When evaluating an applicant’s claim for social security disability (SSD) benefits, or when
completing a continuing disability review (for current SSD recipients), disability examiners must
determine whether the claimant has a disability, and how that impacts his ability to engage in
substantial gainful activity.
Known as the credibility ruling, the Social Security Administration (SSA) revised its regulations in March 2016 to make clear that the evaluation looks to whether the claimant’s “symptoms can reasonably be accepted as consistent with the objective medical and other evidence in the individual’s record”, and not the claimant’s character, i.e., whether or not his statements of pain are truthful or exaggerated. The SSA no longer uses the term credibility when undergoing this evaluation – the policy itself was renamed “Evaluation of Symptoms in Disability Claims” – but for ease of discussion, we will continue use the phrase here.
What the SSA considers ‘symptoms’ in an SSD case
A symptom is the applicant’s description or statement of his or her physical or mental impairments. Symptoms may include, but are not limited to, pain, fatigue, shortness of breath, weakness, nervousness or periods of poor concentration. While an individual’s statements regarding his symptoms are an important part of his SSD application, they are not enough to prove a physical or mental impairment.
If a claimant alleges his symptoms are the result of disability, the SSA uses a two-step process to evaluate whether those symptoms can reasonably be expected to be a result of the stated disability.
SSA’s two-step process for evaluation of symptoms
Every SSD application undergoes a two-step evaluation process for determining whether the claimant’s symptoms could be the result of his disability.
Medically determinable impairment
The SSA must first determine whether the applicant has a medically determinable impairment (MDI) that could cause the symptoms. This requires a thorough examination of the applicant’s medical record to see if medical signs or laboratory findings support the existence of an MDI. Signs and laboratory findings are “anatomical, physiological, or psychological” abnormalities or phenomena, established by medically acceptable diagnostic techniques, that can be observed apart from the individual’s symptoms. This is known as objective medical evidence, and it mustcome from an acceptable medical source, such as a physician, surgeon, oncologist, or specialist.
If the objective medical evidence does not support the existence of an MDI, the SSA may request additional information regarding the claimant’s disability, symptoms and their impact on his level of function. The SSA may also direct the claimant to be examined by an SSA medical consultant, or have its own medical experts review the medical record. It is important to note that the SSA does not evaluate whether the severity of the claimant’s symptoms seem excessive compared to the objective medical evidence. If the patient alleges a symptom that is reasonably expected to be caused by the disability, the fact that it appears out of proportion to the medical evidence plays no part in the determination.
If the medical record does not support an MDI, the evaluation ends. If it does support the existence of an MDI, the disability examiner moves on to step two.
Limitation on ability to perform work-related functions
Once a medically determinable impairment has been identified, the examiner then looks to the extent to which the symptoms interfere with the claimant’s ability to perform work-related activities. When evaluating the intensity, persistence and limiting effects of the claimant’s symptoms, the disability examiner may consider the following:
- Effect on daily activities, such as walking, sitting, or standing or communication;
- Location, duration, frequency and intensity of pain or other symptoms;
- Factors that either precipitate or aggravate the symptoms;
- Type, dosage, effectiveness and side effects of any medication taken to alleviate
- Treatment the applicant has undergone to relieve symptoms;
- Non-treatment measures used to alleviate symptoms, i.e., lying flat on one’s back or
- using a special pillow, and;
- Any other factors that may be relevant regarding the claimant’s functional limitations.
The disability examiner may also consider the claimant’s own statements regarding his limitations, both within the medical record and in prior levels of the review process, to determine whether he has been consistent in his statements of symptoms and their impact on his ability to work.
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