INTRODUCTION
It has been my pleasure to work with literally hundreds of disabled folks WORLDWIDE who are looking to document their situation, and thereby, obtain any and all Disability Insurances for which they are qualified.
The primary assistive device used in this endeavor is the DisabilityKey Workbook, available for sale at my website:
www.disabilitykey.com. The disability insurance “How-To” instructions and various qualifying form blanks and actual completed examples contained within the Disabilitykey Workbook are augmented by the numerous articles and “ebooklets” available at the website for free download. Finally, my two Blogs located within the website contain significant information to assist people who are disabled become Chronic Disease Self-Managers; become “Expert Patients”; and, partner with their Doctors to benefit from Patient-Centered Health Care.
The purpose of this article is to address the Number One cause for people who are denied eligibility for Social Security Disability Insurance (SSDI), and for Long Term Disability (LTD) insurance for “any occupation”:
the inability to convince the Social Security Administration that the person is unable to perform “gainful employment”.
THE “WHY” OF THE DENIAL BY SOCIAL SECURITY
The “yardstick” used by the Social Security Administration can be summarized as follows:
Are you able to perform any gainful employment for which your age, education, and job history equip you to perform, that can earn you the Social Security’s minimum monthly income amount ($830 in 2006).
To better understand this “yardstick”, let’s take a “menial” job like an entry level clerical position, which might pay $10 per hour. $830 divided by $10 per hour equates to a minimum of 83 hours that needed to be worked in any given calendar month. As there are 173 “workable hours” within a calendar month, 83 hours equate to about half time, or, stated another way, about 20 hours per week. AND, since the Social Security Administration is well aware of the ADA (Americans With Disability Act) requiring Employers to make “reasonable accommodations” to allow disabled employees to continue working, they firmly believe that you, the disabled person, can work with a perspective employer to “create” a workable environment for yourself for only 20 hours a week!!
The following story, related to me by a Federal Magistrate who serves as a Social Security Hearings Administrator, rendering decisions on SSDI claims appeals, graphically explains how difficult it is to document and “prove” the inability of many people with disabilities to “meet” this Yardstick.
Mrs. Smith appears before the Social Security ALJ with her attorney to appeal her denial of SSDI eligibility. The SSALJ asks her to describe her day.
[1] Mrs. Smith provides the following information.
“Hello your Honor. My name is Mrs. Mary Smith. I’m here to appeal the Social Security Administration’s decision that I am not disabled. I fully believe that after you hear about my day, you will agree with me that I am disabled.
1. First of all, I get up in the morning, get dressed, and have a little breakfast. Then I go outside – if the weather is good – and do some gardening.
2. Then, I have to take a rest for a while; at lunchtime, I have some lunch. Then, I rest and watch a little TV while doing some crocheting. After a while, I need to take a nap until dinnertime.
3. I cook dinner for my husband –I have to sit while working, I can no longer stand, and he has to do the dishes and clean up.
4. We spend time together, then go to bed.
That’s my day, your Honor.”
Thank you, Mrs. Smith, says the SSALJ. Based on your testimony, I find that you are not disabled; appeal denied.
WHY was she denied, you wonder? Well, I asked the SSALJ who related this story to me, and this was his logic.
1) Her physicality is such that she can kneel to do gardening for a period of time.
2) Her small motor skills, cognitive skills and vision are sufficiently good for her to do crocheting.
3) Her small motor skills, cognitive skills and vision are sufficiently good for her to follow recipes and cook.
4) As Mrs. Smith is in her 40’s; as she has a BA in English; and, as her work experience demonstrates a series of significantly more responsible jobs, I find NO EVIDENCE that Mrs. Smith can NOT perform gainful employment.
The SSALJ’s logic here is the key to understanding SSDI eligibility “justification documentation”. He made his decision because there was no “connect the dots” evidence to prove that Mrs. Smith COULDN’T perform gainful employment; therefore, she can. THE RESPONSIBILITY FOR PROOF – FOR CONNECTING THE DOTS – BELONGS TO THE APPLICANT!
DOCUMENTING INABILITY TO PERFORM GAINFUL EMPLOYMENT
The DisabilityKey Workbook contains the instructions for, and the blank forms and examples for a person with disabilities to document, in GREAT DETAIL AND SPECIFICITY the following:
1) how exactly their symptoms impair their normal daily activities – both at work and at home and over the weekend; and
2) a “picture in words” about what their “normal daily – work, home, and weekend – activities” consisted of when they were working, and since they became a person with disabilities unable to work.
Subsequent to this documentation, my research into the Social Security Administration’s decision-making process has provided me with anecdotal evidence that ANOTHER type of documentation also must be provided. The person with disabilities must take the additional step to document that s/he can not perform “gainful employment” for which their age (years under age 65 or later, depending on the year born); education, and previous job history equip them to perform wherein they can earn the SSA’s monthly minimum earnings amount.
Consider the “disability documentation” provided above by Mrs. Smith, and the excerpt below from a client.
[2] This excerpt came directly from her “Before and After” matrix.
Ø Wake up between 11am and 1 pm.
