Nearly every job requires full and complete use of the hands. Anyone who has “manipulative limitations” caused by injury or pain needs to be aware that this can be an important component of a disability claim. While more obvious in situations involving a condition such as carpal tunnel syndrome or a specific hand injury, this limitation can also be important even when it is not the major disabling condition.
Social Security law says that in order to do even unskilled, sedentary work a person must have good use of both hands and the fingers – this is called “bilateral manual dexterity” in the regulations. Any significant limitation in a person’s ability to handle, pick up and finger small objects is important in the disability decision. Many claimants have conditions that restrict the amount of lifting they can do. Anyone person who can lift and carry even 10 pounds for most of the day may still be found capable of sedentary work, under Social Security regulations. The addition of the factor of a manipulative limitation, particularly of the dominant hand, can be enough to tip the scale in favor of the claimant.
More general medical conditions such as arthritic impairments, fibromyalgia, and chronic fatigue may also include hand, arm and shoulder pain. Often when Social Security is collecting information on these illnesses from a claimant, the entire focus is on lifting, standing and sitting limits. Careful medical record development of limits on use of the hands is very helpful in the decision making process. Soliciting this information from treating medical sources can be extremely important.These limitations may sometimes be viewed as a minor problem in the context of some larger disease process. As such, medical case records often do not specifically mention them.
When the right questions are asked of the medical provider, however, a clearer picture may emerge. Does the person have pain in the dominant hand? Does stiffness prevent full use of the hand, particularly for small motor tasks such as writing? Is the pain increased by repetitive use? Although someone may be able to lift five pounds, or use the painful hand for a task once or even five times, can this be done on a continuous, repetitive basis for an eight hour work day, five days a week? What is the effect of such an activity level on the person’s ongoing condition?
Think of a manipulative limitation in combination with all other impairments that are part of the full story. Often it can be overlooked, for example, when the presenting problem is psychiatric. For example, when a condition such as a personality disorder is not severe enough on its own to qualify a person for benefits, the claim can be strengthened by considering this and other physical limitations. The same applies to