When a person files a claim for social security disability and/or SSI benefits, their statements about pain and other symptoms are important aspects of the case. The regulations define “symptoms” as a person’s own description about his or her impairments. Symptoms are such things as pain, fatigue, shortness of breath, weakness, or nervousness.
Social Security Ruling 96-7p gives guidance on how social security will assess the credibility of a person’s statements. I will attempt to summarize that ruling in this post.
As one might expect, a finding of disability cannot be made based on symptoms alone. There must be a medically determinable impairment that is likely to produce those symptoms. The functional limitations must be severe enough to rule out gainful employment.
There is a two-step process for evaluating symptoms. First, the decision maker (adjudicator) must determine whether or not there is a medically determinable impairment that is likely to cause the alleged symptoms. If not, the symptoms will not be found to limit the person’s basic work activities.
Second, once a medically determinable impairment is found that is likely to cause the alleged symptoms, the adjudicator must evaluate the intensity, persistence, and limiting effects of those symptoms in order to determine their effect on the person’s ability to do basic work activities.
In making this decision the adjudicator considers the objective medical evidence. If the objective medical evidence does not substantiate the person’s statements about the intensity, persistence and functional limitations of their symptoms, the adjudicator must consider the overall record to assess the person’s credibility.
This means looking at seven different types of evidence, including:
- The person’s daily activities;
- The location, duration, frequency, and intensity of the person’s pain or other symptoms;
- Factors that precipitate and aggravate the symptoms;
- The type, dosage, effectiveness, and side effects of any medication the individual takes or has taken to alleviate pain or other symptoms;
- Treatment, other than medication, the individual receives or has received for relief of pain or other symptoms;
- Any measure other than treatment the individual uses or has used to relieve pain or other symptoms (e.g., lying flat on his or her back, standing for 15 to 20 minutes every hour, or sleeping on a board); and
- Any other factors concerning the individual’s functional limitations and restrictions due to pain or other symptoms.
Like an individual fingerprint, each individual’s profile is unique. One person may experience symptoms differently than another person with similar medical impairments. Symptoms, such as pain or fatigue, sometimes suggest a greater degree of severity than is shown by the objective medical evidence alone.
The adjudicator must consider the entire case record in assessing a person’s credibility. They will consider the internal consistency of a person’s own statements, whether those were made to treating doctors or to the social security administration. They will consider a person’s statements about their own daily activities. They will consider statements from third parties who are familiar with the person, who are not medical professionals. They will consider to what extent the person’s allegations are consistent with the medical signs and laboratory findings. They will consider the person’s diagnosis and prognosis. They will consider medical opinions by treating or examining physicians or psychologists, and other medical sources. They will consider the individual’s medical history, treatment and response, prior work record, and efforts to work. They will consider any observations about the person made by social security personnel, whether in person or on the telephone.
The adjudicator must set forth with reasonable specificity the weight assigned to the person’s statements. But it is not enough simply to recite in boilerplate terms that a person is credible, partially credible or not credible. Specific reasons must be given for the credibility assessment, with citations to the case record.
In summary, in my opinion, in any disability application it is important to tell the whole story – in other words, to not exaggerate one’s symptoms, but on the other hand, to not minimize one’s symptoms.
This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.