TN 53 (03-97)
DI 24510.065 Section III of SSA-4734-F4-SUP - Functional Capacity Assessment
Section III is for recording the formal narrative mental RFC assessment and provides for the MC to prepare a narrative statement for each of the subsections (A through D) in section I.
B. Operating Procedure
In preparing the formal narrative statement, the MC is to address each of the four mental categories (Understanding and Memory, Concentration and Persistence, Social Interaction, and Adaptation) by:
1. Writing the Narrative Statement
Identify the subsection (e.g., Understanding and Memory), then discuss the functions that the individual has demonstrated that he/she can do, as well as any limitations of those functions.
Describe, in detail, the mental capacities, limitations, and any other information that is important in the comprehensive expression of mental RFC.
Indicate the extent to which the individual could be expected to perform and sustain the activity.
Include any additional information or consideration that is necessary to give a clear description of the individual's mental functional capacity.
The claimant can understand, remember, and carry out a two-step command involving simple instructions.
The claimant can understand complex instructions but can only recall at a span of two-step commands. The claimant, therefore, would be limited to this span.
The claimant can understand and remember a four-step command, but the disruption of executive functions is such that he can carry out only a single step before confusing the order.
Record conclusions of functional capacity provided by examining physicians that are appropriate and consistent with the documented medical and nonmedical evidence, along with the supporting findings.
Confinediscussion to the effectsof the impairment(s) on function.
Include no severity ratings or nonspecific qualifying terms (e.g., moderate, moderately severe) to describe limitations. Such terms do not describe function and do not usefully convey the extent of capacity limitation.
Offer no opinion as to whether the individual is disabled or whether the individual can or might perform or qualify for levels of work (e.g., unskilled) or specific jobs (e.g., truck driver).
2. Signature and Date
After completing the narrative statement in section III, sign and date the SSA-4734-F4-SUP in the spaces provided.
The MC's name is to be typed or stamped below the signature.