How the Social Security Administration evaluates pain and other symptoms

Your case, like many Riverside County and San Bernardino County Social Security disability cases, may turn on whether Social Security Administration decision makers believe that your symptoms keep you from working. Symptoms are your own description of your physical or mental impairment — pain, fatigue, dizziness, nervousness, shortness of breath, etc. After all, it’s not your diagnosis of arthritis, heart disease, or diabetes that limits what you can do. It’s the pain and other symptoms caused by your medical condition.

The Social Security administration applies a two-step test to evaluate whether your pain and other symptoms prevent you from working.

  • First, the Social Security Administration decision makers consider whether you have objective evidence showing you have a “medically determinable impairment” that could reasonably be expected to cause your symptoms.
  • Second, the Social Security Administration decision makers consider whether your symptoms (a) are reasonably consistent with the objective evidence and other evidence in the record and (b) limit your ability to do work.

The difference between the first step and the second step is the difference between whether your impairment “could cause” the alleged symptom (step 1) and whether your impairment “does cause” the alleged symptom (step 2). Unfortunately, Social Security decision makers don’t always apply the second step correctly resulting in an erroneous denial of some claims.

Step 1: Objective evidence of impairment that could cause your symptoms

First, objective evidence must show you have a “medically determinable impairment” that could cause your symptoms. A medically determinable impairment is one that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques, i.e., objective evidence.

Your statements alone are not enough to establish that you have a physical or mental impairment. For example, if you allege you have fatigue, you must have a medically determinable impairment that could cause fatigue. Thus, regardless of how many symptoms you allege, or how genuine your complaints may appear to be, the existence of a medically determinable physical or mental impairment requires objective medical abnormalities, i.e., abnormalities that can be observed or documented by laboratory tests. Without objective evidence, just claiming you suffer from symptoms is insufficient to prove you are disabled.

For this step, the Social Security decision makers look to your medical records, which is why complete medical records are so important to the success of your claim.

Step 2: Evaluating the consistency and limiting effect of your symptoms

At the second step, the Social Security Administration determines the severity of your symptoms and how they affect your ability to function. The Social Security Administration acknowledges that symptoms vary from person to person and are difficult to measure. Therefore in deciding whether you are disabled, it is required to take into account any symptoms that you, your treating or examining physician or psychologist, or other person report if they are reasonably consistent with the objective medical evidence and other evidence.

Most claimants present symptoms that are reasonably consistent with objective medical evidence given the wide range of symptoms that many medical conditions can cause. And those who do not usually have either an undiagnosed additional physical or mental impairment or need more medical tests to explore a diagnosed impairment. Your disability lawyer can help determine whether you need additional medical examinations or tests to explain your pain or other symptoms and improve your chances of obtaining disability benefits.

The Social Security Administration decision makers are required to consider all of the evidence presented, including information about your prior work record, your statements about your symptoms, evidence submitted by doctors, and observations by Social Security Administration employees and other persons.

The Social Security Administration should consider:

  • What may precipitate or aggravate your symptoms;
  • What medications, treatments or other methods you use to alleviate them, and
  • How the symptoms may affect your pattern of daily living

At this second step, objective medical evidence of the degree of symptoms is not required. The degree of symptoms means how intense and persistent they are. Your allegations about symptoms may not be discredited solely because they are not substantiated by objective evidence.

Where the Social Security Administration sometimes gets it wrong

Many Social Security Administration decision makers give objective medical an importance that is not required by Social Security law. They believe that objective medical evidence is the most important type of evidence. Many Social Security Administration decision makers mistakenly decide cases as if objective medical evidence were required to show the degree of symptoms alleged by a claimant. And they sometimes incorrectly deny cases solely because no objective evidence substantiates the claimant’s statements about symptoms.

We are available to help with these complex rules

If your pain or other symptoms are preventing you from working and you are not already represented by a Riverside County or San Bernardino County Social Security disability attorney and want our evaluation, give us a brief description of your claim using the form to the right. Or contact us at:

Medlegal Disability
Gilbert & Bourke, LLP
Palm Springs Social Security disability attorneys

E-mail us
Phone: 760-327-1285
Fax: 760-327-1160

225 South Civic Drive, Suite 213
Palm Springs, California 92262

Areas Served: We handle Social Security disability claims for claimants from Palm Springs and surrounding areas.