New Social Security Rule for Assessing Subjective Complaints and Symptoms

Navigating the Social Security disability system can be complex, especially when it comes to documenting your complaints and symptoms. Many disability claims rely on an individual’s statements about their pain, limitations, and other subjective experiences.

In an effort to provide clarity and consistency in evaluating these aspects, the Social Security Administration (SSA) has implemented a new rule that impacts how subjective complaints and symptoms are assessed in disability claims. Our Social Security Disability lawyers can help you obtain the necessary medical evidence to maximize your chances of obtaining benefits.

Understanding the Rule for Evaluation of Symptoms in Disability Claims

The Social Security Administration (SSA) implemented a rule on March 28, 2016, known as Social Security Ruling 16-3p, which has had significant implications for the evaluation of symptoms in disability claims. This rule was designed to provide clarity and guidance on how judges should assess disability claims.

One of the key aspects of SSR 16-3p is that it explicitly states that judges are not to assess the personal character of the claimant. Instead, their focus should be on the consistency of the claimant’s subjective allegations of pain and other symptoms with the other evidence available in the record. This is a shift from the previous rule, SSR 96-7p, which SSR 16-3p rescinded and superseded.

The SSA makes a clear distinction between medical signs, laboratory diagnostic findings, and symptoms in the context of disability determination:

1. Medical signs: These are observations made by a doctor during a medical examination. They could include visible signs of a condition, such as swelling or redness, or other indicators like abnormal heart or lung sounds.
2. Laboratory diagnostic findings: These are the results of medical tests, such as blood tests, imaging studies (like X-rays or MRIs), or other diagnostic procedures. These findings provide objective evidence of a medical condition.
3. Symptoms: These are complaints reported by the claimant. Symptoms can include pain, fatigue, shortness of breath, or any other subjective experience related to the claimant’s condition.

Objective Medical Evidence Is Paramount to Your Claim

Before any of your complaints can be considered, medical findings or lab results must establish the presence of a medical abnormality that could reasonably produce the symptom. In other words, there must be objective evidence of a medical problem that would prevent you from participating in work-related activities.

For example, suppose you complain of debilitating migraines headaches. In that case, you cannot have your headaches considered unless there’s an abnormal brain MRI, a history of surgery, or some other objective condition that could reasonably be expected to result in chronic pain.

Once, however, medical signs or laboratory findings establish an abnormality that precludes you from gainful activity, your subjective complaints can be considered. The SSA recognizes that some individuals may experience symptoms differently due to aggravating factors.

For example, if you have a mental impairment or major depressive disorder, you might experience heightened pain from a spinal condition. In contrast, a person who is otherwise healthy might be able to perform basic work activities despite having the same abnormality.

Your Complaints Should Correlate with Medical Findings

The new ruling cautions that symptoms should not be assessed solely based on what is objective. However, there should be some consistency between the objective abnormality and your complaints.

Your statements cannot be disregarded once objective, relevant evidence, such as a laboratory finding, establishes a medical abnormality. This means that inquiries must be made into your daily activities, including the following:

• The location, frequency, intensity, and persistence of pain
• Factors that precipitate or aggravate the symptoms
• The type, dosage, effectiveness, and side effects of medication
• Treatments you receive
• Self-care remedies

Consistency Is Still a Key Factor

The agency will also assess the consistency of your statements with each other. However, your statements’ inconsistencies at varying times do not necessarily mean they are inaccurate.

Consistency in following through with medical treatment is also a major factor in assessing your condition’s severity. However, if you don’t follow your doctor’s treatment recommendations, the SSA must consider the possible reasons for that. These could include the inability to afford treatment, religious considerations, statements made by the doctor about the likely effectiveness of treatment, and your medical impairments.

The ruling clarifies that the decision must contain specific reasons, clearly articulated, to assess how consistent the subjective complaints are. Brushing off your testimony with a conclusory statement that “it’s been considered” won’t suffice.

The Impact of the Administrative Conference of the United States (ACUS) Recommendations

The Administrative Conference of the United States (ACUS) was solicited to provide a study and recommendations on symptom evaluation for disability claims.

At the conclusion of this study, the ACUS recommended eliminating the use of “credibility” from sub-regulatory policies and adhering more closely to regulatory language regarding symptom evaluation.

This new ruling enables adjudicators to separate subjective medical assessment from moral judgment, ensuring decisions are made objectively. These decisions must also be consistent with regulations set forth by the SSA.

Eliminating “Credibility” and Enhancing Symptom Evaluation in Disability Claims

The purpose of rescinding SSR 96-7p is to more closely follow the regulatory language regarding symptom evaluation when making disability claims. This means that the term “credibility” is no longer to be used in the sub-regulatory policy. Instead, adjudicators must consider all evidence in an individual’s record when evaluating the intensity and persistence of symptoms after finding a medically determinable impairment.

This rule helps clarify that the focus of the evaluation is the determination of disability, not someone’s character or whether they are truthful.

Focusing on Consistency and Not Personal Character

Above all, the ruling states that the focus of the evaluation is not just about your performance in an interview or how you word things on the disability application. Instead, it emphasizes assessing the consistency of your complaints with the evidence.

This distinction clarifies that symptom evaluation should not be seen as examining an individual’s character or trustworthiness. For example, the fact that someone spent time in a correctional facility should not detract from their credibility. It’s also improper for the agency to look at an applicant’s Facebook page or sources outside of the evidence of record.

All that being said, you will still need substantial evidence and documentation to qualify for benefits, which is why working with a qualified attorney is strongly advised.

Contact a Social Security Disability Attorney

When navigating the complexities of the Social Security disability system, the guidance and support of a qualified team can make all the difference. Pilzer Klein is a reputable law firm serving the Carolinas. Our team is dedicated to helping individuals navigate the Social Security Disability system and get the benefits they need.

Whether you are ready to apply for Social Security Disability benefits or have already filed a claim, our Social Security Disability attorneys can help. Contact us today for a free consultation to discuss your case and explore your options.