Residual Functional Capacity Assessment for Parkinson’s Disease
What Is RFC?
When your Parkinson’s disease is not severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process, the Social Security Administration will need to determine your residual functional capacity (RFC) to decide whether you are disabled at Step 4 and Step 5 of the Sequential Evaluation Process.RFC is a claimant’s ability to perform work-related activities. In other words, it is what you can still do despite your limitations. An RFC for physical impairments is expressed in terms of whether the Social Security Administration believes you can do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.
Assessing Impairment Caused by Parkinson’s Disease
When considering RFC, the SSA adjudicator should always think in terms of the weight that you able to lift and carry. To be able to lift and carry up to 50 lbs and stand/walk 6–8 hours daily, i.e., perform medium work, you should have no more than very modest deficits in strength, coordination, and balance in regard to gait and station.
Particular attention should be paid to the presence of tremors or bradykinesia, since not only fine manipulation but task speed can be influenced. From a medical-vocational perspective, a manipulatory ability carried out with great slowness and difficulty has little actual work relevance. Any claimant who has a significant manipulatory loss in addition to inability to stand/walk 6–8 hours daily should not be at this RFC step in adjudication, but should be allowed by meeting the listing.
People with parkinsonism may have significant autonomic abnormalities such as temperature intolerances that require environmental restrictions. Sensory symptoms or stiffness in the fingers could affect fine manipulatory ability in the absence of tremors or bradykinesia. Because of postural, balance, and gait problems, claimants with parkinsonism should be restricted from working at unprotected heights. Stiffness and rigidity can limit the amount of time a claimant can push and pull, as with arm or leg controls, and can therefore limit the range of work the claimant can perform. Any information you can provide regarding functional abilities in regard to daily activities can be most helpful, especially specific examples like “I was a mechanic, but now my hand shakes too much to turn a nut.” Any symptoms you can describe in regard to walking, such as freezing and easy fatigability, would be arguments against the ability to do prolonged standing.
The SSA should not use ability to walk around the home or in the doctor’s examining room as evidence of ability to perform a light work or higher RFC, unless the medical evidence as a whole supports the ability for prolonged standing or walking. You and your physicians should be carefully asked about orthostatic hypotension and other autonomic symptoms, and whether testing like the Valsalva maneuver has been done. The SSA adjudicator is likely to overlook autonomic symptoms, or minimize them, and this can be a source of error. Unfortunately, even neurologists may forget to ask about autonomic symptoms.
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