Ø Getting dressed, brushing teeth, combing hair, and washing face, now take me 25-30 minutes.
Ø Crawl downstairs, (literally) to take morning pills and eat something. Typically, a piece of bread, or dry cereal. Crawl back upstairs and rest between 20 and 30 minutes. Attempt to complete light duty household chores in 10 minute intervals. On the days I wake up earlier, I typically take a short nap between 1:30 and 2pm.
Ø Nap between 4 and 5:30pm.
Ø Crawl downstairs to empty dishwasher and set table for dinner. Eat dinner and talk with my family from 6:00pm - 7:00pm.
Ø Showering now takes me between 30 and 45 minutes. If I have to wash my hair it is all that I can do for that day's "activity". I also have stopped shaving my legs.
Ø Nap between 8 and 10:00pm.
Ø 10:00pm wake up to take meds, check emails, and IM friends until Midnight. Typing takes much longer, now, as sometimes the wrong key is hit (i.e., when I want the e, the o comes; the p becomes a w; etc.) as well as forgetting how to spell words, and often losing stream of consciousness. I often substitute words with others that make no sense. For example: Yesterday, I asked my brother if he would put my furniture on the dinner table for me, instead of my dinner plate. I also have trouble "remembering" words. For example: I may want to speak to someone about some music that I have just heard, but can't remember specific phrases or terminology to use. I also often find that I reverse letters in words. (Alos, instead of also; Wednseday, instead of Wednesday; etc.). EVERYTHING that I type must be reviewed by someone else!
Ø Paying bills is a big chore, as it taxes my cognitive and memory skills. Changing the sheets on the bed can take hours, as the activity can be accomplished in only 10 minute intervals; 15 at the most.
Ø I now do my laundry sporadically throughout the week. Typically only washing one load a day. As that is the most I can carry up and down the stairs. To finish my laundry now takes 3-4 days.
As you can see, the specificity of the information about the normal daily activities is much greater in this example as compared to Mrs. Smith’s examples; here, the dots are connected between activities that can lead to gainful employment and the applicant’s symptom impairments.
However, the documentation needs to be taken one step further. As you will see below, it is HIGHLY recommended that you create what is called an ESSENTIAL JOB FUNCTION matrix. Typically, this Matrix will have two components: the essential job functions of the position you held immediately prior to your determination of disability, and the essential job functions of what, for you specifically, would be considered “gainful employment”.
Now, the DisabilityKey Workbook contains an example of what is called an “ADA-qualified Essential Function Job Description”. And, the process recommends that you create such a document for your own job, and use the “essential functional physical, mental, and environmental expectations” when completing your Symptom Impairment and Before and After matrices. This additional matrix merely takes this process one step further.
Right about now, I can hear you say “But, that documentation already is contained in other documents I’ve done; particularly the Symptom Impairment Matrix and the Before and After Matrix!!! Why should I have to do ANOTHER Matrix???”
My response to you, as it has been to many, many, many others is, you don’t. And, you can take your chances on the SSA Claims Representative being able to make the leap between your documents and what would be considered “gainful employment” for you. However, to maximize your chances of success, it is recommended that you “connect these dots” for that Claims Representative yourself!!
The reasons for this recommendation are as follows:
1) Research shows that in some – if not all – SSA decision-making offices, Claims Reps are evaluated based on a “time to claims closure” rate. Hence, the more information that you, the person with disabilities can provide to assist that Claims Rep with the decision, the better your chances of success are.
2) Research and personal anecdotal information provided from dozens of clients using this process indicate that whenever disability insurance applicants leave the documentation or “connecting the dots” process in the hands of someone else, the outcome almost always is denial of claim.
This is why it is STRONGLY RECOMMENDED that a person working to file a claim for any type of disability insurance follow the DisabilityKey Workbook processes EXACTLY AS WRITTEN, and take this additional step of adding the Essential Job Function Matrix to your case documentation process.
The following are actual examples of claims denials resulting from a person with disabilities allowing someone else to either provide documentation, or “connect the dots” about symptom impairment on activities of a person’s “gainful employment”.
1) The SSDI applicant did not obtain copies of the doctor’s chart notes and read them, discussing any “red flags” found with the doctor before submission. The doctor’s office sent in the “wrong” chart notes, and the SSA decision was denial of eligibility.
2) The SSDI applicant faxed the RFC/PCE
[3] blank form and completed draft to the doctor, requesting that he complete the form and mail it directly to the SSA (instead of taking the documents in and having the doctor complete the form in your presence, where any discrepancies can be worked out between the two of you, and you retain control of the process, as is recommended in the DisabilityKey Workbook). SSA decision was denial of eligibility, as the Doctor’s completed form did not correlate (match) with the applicant’s other documentation.
3) The SSDI applicant faxed the doctor a draft copy of a letter s/he wanted the doctor to write documenting why the presence of Multiple Sclerosis lesions resulted in being able to perform gainful employment activities. S/he asked the doctor to submit the letter directly to the SSA. The letter merely wrote that the applicant had “sclerosis lesions”; and that the applicant could no longer perform his/her “job”. SSA decision was denial of eligibility; the “dots were not connected”.
