When disability applicants complain that they are disabled by their pain, the Social Security Administration has special rules for assessing the problem.
Pain complaints are particularly difficult to judge, because there is no meter or objective standard to measure the intensity of pain. Program integrity demands that something more than the applicant’s subjective complaints be produced to support the presence of disabling pain.
First, there must be an ascertainable medical abnormality that could reasonably be expected to produce the pain. This is called a “medically determinable impairment.” The agency will find that there is a medically determinable impairment if there is objective evidence, apart from the patient’s symptoms or complaints, that establishes a medical abnormality. That is, there needs to be medical signs, defined as reported observations by the doctor; or laboratory findings, such as x-rays or MRIs, to establish the existence of the medical abnormality. A medical sign can be something as simple as spinal tenderness, provided that it is documented by the treating doctor. The key to understanding this concept is that the patient’s complaints of pain, standing alone, are not adequate to satisfy the threshold requirement of a medically determinable impairment.
Once it has been established that there is an ascertainable medical condition, established by something objective, beyond the patient’s complaints of pain, that could reasonably be expected to produce the pain, subjective complaints of pain can be considered. The patient’s description of the intensity, duration, and location of the pain is an important starting point. The effectiveness and side effects of pain medications should be considered. Alternative pain relief techniques, such as using heat or ice, lying on a board, epidural steroid injections, water therapy, and the like are all considered.
Finally, the effect of pain on the applicant’s daily activities must be considered. That is, what daily activities can the applicant perform in spite of the pain, and what daily activities is the applicant no longer able to perform.
Very often, pain is disabling, when an applicant cannot sit, stand, and walk in combination for a full eight hours. If an applicant’s need to lie down cannot be accommodated by normal breaks during an eight hour workday, the applicant would be considered disabled.
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Broadly speaking, the more compelling the objective evidence in the claim is, the more believable the pain complaints are. In other words, when an MRI shows nerve root impingement that cannot be surgically repaired, it is very helpful, particularly for younger applicants, who have the most difficulty obtaining benefits arising from subjective complaints of pain.