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.) Therefore, when you file your claim and when you 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.
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 bi-polar 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 bi-polar. 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 disabiilty 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 are 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 was 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.
Read on to find out how inconsistent statements and medical treatment can hurt your chances of getting disability.
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