[4]4) Applicant completed all of the documentation in great detail. SSA’s decision was that she could still perform gainful employment.
[5] During her appeal process, she completed the Essential Job Function Matrix, and was approved for eligibility during the appeal process.
There are many more specific examples, but these are the most significant, and clearly demonstrate the need for this additional Matrix.
ESSENTIAL JOB FUNCTION MATRIX EXAMPLE
The following example has been summarized and sanitized from some clients, and provided to you as an example. You, of course, will need to create your own, based on your best estimate of what “gainful employment” might look like for you. For example: if you came from sedentary, “knowledge worker” positions, the gainful employment of an entry level clerical position might be your example. If you came from a more active employment history, the “Worker Helper” position might be your example.
PLEASE REMEMBER THAT THE “HOW SYMPTOMS IMPAIR PERFORMANCE” DATA ARE EXAMPLES ONLY, and should reflect your specific position. This information serves to “connect the dots”!!!
YOUR NAME’S job at time of full disability was: YOUR JOB TITLE. The purposes of this matrix are: 1) to document the Essential Job Functions of this job, along with their associated Essential Physical, Mental, and Environmental Requirements, and indicate how my specific disease symptoms impair my ability to perform these Essential Job Functions; and, 2) also to document the essential job functions of any gainful employment for which my age, education and past work experience qualify me to perform, and to indicate how my specific disease symptoms also impair my ability to perform what would be these Essential Job Functions along with their associated Essential Physical, Mental, and Environmental Requirements. This includes substantial full-time and part-time work. For purposes of this matrix, work is “gainful” if gross earnings average over Social Security’s minimum monthly allowable income (currently $ 830 per month) after allowable amounts are deducted.
The details of this matrix are supported by the following: 1) letters from my co-workers and friends; 2) my Symptom Impairment Matrix, and my Before and After Matrix; 3) a letter from my Doctor corroborating my documentation and my inability to perform the Essential Job Functions of this position and my inability to perform the essential job functions of any gainful employment; and, 4) my Doctor’s chart notes documenting my diagnosis of YOUR DISEASES/CONDITIONS; my steady, continual decline since YOUR DATE; and the prognosis that this condition will continue indefinitely.
ESSENTIAL/PRIMARY JOB DUTIES
ESSENTIAL PHYSICAL REQUIREMENTS
HOW SYMPTOMS IMPAIR PERFORMANCE
From DATES OF YOUR LAST JOB I worked as YOUR JOB. My responsibilities were primarily as YOUR PRIMARY RESP. Duties included but were not limited to:
· Created and executed project work plans.
· Identified resources needed and assigned individual responsibilities.
· Managed day-to-day operational aspects of a project and scope.
· Reviewed deliverables prepared by team before passing to client.
· Minimized exposure and risk on project.
· Provided technical and business expertise in the analysis of user needs and recommended software or solutions to meet internal customer needs/requests.
· Prepared requirements for enhancements/changes/new products.
· Tested enhancements/changes and new products.
· Developed business reports and performed data analysis.
· Identified needs, created curriculum and provided product training.
· Provided management with status reports on project and/or product.
YOUR JOB TITLE
KNOWLEDGE, SKILLS AND ABILITY EXPECTATIONS:
Ø Knowledge of accepted Project Management skills.
Ø Excellent communication and writing skills.
Ø Good interpersonal and negotiating skills.
Ø Good problem-solving skills.
Ø Knowledge of software development methodologies.
Ø Strong technical and analytical skills.
Ø Ability to query and create reports from relational databases.
Ø Excellent verbal and written communication skills.
Ø Ability to work independently or in a team environment.
Ø Strong leadership skills. Ability to lead a cross-functional team, resolve conflict and build consensus among group members.
Ø Ability to manage without authority/through influence.
Ø Responsible for representing the organization as the primary technical contact on some projects. Interacts on technical matters often requiring coordination between business units within the corporation.
PHYSICAL DEMANDS: The physical demands for this position are moderate (see below). The employee is regularly required to sit, stand, walk and talk for extensive periods of time. Ability to use hands to operate a computer keyboard is required. Occasional lifting, stooping and carrying are required.
WORK ENVIRONMENT: Basic office environment. Occasional travel is required. Overtime is required to meet project deadlines.
ESSENTIAL PHYSICAL REQUIREMENTS:
NR = Not Required; Rarely (R) = 1% or less;
Occasionally (O) = 1-33%; Frequently (F) = 34-65%;
Continually (C)= 66-100%
The work performed by the employee in this position in a physical capacity requires walking, standing, sitting, lifting, and maintaining that posture for varying periods of time.
Sitting – F – From 6 to 7 hours per day for computer work, telephone calls and meetings.
Standing – O – From 5 minutes to up to a total of 60-90 minutes per day attend meetings and talk with other employees.
Walking – O – Walks up to ½ mile accumulatively throughout the day in the office. Walking is normal paced and sometimes sporadic.
Twisting - R
Knees: R
Waist: R
Wrists & Arms: C – Wrists and arms are held in computer operating and phone usage for 6-8 hours per day with few breaks in position.
