Form Ssa-4734-Bk - Physical Residual Functional Capacity Assessment Page 4
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8C. MANIPULATIVE LIMITATIONS
None established. (Proceed to section D.)
LIMITED
UNLIMITED
1. Reaching all directions (including overhead)
2. Handling (gross manipulation)
3. Fingering (fine manipulation)
4. Feeling (skin receptors)
5. Describe how the activities checked "limited" are impaired. Also, explain how and why the evidence supports
your conclusions in item 1 through 4. Cite the specific facts upon which your conclusions are based.
D. VISUAL LIMITATIONS
None established. (Proceed to section E.)
LIMITED
UNLIMITED
1. Near acuity
2. Far acuity
3. Depth perception
4. Accommodation
5. Color vision
6. Field of vision
7. Describe how the faculties checked "limited" are impaired. Also explain how and why the evidence supports
your conclusions in items 1 through 6. Cite the specific facts upon which your conclusions are based.
Continued on Page 5
Page 4
Form SSA-4734-BK (12-2004) ef (12-2004)
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