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Evaluating Credibility in Social Security Disability Claims
By Pitt Dickey

The Biblical adage, "Judge not, that ye shall be judged" doesn't apply in Social Security Disability claims. This column will look at the rules that the Social Security Administration (SSA) Judge uses to decide who is telling the truth in disability insurance benefits claims. Every disability claimant who appears before an Administrative Law Judge will testify under oath where he hurts and why he or she can't work. The Judge then has to decide if the person's testimony is believable. The Judge uses very specific guidelines to evaluate the credibility of the person seeking disability benefits.

The credibility ruling is called SSR 96-7 and applies in every disability claim that involves a person who is complaining of pain. The SSA defines symptoms as "an individual's own description of his or her physical or mental impairments." The SSA uses a two step process to evaluate symptoms such as "pain, fatigue, shortness or breath, weakness or nervousness." The first step is to determine if there is an "underlying medically determinable physical or mental impairment" that can be shown by "medically acceptable clinical and laboratory techniques" that could be "reasonably expected to produce the individual's pain or other symptoms." In English, this means there has to be medical evidence that the person has a condition that could cause pain. If there is no clinical evidence of a condition that could cause pain, then the claimant's swearing to pain on a stack of Bibles will not produce a favorable disability decision.

If the Judge decides there is clinical medical evidence, then the Judge must evaluate the "intensity, persistence, and limiting effects of the individual's symptoms to determine the extent to which the symptoms limit the individual's ability to do basic work activities." In English, the Judge has to decide if the claimants symptoms are so bad that he can't work full time.

The Judge is required to consider the following areas in making a credibility decision:
"1. The person's daily activities; 2. The location, duration, frequency, and intensity of the individual's pain or other symptoms; 3. Factors that precipitate and aggravate the symptoms; 4. The type, dosage, effectiveness, and side effects of any medication the individual takes or has taken to alleviate pain; 5. Treatment other than medication the individual has received; 6. Any other measures other than treatment the individual uses to relieve pain" (such as lying down during the day). All of these topics are covered at the person's hearing to help the Judge determine the claimant's credibility.

The SSA recognizes that not everyone with the same diagnosis will have the same symptoms. Different people react differently to pain. The Judge can't just intuitively decide a person's credibility. The Judge must expressly set forth in his decision the reasons for deciding a claimant's credibility. The Judge must consider all the evidence that is in the claimant's case record. This evidence includes all medical and laboratory findings, the "diagnosis, prognosis or other medical opinions provided by treating or examining physicians, psychologists and other medical sources", statements from the claimant and from his doctors about his "medical history, treatment and response, prior work record and daily activities."

The Judge will also consider any statements made by SSA employees when they interview the claimant either personally or by telephone. It is important for disability claimants to tell the truth about their condition and realize that whatever they tell the SSA is likely to end up in their case file and may be used in a way that can effect the outcome of their claim.

The SSA considers consistency in the claimant's statements to be a "strong indication of the credibility" of the claimant. The Judge will examine whether the statements of pain are consistent with the clinical medical evidence. The claimant's own statements will be examined to see if he is consistently saying the same things about his health and limitations. His statements to the SSA and for claims for other types of benefits such as worker's compensation, Veterans Affairs disability benefits and private insurance disability benefits will be examined for consistency. The SSA recognizes that not all statements will be consistent as symptoms can change over time. The SSA also considers statements from third parties who have observed the claimant such as SSA employees, neighbors, and the Judge at the hearing.

The Judge will review all of the claimant's medical evidence that is available with particular attention to the "longitudinal medical record." The longitudinal medical record is simply the person's medical records over a period of time. The Judge will look to see what symptoms have been described by the patient, what made the symptoms worse or better, and reports of daily activities to the person's doctor. The Judge will look to see if there are notations of side effects of various medications and the success or failure of certain treatments. For example, a person with back trouble might undergo a series of epidural steroid injections in his back. The Judge will be very interested in seeing if these treatments were helpful in relieving the claimant's pain.

The Judge will consider if the patient has tried various types of medications, increased dosages of medication, tried a variety of types of treatment to ease pain, or been referred to various medical specialists for pain relief. If the record shows that patient's treatment is inconsistent with the level of pain complained of and there is no good reason for not following treatment recommendations, then the Judge may determine the claimant is not credible. If however, a patient does not have medical insurance or funds to pay for medical treatment then the Judge will not hold the lack of treatment against the patient's credibility.

Disability claims that involve pain require the claimant to tell the truth, without exaggeration or minimization about his symptoms in dealing with his doctors, the SSA itself and the Judge who may ultimately decide his claim.