An important factor in your claim for Social Security or SSI disability is your credibility. This is especially true if part of the reason you can't work is due to pain or if you suffer from a mental illness, because these conditions are difficult to measure with objective medical tests (like blood tests or MRIs.) So when you file your claim and prepare for your hearing, it's important to make sure your statements about your symptoms are accurate and truthful. The SSA will deny your claim if it believes you are not being truthful about your medical condition.
While the Social Security Administration no longer officially evaluates your "credibility" (according to Social Security's policy interpretation ruling SSR 16-3p), the agency uses a number of other factors to assess the reliability of your claim, including;
Let's take a look at these factors in detail.
The first thing the Social Security Administration (SSA) has to do when deciding whether your statements about your disability are true is to check if you have a medically determinable condition that could cause your symptoms. This means your medical records (such as blood tests, CT scans, MRIs, x-rays, or medical examination reports from medical providers) must document and confirm your diagnosis; otherwise, the SSA will not give credit to your claim and go on to evaluate whether your medical condition is disabling. Here are some examples.
The claimant (applicant) filed for disability because of back pain. He alleged that he suffered from numbness, tingling, weakness, and shooting pain in both of his legs. However, the claimant was unable to provide any medical evidence that showed he suffered from a medical condition that could cause his symptoms; specifically, his MRIs and X-rays were all normal. His claim was denied at the initial application stage.
The claimant filed for disability due to mental illness, primarily intense anxiety and depression. The claimant stated that she was unable to work because her anxiety and depression produced intense nervousness that significantly limited her ability to leave her home. To evaluate this statement, the SSA first had to find that she, in fact, suffered from anxiety. Fortunately, the claimant provided extensive records from her treating psychologist and psychiatrist that discussed and supported her diagnosis. Her claim went on to a full disability evaluation.
A claimant filed for disability based on cubital tunnel syndrome (also known as ulnar nerve syndrome) that affected the use of both of his hands. The claimant had undergone surgery, but his symptoms continued. His surgeon performed a nerve test on his hands and fingers and the results showed that he still suffered from minor CTS in both hands. This showed proof of a medically determinable condition.
A claimant filed for disability based on post-traumatic stress disorder (PTSD) and bipolar disorder. Although she was receiving anti-depressant and anti-anxiety medication from her primary physician, her records reflected that she had never been diagnosed with either PTSD or bipolar. Her claim was denied at the initial application stage.
In the first two examples, the claimants proved that they suffered from conditions that could cause their symptoms. By contrast, the last two claimants could provide no medically documented basis for their claims. If you think you are in this position, you may want to talk to a disability lawyer about how to develop the medical evidence you need.
If the SSA decides that you have a medical condition that can be expected to cause your symptoms, it will next look at statements and observations made by your friends and family, your medical providers, and your employers to assess your credibility. The SSA will also consider your own statements made about your condition, especially statements in the form you filled out about your activities of daily living. Here are some examples of how this works.
The claimant filed for disability based on rheumatoid arthritis. Because of its effects on her hands, she was forced to quit her job as a medical transcriber. Her employer wrote a letter to the SSA that stated the claimant had been a long-time reliable employee, but that he had observed her productivity level decreasing as her hands became more swollen and affected by her disease. The employer's letter gave credibility to the claimant's own statements about her condition.
The claimant filed for disability due to thoracic and lumbar pain. He had sought treatment from a back specialist who conducted several diagnostic exams to test the claimant's reflexes and flexibility. The doctor observed that the claimant's responses to the tests did not reflect the pain he allegedly experienced. For example, the claimant was easily able to touch his toes without complaint. The doctor noted this in the claimant's file, and the claimant's statements about the extent of his pain were discredited.
The claimant filed for disability due to schizophrenia. When she filed for disability, she stated to the SSA examiner that she spent most of her time inside her home, and that she had attempted suicide on several occasions. At the appeal hearing, the claimant was accompanied by her mother, who stated that the claimant's symptoms had become more severe over time and that she, the mother, provided most of her daughter's care. The mother's supporting statements gave credibility to the claimant's statements about the debilitating effects of her mental illness.
