Adult Function Report - Adult (Form SSA-3373-BK)

March 31, 2019

 

 

If you are applying for Social Security Disability this is one of the first forms you will be provided to complete. Most people completing the form do not have an attorney at this stage in the process. That said I believe many people complete the form in such a way that does not help their case or in some circumstances even unknowingly and with no bad intent hurts their case. So following are some tips. Important Note: If the condition(s) that are the primary reasons you cannot work are physical you can follow these tips. If they relate to mental illness I will blog a separate entry for those instances.

 

1. Change Your Mindset About the Form:   Do not think of it as just another government form or just a form like you may have filled out numerous times before for the IRS, a Handicap Parking Placard, Workers Comp or the Supplemental Nutrition Assistance Program (SNAP). Think of it as an important legal document. When you sit down to work on it, don't rush through it. Take your time. Have a cup of coffee or tea or a large glass of water with you. Make yourself comfortable. Know that in one to two years a judge will be looking at the form and comparing it to all your medical records and the specific impairments you are claiming. If they don't coincide you could lose your case. 

 

2. Be Honest:  This goes without saying but I'm saying it. 

 

3. If You Don't Know Something or Are Not Sure Do Not Answer the Question: Just put "Don't Know" or "Not Sure."  This is not the place to guess but it might be a place to provide a good faith estimate in which you are confident. Use the word estimate throughout the document as you see fit.

 

4. Keep a Copy for Yourself to Review Before Your Hearing in Front of the Judge

 

The Judge is likely to ask you about what your wrote either directly or indirectly.

 

5. Don't Provide Your Life Story and Entire Medical History 

 

I believe that you can provide all the information Social Security needs at this early stage of the process in the space provided. If you are attaching additional pages you are probably providing too much information. Use lines, arrows, blank areas or the page and neat handwriting to fit in what you need to say. You can write in just nouns, verbs, adjectives. Cave man talk is ok. So "I have a lot of problems tying my shoes. It takes a while" becomes "problems tying shoes takes awhile."

 

6. Keep in Mind the Disability Examiner, and later the Judge, Will Spend 1-2 minutes Tops Reading Your Responses

 

The Disability Examiner at the initial stage is trying to determine what are your main issues and what's laws and procedures then need to be applied to the review. The Judge is trying to determine whether your testimony and your medical records match what you wrote.

 

7. Section B. Question 5: How do your illnesses, injuries, or conditions limit your ability to work? 

 

To simplify things physical disabilities really come down a couple of basic areas of impairments. The following is what Social Security wants to know. Apply it to your particular circumstances.

 

The first is . . . .

 

Due to my diagnosis(es)  of _______________________  I have limited use/no use/limited range of motion of my ______________________.

 

When providing the body parts affected be specific - not "my knee" but "my left knee" not "fingers" but "my left thumb and left index finger" not "my back" but "my upper, middle, or lower back." You get the idea.

 

Due to my diagnosis(es) of __________________  I suffer from chronic pain and/or chronic fatigue.

 

There is a lot more to say about the issues of chronic pain and chronic fatigue. However for our purposes for this form that is all that needs to be said.

 

There may be other situations not addressed here but you get the idea so you can describe those impairments on your own.

 

8. Section C - Information About Daily Activities Questions 6 to 9: Taking Care of Other People and Animals

 

There are two potential problems that can arise with these questions if the honest answer is Yes.

 

Well look at what you are doing to help others, that indicates you can work! 

Well look at what you are doing to help others ,that indicates your limitations are not as severe as you say! AHA!

 

I am going to write a separate blog on this issue but for our purposes today, when answering these questions be specific as to what you do and don't do in terms of the limitations you already described and the specifics as far as how much time is spent doing these things in terms of how many hours a week. 

 

Likewise with pets, the Judge will often ask such things. So in your answers provide this information. What kind of pets do you have? What kind of dog or cat are they? How much do they weigh? Do you feed them? Do you walk them? Do you play with them? Do you pick up after them?

 

9.  Section C Question 11: Do the illnesses, injuries, or conditions affect your sleep?

 

If the answer is Yes, fill in the blanks. Estimates in this section are fine.