Neck: C – while using computer monitor, using phone; 7-8 hours per day
Stooping/Bending: R
Kneeling: R
Crouching: R
Crawling: R
Climbing: R
Balancing: R
Pushing/Pulling: O
Reaching above Shoulder height: O – Reaches for books and supplies when working at desk.
Grasping (firm): O
Manipulating hands or fingers (e.g., typing): F – Uses fingers to manipulate the computer and calculator and phone. Can be using hands in small motor coordination 6-8 hours per day.
Using feet to operate controls: R
Lifting/Carrying: O – lifts books, manuals and office supplies from under one pound to up to 10 pounds.
ESSENTIAL USE OF SENSES:
Talking: Continually talks in person or on the phone with employees from all levels of the organization and with outside vendors. Conducts meetings and makes group presentations.
Hearing: Continually listens to information from all sources to carry out functions under “talking”. Also, must have acute hearing to “read” the work environment and people in various situations.
Vision: Continually observes surrounding activities.
Near Acuity (clarity of vision at 20 inches or less): C – while typing, reading and writing for 6-8 hours each day.
Far Acuity (clarity of vision at 20 feet or more): O – while in meetings, presentations and various office situations.
Smell: R
Mental Agility: As indicated above under Knowledge Skills and Abilities, this is a combination position requiring a wide variety of tasks and activities. The employee is expected to draw upon her substantial versatility of skills to accomplish the variety of tasks on a daily basis. She must have superior deduction, induction, communication, activity sequential and customer service skills. Functions in a leadership role to resolve conflict and build consensus among team members. Mastery of multi-tasking is critical.
Refer to attached Symptom and Before/After Matrices for specifics. Also, please see below.
My primary symptoms have been dizziness, fatigue and chronic pain in my right arm/neck and lower extremities. In the last year, my symptom impairments have increased to include cognitive problems such as multi-tasking, ability to concentrate, and short term memory.
Chronic pain is being treated with prescription medication which causes severe sedation side effects. I am able to sit upright for about 30 minutes an hour; a total of 2 hours over a 4 hour period in an 8-hour day.
For the last 5-6 months, I have been sleeping 12-16 hours a day due to severe sedation side effects from pain medication. This coupled with the usual fatigue symptoms from my disease have made it difficult to do more than 1-2 hours of any type of activity per day. Anything more than that in a given day takes at least one additional full day of rest to recover.
I recently have been falling 1-2 times per month. Falls usually occur late in the day when I am more fatigued. I have been fortunate so far that they have resulted in only minor bruises and strained muscles. I feel it is necessary to use my cane more frequently to avoid these accidents and more serious injuries.
· Because of my brain and spinal lesions, as documented in the attached matrices and in my doctor’s chart notes, I can no longer sit for periods greater than 10 – 15 minutes at a time. I cannot stand, unassisted for any great period of time without developing leg pain of 7-8 on the “generally accepted” Pain Scale.
· My visual and mobility impairments cause severe nausea whenever I attempt to stand and concentrate on anything; and, especially when moving.
· I cannot walk unassisted for lengths greater than 1 short block (4-6 houses), nor for longer than 15 - 20 minutes at a time.
· Due to neck/arm/wrist pain, I cannot hold my arms up in a horizontal position for an extended period of time and or do any repetitive motion, such as on a PC keyboard beyond 5-10 minutes at a time. I must rest my limbs for an hour or longer in between usages.
· The dizziness occurs when scanning from left to right and affects everything I do from viewing a PC monitor, reading books or doing simple household chores. Symptoms get worse when doing any type of physical activity or when I am fatigued. Activities like gardening or shopping cause symptoms so severe that I reach the point of loosing my balance and falling. I do these activities in 30 minute “blocks”, or avoid altogether.
· Last week I woke up two mornings with true double-vision that gradually went away after 20-30 minutes. I am concerned it may be a sign of worsening symptoms.
· Dizziness causes nausea and I must do any of reading or work on the PC in 5-10 minute increments and then rest for 30+ minutes.
· As a result of dizziness and the cumulative impact of my other symptoms, it is difficult and sometimes impossible for me to do anything that requires concentration for a period of time longer than 5 or 10 minutes at a time. In order to get anything done, I must focus on one thing at a time and I am totally unable to multi-task.
· Due to sedation side effects from the prescription pain medication, for the last 5 or 6 months I have been sleeping 12-16 hours a day. After a few minutes on the PC or watching TV, I literally cannot keep my eyes open and am forced to lie down and sleep for a few minutes before I can resume activity.
This is an example of a full or part-time position that would fall into the category of GAINFUL EMPLOYMENT that would provide gross earnings of at a least $830 per month. It could be offered as an office position or telecommuting (work at home) position. Duties could include but not be limited to:
· Provides administrative support to office staff.
· Operates keyboard for data entry through online computer or personal computer.
· Enters alpha numeric or symbolic data from a PC display terminal or source documents.
· Reviews images or documents for accuracy.
· Files hardcopy documents.
· Provides phone support for internal and/or external customers.
· Inputs and verifies transactional data.
· Performs accounting functions and reconciles out of balance situations.
