“Why doesn’t anyone believe me?” How Social Security Views Your Allegations of Pain and Other Symptoms

When someone suffers from a physical or mental impairment, they often experience day-to-day symptoms that can result in the need to file a claim for disability. Because symptoms vary so much from person to person, it is important that Social Security has a policy in place to evaluate a claimant’s symptoms to verify whether or not the symptoms are severe enough to interfere with basic work activity.

Allegations of symptoms alone are not enough to find someone disabled. A few things must be taken into account in order to find out whether or not someone is disabled.

Medically Determinable Physical and/or Mental Impairment

First, a Social Security claim adjudicator must consider whether or not the physical and/or mental impairment(s) alleged could reasonably be expected to produce the symptoms a claimant alleges. If a medically determinable physical and/or mental impairment cannot be established, the symptoms can not be considered to interfere with basic work activity.

Secondly, the adjudicator must determine the limiting effects the alleged symptoms have on basic work activities. In order to do so, the adjudicator must establish credibility of the claimant’s allegations.  This requires consideration of the entire case record, including the medical evidence of record.

Establishing Credibility

The statements made by the claimant as recorded in the medical evidence of record, as well as through interactions with Social Security employees, must be consistent in order for an adjudicator to find a claimant’s allegations as credible. Other sources an adjudicator can turn to in order to assess credibility may also be statements by third parties and reports completed by the claimant that state medications taken, treatments tried, and factors that either precipitate or relieve pain. Another important factor an adjudicator must keep in mind is that symptoms vary from person to person. What is excruciating pain for one person may be simply a nuisance to another.

Once credibility is established, the adjudicator must have an explanation to back up the allegation of credibility. He or she must cite specific reasons that must also be supported by the evidence in the record.

Medical Evidence of Record and other Sources of Information

As mentioned in the previous section, statements made by the claimant in the medical evidence of record should match up to other records and findings in the claimant’s file. Another reason why medical evidence is important in this aspect is because there may be clinical observations of the symptoms in the records. However, even if the clinical observations are absent from the medical evidence of record, the allegation of symptoms still cannot be totally discounted. An adjudicator must take all of the allegations into consideration in the context of all of the evidence of record.

Longitudinal history established in medical records is also helpful when determining credibility. If an adjudicator can see that a claimant has been persistent in his or her attempts to find relief of his or her symptoms, this can give weight to that person’s allegations of symptoms. However, this is a double-edged sword. If a person, in their attempts to find relief from alleged symptoms, does not follow through with treatment with no good reason, credibility may be damaged. On the other hand, there may be good reasons why a claimant did not follow through with treatment (lack of income, transportation, etc.) that may not be readily apparent in the medical evidence of record and must be investigated further by the adjudicator.

Exams conducted by a state agency of the Social Security Administration must also be taken into account when determining the credibility of a claimant and his or her allegations of symptoms. However, the adjudicator is not bound by these findings. They must explain whether or not they give weight to the state examiner’s findings and why.

Overall, there is a great deal of investigation and research a claim adjudicator must perform in order for the Social Security Administration to make the right decision on a disability claim. This is important for a person to keep in mind when they are applying for benefits. To put it simply, “Honesty is the best policy.” If a claimant is truthful in their allegations of pain or other symptoms, the adjudication process is easier and more clear-cut for all parties involved.

For more information, please visit http://www.ssa.gov/OP_Home/rulings/di/01/SSR96-07-di-01.html

- written by Anna Westfall and Attorney Andrew November