Letter: 02/17/16
1st monthly benefit: 03/21/16

VET76

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Re: Cdr Residual functional capacity?
« Reply #4 on: July 27, 2022, 07:53:17 pm »
I appreciate your in depth reply NewDawn,even while tired you explained it throughly.  I just find ot odd, and you may too that the ALJ decided that one met or exceeded a listing or listings during the hearing. In any case I would argue that th3 internal RFC completed by DDS was grossly wrong. Now I do understand that the Adjuticator does not take into account any evidence prior to your last CPD and only uses the evidence available from that date forward. I wonder if the Adjuticator during the 8 step process at any point differentiate between you are still disabled or b. just decides that you have improved enough to be fully employed again.
What I mean by that is that we can probably agree on , doctors do not annotate in their notes after every visit that your disability prevents you from employment. I can only.speqk for myself, but my two treating sources both put it in there maybe every 12 months.
I just still feel that we all have to proof we are still disabled , even though the burden of proof lies with DDS at that point.
Again, I appreciate you posting these links and I will certainly read through them tomorrow.