What's the Difference Between a Diagnosis and a Limitation?

What are all these terms anyway?

A symptom is an indication of an illness or injury that is personal to an individual. A symptom of a sprained ankle would be pain. A medical sign is a manifestation of an illness or injury that can be observed by someone else. A sign of a sprained ankle would be swelling. For example, our Social Security attorney explains, if a person shows up at an emergency room with a swollen ankle and reports pain, the doctor will probably consider a sprained ankle, but also want to check for more serious concerns such as a broken bone. 

This list of possible conditions is called a differential diagnosis. Once the doctor (or other healthcare provider) has collected enough information (including signs and symptoms) to make a decision about a health condition, that decision will be called an assessment or a diagnosis.  A functional limitation is a restriction in an ability due to disease, illness or injury.

Jim Keller discussing social security benefits with a fellow attorney

Social Security Administration Evaluation

When the Social Security Administration evaluates a person’s application for disability benefits, it will evaluate whether that person’s medical records identify symptoms that are consistent with the diagnosis. The Administration will also evaluate what activities a person can still do within their functional limitations. 

For example, if a person has been diagnosed with migraine headaches, the Administration will want to see whether that person is reporting headaches, nausea, auras, or similar symptoms of migraine headaches to their health care provider. 

The Administration will also look for prescribed functional limitations assessed by healthcare providers.  For example, if a doctor says that a patient should avoid flashing or strobing lights to prevent headaches, that is a prescribed functional limitation. 

Many healthcare providers will provide general information sheets, but do not specifically prescribe limitations to patients.  If your doctor tells you that you should do something or avoid exposure to something because of a medical condition, it is appropriate to ask your provider to add that information to your medical record. 

Once the Administration has determined what a person cannot do as a result of their condition, it will assess what residual functional capacity that person still has.  If that residual functional capacity eliminates that person’s ability to sustain gainful employment, then Social Security will approve an application for benefits.  

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