Articles from prior issues of The Advocate

July/August, 1999

Evaluating Hand Impairments
Presented by Kenneth Bussan M.D.
by Judy Nesbitt, Illinois

The “Hand Doctor”, professionally identified as Kenneth Bussan MD with the Wisconsin DDS, presented his informational and interesting evaluation of hand impairments. This was a second run at the Great Lakes Regional Conference from a successful “brown bag” lunch presentation.

Dr. Bussan began his topic with a basic anatomy class on the skin, bone, muscle, nervous and vascular systems of the hand structure. He reports that there are 16 million injuries to the hand each year. Three to seven million patients suffer from arthritis to the hands and also have loss of hand function due to CVAs.

After a general discussion of the Listings involving hand impairments, Dr. Bussan stated that the adjudicator must gather general information on such items such as dominant hand, occupation of the claimant, past history and physical examination findings.

The discussion moved on to completion of the RFC. He cites a report of a phone call to Ted Neiman on 02/04/97 with the Chicago Regional office. The basic communication is that the term “repetitive” is not a defined SSA term. It has no specific quantitative meaning. The adjudicator should be using the defined terms - never, occasional, frequent, constant for frequency of manipulative functioning. These defined terms are more meaningful and are the same terms used in the Dictionary of Occupational Titles.

The RFC terms for frequency for hand use are defined as follows: constant is use of hands 2/3 of a day, frequent is use of hands 1/3 to 2/3 of a day, occasional is less than 1/3 use of hands of a day and never means not at all. One caution to keep in mind is that the frequency of manipulative functioning is only one part of the description/evaluation of the manipulative RFC. The quality of functioning is also important.

Both SSA and DOT define manipulation as reaching, handling, fingering and feeling. Obviously, the evaluation and description of the manipulative RFC is difficult. There is not much specific policy guidance related to determining an RFC from a given set of medical findings, and there is a wide range of possible medical findings in any given case situation. Pain and medical source statements need to be considered.

Detailed manipulative RFCs may not always be needed in certain case situations. For example, the case may be an allowance because of other impairment restrictions without consideration of the manipulative restrictions. In other cases, we may need to address very specific restrictions or capabilities, such as when considering the ability to return to past relevant work.

Dr. Bussan states that if an RFC, regardless of education or age, is limited to light work with occasional or worse in fingering and handling bilaterally, the decision is an allowance. If a claimant can not do frequent handling, we eliminate all light work activity as well as sedentary work.

In conclusion, the adjudicator must always question effort on the part of the claimant in evaluating hand impairments. If someone can not lift five pounds, he/she can not do sedentary work. Currently, the RFC is more complicated than in the past and the adjudicator must be careful of how to term the limitations when addressing hand impairments.