In another case, a claimant filed for disability based on chronic pain in her hands as a result of carpal tunnel syndrome. The claimant had surgery on both hands but stated that the pain had continued. During an appointment with the disability claims examiner, the examiner noted that the claimant appeared to have no difficulty holding a pen to complete forms. The examiner also observed the claimant using her cell phone to make numerous text messages prior to the interview. The examiner's observations made the claimant's statements about her pain less believable.
In one case, a claimant filed for disability based on thoracic and lumbar (middle and lower) back pain. He had sought treatment from numerous physicians and pain treatment centers. The claimant's treatment was discontinued by several doctors for failure to comply with their narcotic medication policies. In one medical record, a doctor stated that she believed that the claimant was a malingerer (faking pain) who was seeking pain medication. The SSA concluded that the claimant was exaggerating his symptoms.
For information on what to do if you have harmful or inconsistent evidence in your records, see our article on how disability attorneys deal with medical evidence that doesn't help your case.
Another factor that lends credibility to a claimant's statements about pain or other symptoms is what efforts the claimant has made to treat the symptoms. Here are some examples.
The claimant suffered from chronic migraines. She had undergone numerous tests and medications in an attempt to find the source of her headaches and to treat her pain, but she had little success. The claimant then sought treatment from an acupuncturist and began a strict diet to eliminate any foods that might trigger her migraines. The claimant's continued efforts at treating her symptoms made her statements about her pain more credible.
The claimant filed for disability due to borderline personality disorder. In an effort to control his symptoms, the claimant enrolled in an intensive outpatient program that required daily attendance. He was also compliant with his medication and met with his psychiatrist and therapist weekly.
In both of these cases, the fact that the claimants actively sought treatments for their symptoms and were stuck to treatment regimens gave credibility to their claims. For more information on the importance of obeying treatment recommendations, see our article on failing to follow treatment orders.
One of the most important factors when Social Security assesses credibility is whether the disability claimant's statements are consistent. The SSA will look at the consistency of statements that the claimant made to the SSA, doctors, or to anyone else from whom the SSA may get information (for example, if the claimant applied for veteran's benefits as well, the SSA can get information from the VA).
Inconsistent statements are a red flag to the SSA that a claimant is being untruthful about his or her condition. Here are some examples of inconsistent statements that indicate a claimant is exaggerating symptoms.
The claimant claimed she couldn't work due to back pain and said that she could not sit or stand for more than a few minutes at a time. However, during her disability hearing, she testified that she routinely used public transportation to shop, run errands, and attend doctor's appointments.
The claimant filed for disability based on arthritis in both knees and hands. On the claimant's application, he stated that he was unable to walk without the assistance of a cane and that he needed help buttoning clothes and tying shoes. The claimant's treating physician, however, noted that shortly before his hearing, the claimant made statements to the doctor that indicated he had undergone improvement since beginning treatment and that he was now able to get dressed without assistance and only occasionally required his cane. This casts doubt on whether the claimant's difficulties are still disabling.
In another case, a claimant alleged that her anxiety was so intense that she rarely left her house. However, the claimant's psychiatric records included statements made to her psychiatrist that she was able to attend church every week, do her own grocery shopping, and occasionally take walks with her neighbor.
The claimant filed for disability based on diabetic neuropathy in her legs and feet. She testified that she was unable to work because sitting for more than a few minutes at a time aggravated her symptoms and increased her pain. However, when the ALJ asked what types of activities the claimant enjoyed doing she testified that she enjoyed making clothes on her sewing machine, an activity that requires the ability to sit for more than a few minutes at a time.
All of the claimants in the above examples were denied disability because of their inconsistent statements. It is important to be honest in all statements about your pain or other symptoms regardless of who you are speaking to. For information on what to do if you have inconsistent evidence in your medical records (such as different opinions by different doctors), see our article on how disability attorneys deal with medical evidence.
