Upper Extremity Impairments

  • The residual functional capacity (RFC) addresses all aspects of the claimant’s manipulative ability – reaching (in all directions), handling, fingering, and feeling.
  • Have the treating source provide a detailed description of what hand functions the claimant can perform, and the length of time they can be sustained.

Ability to perform past work

  • It is not unusual to find a claimant with an upper extremity impairment who has relevant work despite the impairment.
  • In this situation, the adjudicator must carefully consider the guidelines on work despite a severe impairment in POMS DI 24005.001 D5 before determining whether to adjudicate at step four of sequential evaluation or evaluate further at step five.

Transferability of skills

  • Must be considered when it makes the difference between an allowance and a denial.
  • The greater the degree of functional loss, the narrower becomes the range of other work available.
  • It would be extremely rare to find a claimant who has lost major use of an upper extremity while still retaining transferable skills.

Sedentary exertional level

  • Use of both upper extremities is critical for sedentary work.
  • A claimant with an impairment restricting his ability to stand and walk will have a very limited occupational base if he also has an impairment of one or both upper extremities.
  • A finding of disabled is appropriate for a claimant with a sedentary exertional level and an upper extremity impairment that limits function, providing he is not capable of performing past relevant work or transferring skills (these would be rare occurrences).
  • Age or educational levels are not major considerations in this situation because the occupational base is so narrow that the claimant could not realistically be expected to work.

Bilateral manipulative restrictions

  • There are approximately thirty unskilled light and sedentary occupations listed in the “Dictionary of Occupational Titles” (DOT) not coded as requiring sustained manipulative abilities.
  • Many of these occupations are suitable for even one-armed individuals; however, this consideration is based on the individual having essentially full use of at least one upper extremity.
  • When both upper extremities are involved, the remaining occupational base is further compromised since both are reduced to functioning only as assistive members.
  • If an individual has an additional restriction to no more than occasional handling and fingering bilaterally, a finding of disabled would be appropriate.

Loss of use of an upper extremity

  • Since most occupations listed in the DOT require good use of both upper extremities, an individual who has lost the major use of an upper extremity has a very unique and narrow occupational base.
  • While some individuals have been known to perform selected occupations at all exertional levels, experience has shown that such an individual’s occupational base lies between those represented in the vocational rules by light and sedentary exertion.
  • That base generally involves elementary handling functions, non-complex clerical duties, customer service, and machine tending duties.
  • Whether a claimant can be expected to adapt to such work depends on the remaining vocational profile, in particular on the individual’s age.

Uncomplicated loss of use of one upper extremity usually means the claimant is capable of performing light work with one arm .

Note: If a person has performed past relevant work (PRW) with an absent or other otherwise limited upper extremity, and no additional functional limitations or restrictions are present which would preclude performance of PRW, SSA opines a finding of “not disabled” is appropriate. (The ability to do PRW as it is ordinarily performed in the national economy is usually precluded in these types of cases.)

Traumatic versus congenital loss of a thumb

  • Traumatic loss of a thumb results in loss of major function in that extremity.
  • However, individuals with congenital absence of a thumb do not experience as significant a loss because they have had a lifetime to adapt to their loss and may function very well despite this.
  • For congenital loss of the thumb to be classified as loss of major use of that extremity, the treating or examining source should describe exactly what manipulative functions the individual can and can not perform.