Residual Functional Capacity Assessment for Schizophrenia
What Is RFC?
When schizophrenia 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 residual functional capacity (RFC) to decide whether the claimant is 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 mental impairments is expressed in terms of whether Social Security Administration believes the claimant can do skilled, semi-skilled, or unskilled work in spite of impairments, or whether the claimant cannot even do unskilled work.
Denial Is Likely for RFCs for Unskilled Work or Better
Claimants with a mental RFC for the ability to perform unskilled work who have no physical impairments will almost always be denied Social Security disability benefits. Rare exceptions are claimants with no more than a limited education, who are close to retirement age, and who have a lifelong history of unskilled work that they can no longer perform. Large numbers of claimants are denied with mental RFCs for unskilled work because the Social Security Administration can cite many jobs that require only unskilled work.
Mental and Physical Impairments Together May Qualify
Many claimants have both physical and mental impairments. The claimant may be found disabled when the effect of both impairments is considered, even though the physical impairment alone or the mental impairment alone would not be sufficient.
Inability to Perform Even Unskilled Work Should Result in Allowance
A marked impairment in any of the abilities required for unskilled work will result in allowance of a claim even in the absence of any physical impairment. These basic mental demands are:
- Remember work-like procedures (locations are not critical).
- Understand and remember very short and simple instructions.
- Carry out very short and simple instructions.
- Maintain attention for extended periods of 2-hour segments (concentration is not critical).
- Maintain regular attendance and be punctual within customary tolerances. (These tolerances are usually strict.) Maintaining a schedule is not critical.
- Sustain an ordinary routine without special supervision.
- Work in coordination with or proximity to others without being (unduly) distracted by them.
- Make simple work-related decisions.
- Complete a normal workday and workweek without interruptions from psychologically based symptoms and perform at a consistent pace without an unreasonable number and length of rest periods. (These requirements are usually strict.)
- Ask simple questions or request assistance.
- Accept instructions and respond appropriately to criticism from supervisors.
- Get along with coworkers or peers without (unduly) distracting them or exhibiting behavioral extremes.
- Respond appropriately to changes in a (routine) work setting.
- Be aware of normal hazards and take appropriate precautions.
The Social Security Administration requires a lot of information to assess whether a claimant has these abilities. This is an important area in which the Social Security Administration may not develop the case very well. Information from family members about how the claimant behaves at home and in social situations can help. This information can be extrapolated to a work setting. Specific work-setting information can sometimes be obtained from former supervisors or co-workers. Treating physicians may have made observations or have opinions regarding the claimant’s ability to perform these basic capacities.
Negative Symptoms of Schizophrenia
Individuals with schizophrenia always have significant residual functional limitations if not qualifying under the listing criteria. Delusions, hallucinations, catatonia, and disorganized speech are known as positive symptoms. Flattening of affect (loss of emotion), alogia (poverty of speech), anhedonia (inability to experience pleasure), and avolition (lack of motivation) are known as negative symptoms. Negative symptoms are more difficult to control and more disabling in the long term.
Most of the claimants suffering from schizophrenia that are seen by the Social Security Administration are under treatment and have control of their positive symptoms, but are limited by their negative symptoms as well mood and cognitive abnormalities. These abnormalities can affect their self-care, social relationships, and ability to work. A claimant who is not actively psychotic and who has memory problems should be tested (if not actively psychotic), as by the Wechsler Memory Scale. Some require IQ testing, but considerable skill must be used to assure valid results if the person has significant residual symptoms affecting motivation or attentional ability.