There's long been a desire to determine disability with "scientific" tests of functional ability. There are people who designed and administer such tests, usually referred to as Functional Capacity Evaluations or FCEs. In the real world, such testing is usually paid for by insurance companies who are trying to limit how much they pay for workers compensation benefits. There have been those who want Social Security to use FCEs. You can guess what goal they're trying to achieve.
The National Academies of Sciences, Engineering and Medicine recently did a study of these function assessments for Social Security. The report is basically an elaboration of what was already known by anyone who has taken a look at these tests -- they're unreliable. The biggest problem is what I'll call the marathon problem. These tests take at most a few hours. Thus, at most, they show what an individual can do over a relatively short period of time. However, work is something you do five days a week every week. Relying upon a short test is like saying that someone who can run 100 meters at a certain pace can run a marathon at the same pace. You can no more determine how fast a person can run a marathon from how fast they run 100 meters than you can determine how a person can work day in and day out from testing them for a few hours.
The National Academies of Sciences, Engineering and Medicine recently did a study of these function assessments for Social Security. The report is basically an elaboration of what was already known by anyone who has taken a look at these tests -- they're unreliable. The biggest problem is what I'll call the marathon problem. These tests take at most a few hours. Thus, at most, they show what an individual can do over a relatively short period of time. However, work is something you do five days a week every week. Relying upon a short test is like saying that someone who can run 100 meters at a certain pace can run a marathon at the same pace. You can no more determine how fast a person can run a marathon from how fast they run 100 meters than you can determine how a person can work day in and day out from testing them for a few hours.
This study was a waste of money. It only tells us what anyone who had looked at this kind of testing already knew. FCEs have, at best, highly limited validity and cannot be used as a shortcut for disability determination.
13 comments:
But if you get a FCE that supports your Claimant I bet you use it don't you!
9:20: of course, but what is your point? As an advocate, our job is argue disability for our clients. It is ultimately up to Social Security to determine the validity of the FCE's findings.
Given that it lasts a few hours, it's a more valid measure than a 20-25 minute assessment with a CE or a note taken after a 5 minute visit with a doctor that shows all systems "within normal limits." And certainly more valid than a residual functional capacity statement from that doctor that shows his patient is essentially an invalid despite those "within normal limits" notes.
9:20 AM - Fallacy. There is no such thing as an FCE that supports the claimant.
@9:20
It's pretty rare to find a supportive FCE. The only time I've seen it is when the FCE cannot be completed because, for example, the claimant's knee collapses, pulmonary readings exceed safe levels, etc. In those instances, it's relevant evidence because it shows a claimant cannot complete even a test lasting a few hours, which goes to whether they could complete a full-time work schedule. Even then I wouldn't say it is particularly strong because the whole point of the test is to push the claimant and given the design, if the test fails at medium, nothing says the claimant couldn't do sedentary. It's not a useful system for disability purposes.
But even if the claimant can complete a test, it's of limited value. First, the test is usually not even the length of a normal workday. Second, the test cannot show the duration of the claimant's recovery. Could the average claimant work one or two days a month? Probably. Can they work 40 hours a week, every week? Generally not.
All insurance companies (SSA included) are designed to deny.
I did workers comp in California. We did not rely on these FCE evaluations much. It was more about sending claimants (applicants as they are called here) to examiners. The Qualified Medical Examiners (QMEs) are kind of like the bogus CEs in the SSA. No good ALJ took them seriously.
What you were looking for is an Agreed Medical Examiner (AME). These are very thorough. And both the applicant's attorney and defense attorney agreed on the person. So whatever they decide was pretty much what the case is worth.
The only fairly neutral examiners we get if lucky at the SSA are the medical experts at the hearing. And a lot of time they are biased or worse just not prepared.
But the system is always rigged to deny.
Most FCEs are performed by physical therapists who are not considered an acceptable medical source
@ 9:20 - of course we would use it. Simple logic dictates that if a person cant sustain work activity for even a 2 hour FCE, they cant for a full time job. On the other hand, being able to sustain activity for an hour or two FCE is not always proof of someone's ability to sustain that activity 40 hours a week. So....what was your point?
Random thought. Why does the SSA call it "Residual Functional Capacity"?
Never really understood the need for the word "Residual". It could be resultant or documented or objective. Other words seem better.
Seems like Functional Capacity Evaluation is sufficient.
@2:48
Objective would not be good, since residual functional capacity (or it's equivalent) is a subjective judgement based on the evidence of record which requires consideration of the objective evidence, but also a great deal of subjective things (credibility, weighing of ME/VE testimony, etc.)
I had not given it much thought, but why not just "functional capacity?" I don't see why "the claimant's residual functional capacity is light exertion" is any better than "the claimant's functional capacity is light exertion."
These need to be done by a physical therapist and that person needs to be recognized by SSA as word.
The real problem with RFC is they are the MOST you can do, not what you can SUSTAIN. But, sustaining a job is based upon the LEAST you can maintain. It doesn't matter if one or 2 days a month if you can lift 20 pounds several times. Can you lift and carry 10 pounds many times a day everyday? Does doing that, over time, decrease your ability to do that and other things?
FCEs were designed to measure functional ability of an "injured" body part. At best, they can be a tool that gives you an "idea" about how well an injured part can perform. However, there is no follow up in the days after the test. Therefore, they can't show what the person can sustain. The Purdue pegboard test, often used as part of an FCE, lasts about 3-4 minutes. So, if what someone can do for 3-4 minutes can be extrapolated into an 8 hour DAILY capability... then a runner who can run a four minute mile (15 mph x 7 (8- breaks) x 5 (days a week) x 49 (52 weeks-vacation and holidays) = 25,725 miles) COULD run around the world at the equater in a year (assuming a pathway to run).
Nice fallacy argument. Bet you would have used one if it supported your case 10:27.
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