Showing posts with label residual functional capacity. Show all posts
Showing posts with label residual functional capacity. Show all posts

Monday, July 29, 2019

Interrogatories to a Examining or Non-Examining Medical Source


The claimant has moderate limitation in detailed and complex tasks and in interacting with supervisors, coworkers, and the public.  That is the general framework of limitations that are set forth by examining psychologists/psychiatrists and part of the work sheet portion of the mental residual functional capacity assessment made by state agency psychologists/psychiatrists.  Moderate limitations are ambiguous.  The claimant, representative, and the ALJ have no idea what moderate means.  If we had a case worth a half a million dollars, we would resolve that ambiguity before trial.  Many time, we have exactly that, a half a million dollar case.  Every Social Security disability case, whether involving disability insurance or supplemental security income is a big case by standards applicable to other legal endeavors.  To the client, it isn’t big, it is everything.  So let’s propound interrogatories to the examining and non-examining psychologists/psychiatrists based upon POMS DI 25020.010 and the Dictionary of Occupational Titles, Appendix C.  

Be judicious and ask the questions reasonably related to the opinions expressed.  For instance, a psychiatrist that opines that the claimant with low average or borderline intellectual functioning can do complex work, it is reasonable to ask about reasoning level 4.  Other reasoning levels apply when the claimant has a skilled background and a colorable mental impairment, even non-severe.  

INTERROGATORIES TO <NAME OF PSYCHOLOGIST/PSYCHIATRIST>
1.    Did you examine (review the record for) <client name> on <date of evaluation>?
__________________________

2.    Is the document attached as exhibit <exhibit no.> a true copy of your report of findings and opinions?
__________________________

3.   In the <functional assessment title>, you describe <client name> as having moderate limitations in <designate the functional limitation>.  Can <client name> sustain of a full-time regular work schedule (mark all that apply) where the employer treats the function as critical to performing work:

A.   Memory Functions

o Remember work-like procedures (locations are not critical).

o Understand and remember very short and simple instructions.

o Carry out very short and simple instructions.

o Apply principles of logical or scientific thinking to a wide range of intellectual and practical problems. Deal with nonverbal symbolism (formulas, scientific equations, graphs, musical notes, etc.) in its most difficult phases. Deal with a variety of abstract and concrete variables. Apprehend the most abstruse classes of concepts.

o  Apply principles of logical or scientific thinking to define problems, collect data, establish facts, and draw valid conclusions. Interpret an extensive variety of technical instructions in mathematical or diagrammatic form. Deal with several abstract and concrete variables.

o  Apply principles of rational systems to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Interpret a variety of instructions furnished in written, oral, diagrammatic, or schedule form.

o Apply commonsense understanding to carry out instructions furnished in written, oral, or diagrammatic form. Deal with problems involving several concrete variables in or from standardized situations.

o Apply commonsense understanding to carry out detailed but uninvolved written or oral instructions. Deal with problems involving a few concrete variables in or from standardized situations.

o Apply commonsense understanding to carry out simple one- or two-step instructions. Deal with standardized situations with occasional or no variables in or from these situations encountered on the job.

B.   Concentration, Persistence and Pace Functions

o Maintain attention for extended periods of 2-hour segments (concentration is not critical).

o Maintain regular attendance and be punctual within customary tolerances. (These tolerances are usually strict.) Maintaining a schedule is not critical.

o Sustain an ordinary routine without special supervision.

o Work in coordination with or proximity to others without being (unduly) distracted by them.

o Make simple work-related decisions.

o 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.)

C.   SOCIAL FUNCTIONS

o Ask simple questions or request assistance.

o Accept instructions and respond appropriately to criticism from supervisors.

o Get along with coworkers or peers without (unduly) distracting them or exhibiting behavioral extremes.

D.  ADAPTATION FUNCTIONS

o Respond appropriately to changes in a (routine) work setting.

o Be aware of normal hazards and take appropriate precautions.
I declare under penalty of perjury that the foregoing are my true and correct opinions. 
Executed this ___ day of ___________, ____, at _____________, _________. 
<signature block> 
Be aggressive in using interrogatories, your client's entitlement to benefits may depend on it.

Friday, November 18, 2016

How to Cross-Examine a Vocational Expert on Superficial Contact with Supervisors

I addressed the issue of superficial contact with supervisors and coworkers earlier this year.  A transcript from a real case pending in federal court provides context and illustrates the methodology.
BY THE ADMINISTRATIVE LAW JUDGE:

Q So what he would be limited to would be a light level of work. Occasional posturals, and avoiding hazards which would be working at heights, or operating dangerous, moving machinery. And visually would be according to doctor, he has -- his vision is corrected by glasses but he certainly would have distance problems if he did not wear his glasses. So he has a visual limitation but again, correctable by glasses.

In terms of his non-exertional limitations, he suffers from a disorder that would limit him to simple, routine instructions, and also would limit him to brief and superficial contact with the public, the supervisors and the co-workers. Now with those limitations, [vocational expert], can you identify some jobs that would exist, if there are any jobs that would exist, that exist in the national environment?

[colloquy and clarification of the exertional limitations]

A Okay. All right. Well, thank you, Your Honor. At the sedentary level, sedentary, unskilled, SVP 2 work, would be hand sorter of small fruits and vegetables, nuts, food products. The DOT is 521.687-086, approximately 3,000 jobs nationally.

[colloquy about the nut sorter jobs]

A Okay. And then, Your Honor, the other would be assembler, hand assembler and that would be 726.684-050, sedentary, unskilled. It's touch up assembler, excuse me. And also approximately 3,000 jobs nationally.

Q Okay.

A And then, Your Honor, another would be production bear with me. You said superficial contact with others?

Q Yes.

A Okay. I would leave it there, Your Honor.

BY THE ATTORNEY:

Q [...] in terms of brief and superficial contact with supervisors, that would also include criticism, work instructions, training. Are all of those brief and superficial?

A That's a very good question. It depends upon the level -- you're describing a situation that's going to vary also according to the level of work performance which would elicit
greater or lesser interaction with supervisors regarding instruction and supervision.

Q Do you consider the ability to accept and respond appropriately to criticism from supervisors to be critical to performing unskilled work?

A Yes, yeah.

Q Okay. So if the person can only tolerate brief and superficial contact, and the ability to accept instructions and respond appropriately to criticism from supervisors is critical to performing unskilled work, how can those two marry?

A Excuse me. You lost me on -- you're jumping from one to the other, so --

Q Okay.

A -- my understanding of your question was is it critical being able to accept criticism, and -- okay, I see what you're saying. Repeat the hypothetical again, please?

Q Well, it's not a hypothetical, it's an observation. If the person can only tolerate brief and superficial contact with supervisors, and we agree that the ability to accept instruction and respond appropriately to criticism from supervisors is critical to performing unskilled work, how could such a person that can only tolerate brief and superficial contact also tolerate and accept criticism from supervisors?

A All right. You -- correct. There would be a conflict there. I don't believe it would be possible.

Q So would you agree that a person can tolerate only brief and superficial contact from supervisors could not engage in competitive employment?

A As presented right now, yes.
The ALJ went on to reject the testimony on cross-examination as somehow changing the hypothetical question.  The court will get to review that assessment.  But this is an example of the "how" of cross-examining a vocational expert on superficial contact with others.