· Performs routine item processing functions, prepares reports and other duties as assigned.
OFFICE ASSISTANT
KNOWLEDGE, SKILLS AND ABILITY EXPECTATIONS:
Ø Must have basic Internet, Windows and MS Office skills.
Ø Data entry and PC experience.
Ø Ability to type a minimum of 65 wpm.
Ø Attention to detail.
Ø Excellent spelling, grammar and proofing skills.
Ø Must have effective written and oral communication skills (good projection, enthusiasm, grammar, and clear communication skills).
Ø Ability to work independently or in a team environment.
Ø Strong organizational skills with the ability to work in a fast paced, high production and deadline-oriented environment.
Ø Must be multi-task oriented and organized with the ability to set priorities and meet established deadlines.
Ø Positive attitude with sound problem- solving and math skills.
PHYSICAL DEMANDS: The physical demands for this position are medium to low (see below). The employee will be regularly required to sit, stand, walk and talk for moderate periods of time. Ability to use hands to operate a computer keyboard is required. Occasional lifting, stooping and carrying may be required.
WORK ENVIRONMENT: Basic office environment or telecommuting position if work situation allows.
ESSENTIAL PHYSICAL REQUIREMENTS:
NR = Not Required; Rarely (R) = 1% or less;
Occasionally (O) = 1-33%; Frequently (F) = 34-65%;
Continually (C)= 66-100%
The work performed by the employee in this position in a physical capacity requires occasional walking, standing, sitting, lifting, and maintaining that posture for varying periods of time.
Sitting – F – From 3 to 7 hours per day for computer work, telephone calls and meetings.
Standing – O – From 5 minutes to up to a total of 30-60 minutes per day to attend meetings and talk with other employees.
Walking – O – Walks up to ¼ mile accumulatively throughout the day in the office. Walking is normal paced and sometimes sporadic.
Twisting - R
Knees: R
Waist: R
Wrists & Arms: C – Wrists and arms held in computer operating and phone usage for 6-8 hours per day with few breaks in position.
Neck: C – while using computer monitor, using phone; 3-7 hours per day
Stooping/Bending: R
Kneeling: R
Crouching: R
Crawling: R
Climbing: R
Balancing: R
Pushing/Pulling: O
Reaching above Shoulder height: O – Reaches for books and supplies when working at desk.
Grasping (firm): O
Manipulating hands or fingers (e.g., typing): F – Uses fingers to manipulate the computer and calculator and phone. Can be using hands in small motor coordination 3-7 hours per day.
Using feet to operate controls: R
Lifting/Carrying: O – lifts books, manuals and office supplies from under one pound to up to 10 pounds.
ESSENTIAL USE OF SENSES:
Talking: Continually talks in person or on the phone with employees from all levels of the organization and with outside customers.
Hearing: Continually listens to information from all sources to carry out functions under “talking”.
Vision: Continually observes surrounding activities.
Near Acuity (clarity of vision at 20 inches or less): C – while typing, reading and writing.
Far Acuity (clarity of vision at 20 feet or more): O – while in meetings and various office situations.
Smell: R
Mental Agility: As indicated above under Knowledge, Skills and Abilities, this is a combination position requiring a wide variety of tasks and activities. Mastery of multi-tasking is critical.
VISUAL PROBLEMS
· The biggest coordination problem that I have is the vertigo that comes from my vision problems, thus limiting the time that I can look at objects near and far.
· Scanning left to right makes me dizzy and nauseous as I view a PC monitor, hardcopy document or TV. Hence, I must do so in small 10 minute increments, changing my vision from near to far frequently.
· In order to do any work on the PC, I must work in small “bites” of no more than 10 minutes at a time with 15-30 minutes of rest in between.
· My visual problems cause me to have to change my near and far viewing every 10 minutes or so to avoid severe nausea.
· Symptoms are worse when I do any sort of physical activity – walking, turning my head, bending over, stooping or kneeling. It occurs when I do everything -- sit, stand or lie down.
· My visual and mobility impairments cause severe nausea whenever I attempt to stand and concentrate on anything; and get worse with any type of physical activity.
· Dizziness occurs 24 hours a day, 7 days a week. I generally have 2 good days and 5 bad days a week, although symptoms are totally unpredictable. Dizziness can spontaneously worsen or get better for a day or week at a time, without warning. There are times it gets so severe I must stay in bed.
· Consistent rest, and specifically 12 + hours of sleep per night help to control dizziness symptoms. My physicians have found no treatments, medications or exercises that can provide any long-term improvement.
· I continue take whatever prescription medications, and to engage in whatever therapy recommended to me by my doctor(s) which may help to keep my symptoms from getting worse, but I have been told by my physician that it is not realistic to expect any real improvement in my symptoms in the future.
COORDINATION / MOTOR SKILLS
· Since DATE, my leg and arm muscles have been jumping and twitching all by themselves.
· I experience some stiffness and general coordination problems in my hands; in particular with typing or delicate finger activities.
· The lack of proper hand coordination is a symptom that I have when typing on the computer. I’ll mix up letters, consistently leave out the o in you, think one letter, and type another, etc. I rely on spell-check to find typographical errors in email and other PC generated documents.