 

I usually go to bed at _______ pm. It take me on average _______ minutes/hours to fall asleep. I usually get up to start the day at ________ am.  During the night I wake up on average ______ times and it takes me about ______ minutes/hours to fall back asleep.  ___________   is what is causing me to wake-up.  I sleep in a _________ and position myself __________ using ________  My husband/wife/significant other does/does not does not sleep in the same bed/room. To help myself fall back asleep I _______________.   During the day I nap for about X usually around X.

 

10. Section C: Question 12: PERSONAL CARE

 

NO PROBLEM does not mean CAN YOU DO IT. This question should really read as follows:

 

Do your conditions affect your ability to do any of the following in terms of whether you can do them at all, whether you can do them with difficulty, whether you can do them but at a slower pace than before your conditions, or whether doing them causes any pain. Do you need any kind of assistance in terms of tools/physical items and/or other people to do these things. What is different in how you do these things now as compared to before you became disabled?

 

Here are some questions you may want to answer with details.

 

How do you put on your pants? Can you use a zipper? Can you button your shirt? Can you put on a t-shirt? Can you put on socks? A belt? Shoes? Can you tie your shoes? Does someone ever need to help you with any of this?

 

How do you get in and out of the shower? How do you shower? How do you get in and out of the bathtub? Can you wash your hair? Can you reach everywhere to soap your body? How do you shave your face or legs? Can you do/put up your hair? How do you get on and off the toilet? How do you wipe yourself? Does someone ever need to help you with any of this?

 

11. Questions 13 and 14 Meals and House Work

 

The same guidance giving for the previous question also applies here. Social Security wants to know about you doing laundry, washing/drying/putting away dishes, emptying out the dishwasher, dusting, mopping. vacumeing, picking up around the house, making beds, cleaning the bathroom.

 

12. 15 and 16 Getting Around and Shopping

 

Again think along the same lines. How often do you go to the supermarket? Does someone always go with you? Do you need their help? If yes with what? Do you ride around in one of those carts? Do you push the regular cart? Can you reach all the shelves in both they dry foods and refrigerated/freezer sections? Can you empty your cart onto the conveyer belt, put them in your basket, and unload them into your car?

 

If you drive or have a license answer how many times a week, where you go, and how far is it to where you go. Then state how your disability affects your ability to drive in any way if it does. If you never drive but have a license state why. 

 

13. 20.C. How far can you walk without needing to stop and rest? If you have to rest how long until you can resume walking (FOR THE SAME AMOUNT OF TIME)?

 

This is one of the most important questions on the form. You want to try to provide as accurate answer as possible. In all the times I have asked people this question they never answer it correctly the first time. This is because they are just guessing, have never actually time themselves in such a situation, and/or on some level they want to minimize the severity of their situation. After much more talking with them about various aspects of their day to day lives I can usually get a more accurate answer.

 

I recommend you either answer "Don't Know. Never Timed" or go to the mall with a friend and have them time you. When you put your answer on the form next to it put the kind of day it was that you did it  - "A Good Day. An average day. A Bad Day." in terms of how you were feeling. Also measure both time and distance. Measure distance in terms of feet. Bring a tape measure with you. Make your best good faith effort at doing as well as you can. If you have been prescribed a cane or walker do it both with and without the cane/walker.

 

14 Side Effects of Medications

 

This is another important section. Sometimes people become so used to the side effects of their medications that they almost forget about them. Here are some of the more common side effects of prescription drugs: drowsiness, fatigue, headaches, mental slowness, poor concentration, nasaue  vomiting, gastrointestinal/digestive problems, blurred vision and dizziness.

 

That's all folks. It goes without saying that you are almost always better with an attorney. However according to Social Security only about 11% of individuals applying were represented at the initial determination level. That's unfortunate but that's a separate blog topic.

 

 

 

 

 

 

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Damian Leone Esquire
Scranton Wilkes-Barre Northeastern Pennsylvania
Social Security Disability Attorney

(570) 677-3914

dleone@nepasocialsecurity.com