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How does Social Security evaluate symptoms such as pain, fatigue, shortness of breath, weakness, and nervousness in a disability claim?

The Commissioner of Social Security has published Social Security Rulings (SSRs) which are a series of decisions relating to the programs administrated by Social Security Administration. These SSRs may be based on case decisions made at all administrative levels of adjudication, Federal court decisions, Commissioner's decisions, opinions of the Office of the General Counsel, and policy interpretations of the Social Security law and regulations. There is a SSR addressing our question posed above.

SSR-96-7p addresses the two-step process for evaluating claims involving symptoms, such as pain, fatigue, shortness of breath, weakness, or nervousness:

  • First, the adjudicator must consider whether there is an underlying medically determinable physical or mental impairment(s)--i.e., an impairment(s) that can be shown by medically acceptable clinical and laboratory diagnostic techniques--that could reasonably be expected to produce the individual's pain or other symptoms. The finding that an individual's impairment(s) could reasonably be expected to produce the individual's pain or other symptoms does not involve a determination as to the intensity, persistence, or functionally limiting effects of the individual's symptoms. If there is no medically determinable physical or mental impairment(s), or if there is a medically determinable physical or mental impairment(s) but the impairment(s) could not reasonably be expected to produce the individual's pain or other symptoms, the symptoms cannot be found to affect the individual's ability to do basic work activities.
  • Second, once an underlying physical or mental impairment(s) that could reasonably be expected to produce the individual's pain or other symptoms has been shown, the adjudicator must evaluate the intensity, persistence, and limiting effects of the individual's symptoms to determine the extent to which the symptoms limit the individual's ability to do basic work activities. For this purpose, whenever the individual's statements about the intensity, persistence, or functionally limiting effects of pain or other symptoms are not substantiated by objective medical evidence, the adjudicator must make a finding on the credibility of the individual's statements based on a consideration of the entire case record. This includes the medical signs and laboratory findings, the individual's own statements about the symptoms, any statements and other information provided by treating or examining physicians or psychologists and other persons about the symptoms and how they affect the individual, and any other relevant evidence in the case record. This requirement for a finding on the credibility of the individual's statements about symptoms and their effects is reflected in 20 CFR 404.1529(c)(4) and 416.929(c)(4). These provisions of the regulations provide that an individual's symptoms, including pain, will be determined to diminish the individual's capacity for basic work activities to the extent that the individual's alleged functional limitations and restrictions due to symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence in the case record.

SSR-96-7p, page 2

I find that it is very helpful to get opinions from the treating physician regarding the pain or other symptoms and how they affect the individual. In cases involving pain I have a pain questionnaire which addresses whether the physician believes the claimant's complaints of pain are credible, whether the diagnosis and objective medical findings support the pain levels expressed; the level of pain at rest, and with certain activities; whether the pain interferes with the claimant's attention and concentration capabilities and, if so, the degree of such; whether the claimant is likely to have "flare ups" and, if so, an estimate as to how this might cause absences from work; whether rest breaks where the claimant is allowed to lay down are required and, if so, the frequency and duration of same; and whether the side-effects of the pain medications would interfere with the claimant's attention and concentration capabilities and, if so, the degree of such. If the opinions are well supported by the treatment notes this can result in a favorable ruling. The opinions of pain specialists are particularly helpful where pain is a big part of the claim.

Other evidence a judge must consider pursuant to SSR-96-7p, in addition to the objective medical evidence, when assessing the credibility of a claimant's statements includes:

  • The individual's daily activities;
  • The location, duration, frequency, and intensity of the individual'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 measures 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.

SSR-96-7p, page 3

If the claimant's daily activities are strenuous and inconsistent with complaints of disabling pain, this can cause the judge to question the credibility of the claimant. Many judges will carefully examine the Adult Disability Report (completed by the claimant) to see what the claimant says about how they are limited by their condition. Therefore, it is important to take your time and be very careful when these forms are filled out. Our law office will normally review these forms before they are turned in to the Social Security Administration to make sure the claimant fully understands what information is being requested and to make sure there are no inconsistencies in the responses. A careless answer can lose a case. Also, judges will review the medical records, especially emergency room records, to see what history is given by the claimant. If there are a lot of ER records containing evidence of strenuous activities such as moving furniture, painting a house, working, riding 4 wheeler or jet skis, working out, etc., these can be problematic.

Also, it is also important that a claimant inform their physician when they are having side-effects from their medications, such as drowsiness; confusion; and inability to maintain focus, attention and concentration. I frequently see medical records which record no side-effects, although the claimant later tells me otherwise.

Your medical records should contain a description of all the treatment the physician has provided, but you want to be sure to let your lawyer know about other things you do on your own to relieve your pain. These may include: lying flat on your back (recumbent rest breaks); alternating sitting and standing periodically; periodic stretching exercises; massages; sleeping on a board; sleeping with pillows between your legs; use of a TENs Unit; wearing back braces, neck braces, wrist splints or use other orthopedic devices, such as a cane, or orthotics.

Be sure to let your lawyer know if you have been issued a handicapped parking tag or placard. He may want to make a copy of the placard to place in evidence. If you must use an electric shopping cart at the grocery store or department stores like Walmart and Target, be sure to tell your lawyer.

The judge will be making a credibility determination regarding your symptoms such as pain, fatigue, shortness of breath, and weakness. The judge only has about 45 minutes at the hearing to make that credibility determination. You can help your lawyer in establishing that your testimony is worthy of belief and that your symptoms are as severe as you say if you will remember these suggestions.

This article is meant for general information only, and it is not to be construed as legal advice. If you would like more information about applying for Social Security disability programs or appealing a denial, please contact us at 678-563-1584 or [email protected] for an evaluation of your case by a Social Security lawyer.

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