· These additional errors and proofreading steps make it difficult to work in a fast-pace environment with interruptions. I must work slower and in addition to rest periods it is impossible to meet any reasonable work deadlines.
FATIGUE / CHRONIC PAIN
· I cannot sit or stand for significant periods of time because of chronic pain, muscle, nerve, balance, coordination and fatigue problems.
· I can stand for about 5 minutes per hour unsupported and 10-15 minutes supported; however during this period leg pain reaches 7-8 on the Pain Scale. Within an 8 hour period I can stand for about 1 hour of cumulative time with rest periods every 15 minutes.
· I can sit continuously for about 30 minutes an hour; a total of 2 hours over a 4 hour period in an 8-hour day.
· Spinal chord lesions have been diagnosed as the probable source of chronic pain in right arm and neck. Pain interferes with any kind of repetitive motion such as operating a computer keyboard, writing and other hand movements.
· My pain is constant to some degree or another. Neck/shoulder pain prevents me from holding arms up for an extended period of time and from doing any repetitive motion, such as on a PC keyboard beyond 5-10 minutes at a time.
· Prescription medications allow me to function at the minimal level as depicted in the attached matrices. I sleep 12-16 hours a day.
· I have some problems grasping, pulling and pushing, primarily due to stamina/fatigue and balance problems.
IMPAIRED MEMORY AND COGNITIVE FUNCTIONS:
· Talking: Problems with cognitive abilities sometimes results in jumbled and lost words. The problem increases when I am fatigued or stressed. It especially affects my ability to communicate in group settings or on the phone.
· Multi-tasking: Cognitive changes have affected my ability to multi-task. Also, I have difficulty focusing on more than one task at a time and am easily distracted.
SECOND EXAMPLE OF OFFICE ASSISTANT POSITION SYMPTOM IMPAIRMENTS.
I am constantly forgetting words, and sometimes think that I have finished sentences, when I have not.
I often mix words up and say something completely different from what I mean. (e.g. "inconsistently" often becomes "infrequently").
I find that I often have times when I am speaking, and I know the word in my head that I want to say, but I can't seem to make it come out of my mouth. However, during these times, I can typically write what I can't get out of my mouth.
I often jump from topic to topic and back again in my conversations with people.
These symptoms make it difficult to deal effectively with customers, as well as writing invoices, filling out forms etc. (This matrix alone took me 3 weeks to complete.) I constantly need my work proof read for spelling and grammatical errors.
It is incredibly frustrating when I feel that I am not getting my points across correctly to customers, coworkers, etc. The more frustrated I get, the more prominent these symptoms become; This is a vicious cycle to get into.
I have frequent dizzy spells, which can last minutes, hours, even days. These dizzy spells often include headaches, and nausea. They happen whether I am moving too fast, or standing, sitting, or lying still. I am uncertain whether these spells are due to my illnesses and/or to my medications.
I have muscle twitches, or spasms, in both arms, hands, and legs. I am uncertain what causes these twitches. I also have intermittent shaking. Mostly it appears in my hands, but sometimes affects my whole body.
I have numbness, tingling, and pain in one or both of my hands, at any given time. Episodes where I will lose all feeling in my hands, as well as regular "pins and needles" sensation in one or both hands.
I have strength and gripping problems in both of my hands. This is also a symptom that appears one day, and may be gone the next.
I have severe pain in both feet (mostly, the top of my feet) that is becoming more and more frequent, whether I stand on them or not.
I have severe pain in my ankle, knee, and hip joints. Again, this pain occurs whether I stand, sit, or lay down.
I have frequent sporadic numbness in both feet, and occasionally both legs from the knee down.
I have increasing pain in both my thighs, that varies between a burning and aching sensation, which is also becoming more and more frequent.
I have frequent muscle weakness in my legs, which makes me shaky and unstable, sometimes even with the aid of a cane.
I cannot stand for more than 10 minutes at a time; sometimes as little 5 minutes.
These symptoms make it difficult to lift and carry things; as well as walk, climb, sit, stand, or do anything for an extended period of time. Due to the uncertainty of when, where, or why these symptoms appear I have limited my driving as well as generally "going out".
Severe fatigue also limits the things that I can and cannot do. If I do not get enough sleep, (which is often the case, due to pain and various other factors) my symptoms are exasperated.
As a result of all of these symptom Impairments, I cannot sit for periods greater that 15 minutes at a time; then, I have to change position and rest for at least 30 minutes.
I cannot walk without assistance; I cannot carry items that weigh more than ½ a pound.
When I use my fingers to type or use the phone, I do so SLOWLEY, and with repeated errors. Again, I cannot do these tasks for any period of time greater than 10 minutes at a time, followed by a rest period of 30-60 minutes each time.
As for talking to customers and suppliers: I can no longer retain information long enough to multi-task in rapidly responding to questions and information.
My dizzy spells make it important for me to very frequently change my vision from near (like typing) to far (like watching TV).
Biggest challenge for me is that I can no longer keep track of the myriad of tasks that need to be done, let alone get them done!! I can no longer be the “primary fulcrum” of the busy business.
