Symptoms, Nothing More Than Symptoms?

by | May 19, 2016 | Disability: SSDI and SSI

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Are symptoms enough to prove disability?  According to a recent ruling by the Social Security Administration, no.

On March 16, 2016, the Social Security Administration (SSA) published a new disability Ruling SSR 16 -3p (“Titles II and XVI: Evaluation of Symptoms in Disability Claims”).  Effective on that date, it replaced Ruling 96-7p . Ruling 96-7p also dealt with the evaluation of symptoms.  It was titled “Titles II and XVI: Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual’s Statements.”

What is a Social Security Ruling anyway?  SSA defines them as a standard to be used in later decisions.  A Ruling is not a federal law passed by Congress and is not a federal regulation it does provide guidance to Social Security’s decision makers in deciding whether an individual is disabled under the law.

The old Ruling emphasized the credibility of the claimant.  The new Ruling, however, focuses on the evaluation of the symptoms and drops the credibility analysis.

Why did SSA discard the credibility analysis?  Simply because SSA’s regulations do not mention “credibility” in evaluating symptoms.  If the regulations don’t mention credibility, then the Rulings that clarify the regulations should not either.

Before taking a closer look at this new Ruling, we first have to understand what is meant by “credibility.”  Credibility is defined a the quality of being trusted, believed in and convincing.  In superseding the old Ruling, SSA stated that when evaluating symptoms, SSA will not “…assess an individual’s overall character or truthfulness in the manner typically used during an adversarial court litigation. The focus of the evaluation of an individual’s symptoms should not be to determine whether he or she is a truthful person. ”

Rather than evaluating the credibility of a claimant, SSA instead will focus on whether the evidence shows that there is at least one “medically determinable impairment.”  The next question is whether it could produce the claimant’s symptoms.   SSA will then determine whether the  intensity and persistence of the symptoms limit the claimant’s ability to perform work-related activities.  These activities include standing, walking, lifting, carrying, and concentrating.

But how does SSA define symptoms? Why are they so important in evaluating disability? And why alone are they not enough to establish the existence of a medically determinable impairment?

In its regulations, SSA defines symptoms as “…your own description of your physical or mental impairment.”  Examples of symptoms are pain, fatigue, shortness of breath, weakness, nervousness, or periods of poor concentration.   Obviously, your symptoms can affect your ability to function.  For example, if you are experiencing constant pain, it may be hard to move or think.  Although symptoms are very important in evaluating disability, they are not enough to establish that there is a medically determinable impairment.  For that, objective medical evidence is needed.

This ruling highlights the importance of objective medical evidence in establishing a medically determinable impairment.  This Ruling states that “…medical evidence that provides signs or laboratory findings” is called objective medical evidence.  A sign is an abnormality, other than a symptom, must be shown by medically acceptable clinical diagnostic techniques.  According to SSA’s definition of signs, they must be shown by observable facts that can be medically described and evaluated.  Laboratory findings, on the other hand, are shown through the use of acceptable laboratory diagnostic techniques.  Some examples of laboratory findings are x-rays, MRIs and electrocardiograms.

What  does all this mean to someone who is applying for benefits? This Ruling discusses certain key factors used to figure out how to look at a claimant’s symptoms. These factors can help show how intense and persistent the symptoms are and include the following:

  • The claimant’s statements, made to medical providers, SSA and others
  • The consistency of the symptoms as compared to the objective medical evidence
  • Whether the claimant seeks out and/or follows medical treatment
  • Persistent attempts to obtain relief, such as changing or increasing doses of medication
  • Trying different treatments, seeing specialists or changing treatment sources
  • Reasons why a claimant did comply with or seek treatment

It is helpful to keep these key points in mind. This Ruling guides those deciding cases for the Social Security Administration.  It also helps educate claimants and their representatives in these increasingly difficult and complicated claims.