A Functional Capacity Evaluation (FCE) is a comprehensive performance-based medical assessment of an individual’s physical and/or cognitive abilities to safely participate in work and other major life activities. The four major components of an FCE include:
- Intake interview
- Medical records review
- Physical examination
- Functional testing.
An FCE attempts to identify an individual’s ability to safely participate in work and other major life activities. In instances where an individual has an illness, medical condition, or disorder that impairs his/her ability to safely participate in work or other major life activities, functional limitations may be present. Residual functional capacity represents what an individual can still do despite functional limitations resulting from a medically determinable impairment(s) and impairment-related symptoms. In determining an individual’s residual functional capacity, Functional Capacity Examiners should rely on objective clinical measurements and observations during content valid functional testing in combination with objective evidence gathered from a physical examination and a review of medical records. Functional Capacity Examiners should also consider subjective evidence from the individual’s self-reported pain and disability reports, which may include standardized questionnaires as well as subjective information provided by the individual through an interview as part of the FCE. Historically, return-to-work decisions were based upon diagnoses and prognoses of physicians but did not include objective measurements of an individual’s functional abilities. Most physicians are not trained to assess the full array of human functional abilities required for comprehensive disability determinations or return to work recommendations. The physician or treating provider determines the diagnosis and medical prognosis but should rely on functional testing to more objectively identify an individual’s functional abilities and limitations rather than their use of estimates, commonly called restrictions. In an evidence-based medical model, measurements are preferable to estimates.
Medically determinable impairments combined with the results from content valid functional testing administered by qualified Functional Capacity Examiners form the basis for establishing the severity of functional limitations and functional impairments.