This is an example of a full or part-time “WORKER HELPER” position that would fall into the category of GAINFUL EMPLOYMENT that would provide gross earnings of at least $830 per month. It could be performed in any shop, warehouse, store etc. where the primary duties are physical in nature. Duties could include, but are not limited to:
● Provides assistance/help of any and all type to a “fully functioning” worker in the work environment.
● In a store, might stock shelves; affix prices to stock; answer customer questions; locate stock for customers; take inventory; loan and unload inventory; etc.
● In a warehouse, might stock shelves; locate stock; take inventory; load and unload merchandise; etc.
● In any work environment, responsible for site cleaning.
● In a trades or craft “shop”, might locate tools for craftsperson; assist craftsperson with minor, directly assigned and supervised tasks; stock shelves; locate stock; take inventory; load and unload merchandise; answer specific customer questions, etc.
● In every case, might do basic customer contact; might work basic office equipment like telephone, cash register, radios, dollies, etc.
● Performs routine tasks, under close supervision, as assigned.
WORKER HELPER
KKNOWLEDGE, SKILLS AND ABILITY EXPECTATIONS:
Ø Must be able to carry out detailed and specific instructions.
Ø Must be able to work basic equipment like telephone, dollies, etc.
Ø Must be able to follow sequential instructions, knowing when to act and when to seek help from the craftsperson or fully functioning worker.
Ø Strong attention skills to follow the tasks associated with helping the craftsperson or fully functioning worker.
Ø Maintains a positive, contributive work attitude.
Ø Must pass the entry level physical capability assessment for this position.
Ø If interact with customers, must greet them and respond to their questions and requests in a timely, courteous and helpful way.
PHYSICAL DEMANDS: The physical demands for this position are medium to high (see below). The employee will be regularly required to stand, walk, and talk for extensive periods of time. Ability to use hands to perform all tasks is mandatory. Position requires frequent, if not continual lifting, stooping, carrying, twisting etc.
WORK ENVIRONMENT: The work environment of this position is that of a store, warehouse, craft/trade shop. Temperatures might be hot (between 90 and 110 degrees) in the summer and cold (32 degrees and below 0 degrees) in the winter; or, may be heated and air conditioned, depending on location.
Work also is conducted in an environment characterized by: noise;, sudden changes in temperature; fumes; cramped quarters; cold/hot surfaces; tools handled; products moved; sharp edges; etc.
ESSENTIAL PHYSICAL REQUIREMENTS
NR = Not Required;
Rarely (R) = 1% or less
Occasionally (O) = 34-65%
Frequently (F) = 34-65%
Continually (C) = 66-100%
The work performed by the employee in this position in a physical capacity requires frequent walking, continual standing, lifting, twisting, bending, etc., and maintaining that posture for extended and/or varied periods of time as detailed below.
Sitting – R – Usually, only on breaks or at lunch.
Standing – C Various duties involved require standing and moving in support of required tasks. Estimated Total hours 6-8; Maximum continuous time – 6 hrs.
Walking – C - Walks between 2 and 5 miles each day in carrying out required tasks.
Twisting –F – Tasks associated with the lifting, pushing, pulling, and bending, squatting and kneeling all require twisting.
Knees – F – Tasks frequently require use of knees when bending, lifting, squatting and kneeling.
Waist – F – Tasks listed above also include movement using the waist.
Wrists & arms – F – Tasks listed above all include use of wrists and arms.
Neck – C – All tasks involve the neck’s use. Particularly when around heavy equipment, produce, store supplies, etc., environmental scanning is a safety requirement, so use of the neck is 100% of the time.
Bending/Squatting/Kneeling/stooping – O – Tasks associated with product movement (storage, placement, retrieval, inventory, etc.) and site cleaning, all include bending/squatting/kneeling/stooping.
Crouching – O – As with kneeling.
Crawling – O – As with kneeling.
Lifting/Carrying – F – Products require hourly lifting up to 25 lbs; daily lifting up to 50 lbs. Assistive devices used for greater than 50 lbs.
Climbing – O – Tasks associated with product movement and site cleaning involve climbing one, two and up to 5 ft. ladders.
Balancing – C – All tasks require balancing.
Pushing/Pulling – O – Tasks require pushing and pulling.
Reaching above shoulder height – O – Tasks associated with product movement and site cleaning involve reaching at and below shoulder height.
Grasping (firm) – C – 95 – 100% of tasks associated with product movement and site cleaning require the ability to grasp objects of varying weight, size and structure firmly.
Manipulating hands or fingers – O – when using telephone and/or when conducting inventory checks.
Using feet to operate controls – R
ESSENTIAL USE OF SENSES:
Talking: Talks about 60% of the time. Whether with supervisors, co-workers, customers, or vendors, the primary purposes of talking are to ask questions or to relay information.
Hearing: Continually listens to information and questions from all sources to carry our functions under “talking”. Also, “listens” to surroundings, aware of safety hazards.
Vision: Continually observes surrounding activities.
Near Acuity (clarity of vision at 20 inches or less): C – while dealing with product movement, inventory, and site cleaning customers.