Gaps in a claimant's medical history -- that is, periods of time when the claimant didn't visit a doctor -- may affect his or her credibility. This is because the SSA may think that the claimant's medical condition was not serious enough to need help. However, the SSA will consider the claimant's explanation for the gap when assessing credibility. Here are some examples where lack of medical treatment did not affect the claimant's credibility.
The claimant suffered from severe bipolar disorder that prevented him from working. He had been successfully treated by a psychiatrist for many years until his employment was terminated and he lost his insurance. Although he began treatment again shortly before filing his claim, he had no medical treatment during the months he lacked coverage. Since the claimant provided evidence to the SSA that he was without insurance during this time period, his credibility was not affected.
In another case, a claimant suffered from chronic migraines. After trying numerous medications prescribed by her neurologist, the claimant was prescribed a medication that successfully treated the headaches. However, shortly after beginning treatment, the claimant developed an allergic reaction to the medication and was forced to stop the treatment. The SSA considered this when evaluating her claims about her pain, and the agency concluded that her statements about her pain were credible.
The claimant suffered from carpal tunnel syndrome in both hands. She had undergone surgery and physical therapy, but tests still indicated significant nerve damage. In addition, the claimant had taken pain medication and a nerve blocker that was only minimally effective. Her treating physician eventually advised her that there was nothing else that could be done to treat her pain; therefore, the claimant stopped treatment for her hands.
In all three examples above, the claimants effectively explained to the SSA why there were periods of time where they didn't seek treatment. The gaps in medical treatment, therefore, did not affect their credibility. For more information on how to deal with gaps in medical treatment, see our article on developing medical evidence when you haven't see a doctor.
The SSA will also use the following to assess the credibility of a claimant's statements about his or her symptoms.
An ALJ will pay close attention to the claimant's body language during a hearing. For example, in one case a claimant filed for disability due to a back injury. The ALJ observed that the claimant frequently shifted in his chair and stretched his legs. The claimant also asked to be able to occasionally stand. In this case, the claimant's body language during the hearing convinced the ALJ that his statements about pain were truthful. However, a judge is not allowed to hold it against you if you don't show any signs of pain or discomfort during the hearing because this could encourage claimants to exaggerate or even fake symptoms. (This is called the "sit and squirm" principle.)
The SSA will give more credence to a claimant who has a long work history. For example, in one case, the claimant filed for disability based on emphysema and chronic bronchitis. The claimant had worked with the same company as a welder for over 20 years. The SSA considered his long-term employment as evidence that he was a hard worker and that the claimant's statements about his breathing difficulties were credible.
If, before you filed a claim for disability, you tried to do different kinds of work to avoid having to apply for benefits, this will reflect well on the validity of your claims. For instance, if you had to quit your job as a delivery truck loader because of back pain, but you tried to work as a driver and dispatcher for a couple of months each, this shows you were trying to work but couldn't (and having worked won't hurt your claim because the work will count as an unsuccessful work attempt).
Another factor the SSA will consider is the claimant's attitude about applying for disability. For example, in one case, a claimant applied for disability based on severe mental illness including anxiety and depression. During her hearing, the claimant expressed embarrassment because of her inability to work. She also testified that she had lived off of savings and only applied for disability as a last resort. These statements gave additional credibility to her statements about the effects of her condition on her ability to work by showing she wasn't just trying to get out of working.
Credibility is especially important if you suffer from symptoms that are hard to document with objective medical evidence. If you have a condition that involves subjective complaints like chronic pain, back pain, migraines, carpal tunnel syndrome, fibromyalgia, chronic fatigue syndrome, or various other syndromes, having good credibility is critical to your case. Simply put, if the SSA believes you are being untruthful or exaggerating your symptoms, you will be denied. To avoid this, ask an experienced disability attorney to review your case so that you can ensure the best possible outcome.
Updated January 13, 2023