Assessment of Pain

By the Social Security Administration

 

Many denial letters from the Social Security Administration and its State Agencies improperly apply (or completely ignore) the requirements of Social Security Administration Ruling SSR 96-7p.

This ruling sets forth criteria for assessing the credibility of a claimant's statements about symptoms and their effects. Specifically, it requires the Social Security Administration to consider

(1)     the individual's daily activities;

(2)     the location, duration, frequency, and intensity of the individual's pain or other symptoms;

(3)     factors that precipitate or aggravate the symptoms;

(4)     the type, dosage, effectiveness, and side effects of medication;

(5)     treatment other than medication the person receives for pain or other symptoms;

(6)     any measures other than treatment the person has used to relieve pain; and

(7)     any other factors concerning the person's functional limitations and restrictions due to pain or other symptoms.

An unfavorable decision must contain a credibility determination whether the Social Security Administration thinks the claimant is or is not credible. Thus, the Ruling states that in setting forth a decision it is not enough for the Social Security Administration to make a conclusory statement such as "the allegations have been considered," or "the allegations are (or are not) credible." Neither is it sufficient to simply set forth the factors described in the regulations. Rather, the decision must set forth the "specific reasons for the finding on credibility, supported by evidence in the case record, and must be sufficiently specific to make clear to the individual and to any subsequent reviewers the weight the adjudicator gave to the individual's statements and the reasons for that weight." The ruling essentially restates the requirement that decision makers build an accurate and logical bridge from the evidence to the conclusion, and that they state which of a claimant's complaints are being rejected and why such complaints were unsupported by the record.

Recent publications by the Social Security Administration (when changing the Musculoskeletal Listings) make this point clear: objective evidence of severity of pain is not required.

. . . Our intention is to make sure that no one has the erroneous impression that there must be objective medical findings that directly support the severity of a person's pain. 66 FR 58013

The new language, . . . clarifies that there need only be medical signs or laboratory findings that show the existence of a medically determinable impairment which could reasonably be expected to cause pain or other symptoms for these symptoms to be found to affect an individual's ability to perform basic work activities. 66 FR 58013

Considering pain as a factor in an individual's loss of function is consistent with 404.1529 and 416.929 on evaluation of symptoms, including pain. Because the language in these final regulations is consistent with the current regulatory language regarding pain and other symptoms, it should not affect documentation requirements or practices, nor do we see any need for further clarification of the pain standard. 66 FR 58028

We do not see lack of objectivity as an issue. A claimant's own statements about his or her functioning have always been factored into a decision, because symptoms are the claimant's statements about how impairment affects the individual. We base disability determinations and decisions on all of the evidence in file, objective and subjective, and we consider whether there are any conflicts between the objective evidence and the claimant's own statements. 66 FR 58028