Far Acuity (clarity of vision at 20 feet or more): C – while dealing with product movement and site cleaning.
Smell – F – wile dealing with product movement and site cleaning.
Mental Agility: As indicated above under Knowledge, Skills and Ability, this is a position requiring a wide variety of tasks and activities. Ability to remain safe in a physically demanding, task-oriented environment is critical.
The position I tried to perform is that of a Deli Clerk Trainee. The primary responsibilities of this position are as follows:
Customer Service - The must greet the customers and respond to their questions and requests in a courteous and helpful way.
Preparing and Displaying Food - They prepare food sold in the deli. Several times each hour they slice, pour, and dip food into containers, weigh and attach proper price labels. They prepare meats and vegetables for cooking and operate various types of mixing, frying, and backing equipment.
Operate Registers - They may be required to operate registers and transact sales properly.
Cleaning the Work Area – They sweep and mop the deli floors as well as wash and sanitize cookware according to procedures required by local health departments. This involves contact with water and various cleaning products.
Work Location – They stand or walk for up to 4 hours at a time and frequently bend, twist, and reach.
As a trainee, Deli Clerk performs routine tasks under close supervision and direction.
The Trainee Deli Clerk is also responsible for the following ADDITIONAL DUTIES which may become ESSENTIAL FUNCTIONS depending on the particular store, availability of personnel, time of day, etc.: Bringing containers of food product form the stock room; loading them onto carts which are pushed to the deli area; and placing the product in the proper storage areas, all of which involves working in and out of cold storage areas; unloading food and other deli inventory in the receiving area and moving it to the proper storage areas; tending the coffee and soft drink dispensers and connecting them to the dispenser; climbing a step ladder to get items from shelves; carrying trash to the dumpster and operating the baler; and conducting inventory by making a proper accounting of products and supplies.
VISUAL PROBLEMS: The biggest coordination problem that I have is the vertigo that comes from my vision problems, thus limiting the time that I can look at objects near and far.
Scanning left to right makes me dizzy and nauseous as I look at objects near and far. This makes it very difficult to view product and to the essential functions of this job. In order to do any of the visual work, I must work in small “bites” of n more than 10 minutes at a time with 15-30 minutes of rest in between.
Also, my symptoms are worsened when I do any sort of physical activity – walking, turning my head, bending over, stooping, kneeling, etc.
My dizziness occurs 24 hours a day, 7 days a week. I generally have 2 good days, followed by 5 bad days a week, although my symptoms are totally unpredictable. Dizziness can spontaneously worsen or get better for a day or week at a time, without warning. There are times it gets so severe that I must stay in bed.
I continue to take whatever prescription meds, and engage in whatever therapy recommended by my doctors which may help to keep my symptoms from getting worse, but I have been told by my Dr. that it is not realistic to expect any real improvement in my symptoms in the future.
COORDINATION/MOTOR SKILL PROBLEMS
Since 2004 my leg and arm muscles have been jumping and twitching all by themselves. I experience stiffness and general coordination problems in my hands and feet. Also, as stated above, I cannot perform any physical activity without getting dizzy, which pretty much makes it impossible to do the majority of the tasks associated with this position.
FATIGUE/CHRONIC PAIN
I cannot sit or stand for significant periods of time because of chronic pain muscle, nerve, balance, coordination, and fatigue problems. I can stand for about 5 minutes per hour unsupported, and 10-15 minutes supported; however, during this period, leg pain reaches 7-8 on the (normally accepted) Pain Scale. Within an 8 hour period, I can stand for about 1 hour of cumulative time, with rest periods every 15 minutes.
Specifically: As also documented in the Attached RFC/PCE form completed by my doctor, I cannot perform the standing, walking, twisting, kneeling, bending, squatting, lifting, carrying, climbing, balancing, pushing, pulling, reaching over shoulders, grasping, manipulating hands or fingers, talking, and seeing that are depicted as essential requirements of this position.
[1] This story is critical in understanding the Social Security Administration’s decision-making process, and in understanding the absolute need for persons with disabilities to document – IN SPECIFIC DETAIL – how their symptoms impair their normal daily living activities so that they cannot carry out activities that would allow them to perform their “gainful employment”.
[2] Note: sanitized and used with client’s permission.
[3] RFC/PCE means Residual Functional Capacity/Physical Capacity Evaluation; this is one of the key Forms used by the SSA to determine a claimants “functional” capabilities as they relate to being disabled and unable to perform gainful employment. It is also used by LTD Insurance Companies to determine whether a claimant is disabled from “any occupation”.
[4] In this particular example, connecting the dots could be as follows. The Doctor would state in his letter to the SSA that the applicant’s sclerosis lesions were in the brain, and that these lesions caused her significant vision and mental problems that were explained in detail in her symptom impairment documentation. Then, in THAT documentation, the applicant needs to be very specific about what gainful employment tasks are impaired by these specific impairments.
[5] Research shows that if an applicant’s age is two or three decades below “normal retirement age”, and that the applicant has one or more higher education degrees, the decision that the person can perform “gainful employment” is significantly higher. This is why the new matrix is so important.
