Social Security's rules and regulations dealing with the evaluation of subjective symptoms, including chronic pain, are intended to separate bona fide symptoms from those that are exaggerated or fraudulent. In practice, this system often results in Social Security's ignoring genuine complaints for dubious reasons. If you're filing for disability benefits because you suffer from chronic pain, you need to understand Social Security's process for evaluating pain allegations so that you can present the most persuasive case possible.
Pain is often the only symptom of back problems, migraines, fibromyalgia, joint pain, carpal tunnel syndrome, and reflex sympathetic dystrophy (RSD), and because of this, it can be difficult to get disability benefits for these conditions.
Social Security's Process for Evaluating Subjective Complaints, Including Pain
Social Security will likely dismiss vague allegations of pain with no apparent cause. The Social Security Administration (SSA) first has to determine whether your pain is the result of an underlying "medically determinable impairment" that can be demonstrated by medical signs and laboratory findings.
Having a Medically Determinable Impairment
If you have pain but your doctors have not been able to identify the cause or diagnose you with an impairment caused by "anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable techniques," your claim will be denied. Your medical record should include the results of the clinical exams (such as a tender-point exam for fibromyalgia or a straight-leg-raising test for back pain), x-rays, and MRIs that led to your diagnosis, as well as any lab tests that ruled out other conditions.
Evaluation of Pain's Cause and Severity
If the SSA finds you have a medically determinable impairment, the agency will determine whether your impairment can reasonably be expected to produce the pain you claim to have. If the SSA finds your impairment is unconnected from your allegations of pain, your subjective complaints such as pain won't be considered.
If Social Security agrees that your condition can be expected to cause the type of pain you have, Social Security will evaluate the persistence and intensity of the pain and the functional limitations it causes. To the extent that your reported pain exceeds the level suggested by the medical evidence, Social Security must consider your credibility.
The claims examiner or the administrative law judge considers how credible you are by looking at the entire case record and assessing the consistency of your statements. He or she must provide specific reasons for the weight, or lack of weight, given to your allegations. It is not enough for the examiner or judge to state that your complaints of pain were "not credible" and to deny your claim.
Other factors that Social Security uses in determining your credibility include:
- your reported daily activities
- the medical opinions of treating or examining physicians
- whether you consistently seek out medical treatment
- the frequency, duration, and intensity of your reported pain
- the nature of the pain therapies you've attempted, including medication, injections, physical therapy, and surgery
- the strength of your work history, and
- statements of third parties (family members, friends, co-workers) about limitations you have that they've observed.
Make sure that your doctor has included as much of this information as possible in your medical record.
Again, it's not sufficient for the examiner or judge to simply recite the factors above; he or she must give a specific explanation as to how these factors render your complaints more or less persuasive. If the above credibility factors are working in your favor, the SSA may decide to credit your allegations of pain even where they're not fully supported by the objective medical evidence.
How Do I Enhance My Credibility With Social Security?
If Social Security doesn't find your complaints entirely believable, your chances of prevailing on your case decrease considerably. Unfortunately, disability claimants tend to make the same mistakes over and over, both on the initial application for benefits and at the disability hearing. The worst part is that these self-inflicted wounds are entirely avoidable. Here are some "best practices" you should keep in mind if you want to maximize your credibility with the SSA
Be realistic when rating your pain. Administrative law judges (ALJs) routinely ask claimants to "rate their pain" on a ten-point scale. Be extremely careful when responding to this question; it might be a trap. If you state that your pain is a "9" or "10," the judge may think that if the pain were really this severe, you'd be in the emergency room. On the other hand, stating that your pain is a "4" or "5" will lead the judge to believe it's not particularly severe. If the ALJ insists that you put a number on your pain, you should certainly be honest and realistic, but also remember that no one's ever had a claim denied because they rated their pain a nice, safe "7" or "8."
Tell Social Security if your pain comes and goes. Those who suffer from fibromyalgia, arthritis, and other conditions involving chronic pain tend to have symptoms that wax and wane. If this applies to you, make sure you indicate this repeatedly to Social Security on your initial application and at the hearing. Why is this so important? If you've told the SSA that you're able to cook, clean, shop, and mow the lawn, the agency will assume that you can perform these activities at all times. Emphasizing that you have good days and bad days removes the inconsistency between your reported daily activities and your claims of disability.
Emphasize your strong work history. A consistent record of employment tends to enhance your credibility, while a sporadic work history might lead the SSA to believe you're not disabled but merely seeking a new source of income. Statements from former co-workers and bosses with regards to your employment record might persuade Social Security of your desire to work and, ultimately, the legitimacy of your symptoms.
Obtain appropriate medical treatment. Social Security tends to assume that any pain left untreated must not be very severe. Be sure to receive consistent medical treatment from the appropriate specialists, and follow through with their recommendations for managing your pain. If you've been diagnosed with fibromyalgia by a family physician, seek a referral to a specialist, preferably a rheumatologist. The fibromyalgia diagnosis, especially when made by a family doctor, is often treated with skepticism by Social Security.
Ask for opinions from your treating physicians. A favorable opinion from your treating doctor can turn a losing disability case into a winning one. In a statement to Social Security, your treating physician should address your exertional (strength-related) and non-exertional limitations, including your ability to lift, carry, stand, sit, walk, bend, and stoop. Your doctor should also address whether he or she has observed any signs of "malingering," or exaggerating the severity of your symptoms.
To continue learning about enhancing your credibility, read Nolo's article on how to increase your credibility in a Social Security disability case. Finally, remember that individuals with largely subjective symptoms, including chronic pain, face an uphill battle in their quest for disability benefits. Therefore, it's critical to contact an experienced disability attorney to help you obtain the benefits you deserve.