What medical evidence is needed for your Michigan Social Security disability claim?

I find that most of my Detroit Social Security disability cases are about symptoms. Symptoms—pain, fatigue, dizziness, nervousness, shortness of breath, etc.—keep claimants from doing past relevant work and other work. Symptoms are what make claimants disabled.

The Social Security Administration’s Mistaken View

Many Social Security Administration (SSA) decision-makers, on the other hand, may say that disability cases are really about objective medical evidence. They comment that objective medical evidence is the most important category of evidence. Objective medical evidence is what they review first to figure out if a claimant is disabled. Many SSA decision-makers decide cases as if objective medical evidence were required to show the degree of symptoms alleged by a claimant or a claimant could be denied solely because objective evidence does not substantiate the claimant’s statements about symptoms. Indeed, many SSA decision-makers give objective medical evidence an importance in their decisions beyond that which is required by the Social Security Act and regulations.

The Social Security Act and regulations require only that objective medical evidence show that the claimant’s impairment could cause the sort of symptom alleged by the claimant. Although SSA regulations require that a claimant’s limitations be consistent with objective medical evidence, they also require consistency with all other evidence in the record. Thus, the importance of objective medical evidence is not elevated above the importance of other evidence in the record. And a requirement that limitations be consistent with objective evidence is vastly different from requiring objective evidence to support the degree of impairment. The regulations require that a claimant’s statements about symptoms not be rejected solely because objective evidence does not substantiate them.

SSA’s symptom regulation is summarized in 20 C.F.R. § 404.1529(a) as follows:

(a) General. In determining whether you are disabled, we consider all your symptoms, including pain, and the extent to which your symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence. By objective medical evidence, we mean medical signs and laboratory findings as defined in § 404.1528 (b) and (c). By other evidence, we mean the kinds of evidence described in §§ 404.1512(b)(2) through (6) and 404.1513(b)(1), (4), and (5), and (d). These include statements or reports from you, your treating or nontreating source, and others about your medical history, diagnosis, prescribed treatment, daily activities, efforts to work, and any other evidence showing how your impairment(s) and any related symptoms affect your ability to work. We will consider all of your statements about your symptoms, such as pain, and any description you, your treating source or nontreating source, or other persons may provide about how the symptoms affect your activities of daily living and your ability to work. However, statements about your pain or other symptoms will not alone establish that you are disabled; there must be medical signs and laboratory findings which show that you have a medical impairment(s) which could reasonably be expected to produce the pain or other symptoms alleged and which, when considered with all of the other evidence (including statements about the intensity and persistence of your pain or other symptoms which may reasonably be accepted as consistent with the medical signs and laboratory findings), would lead to a conclusion that you are disabled. In evaluating the intensity and persistence of your symptoms, including pain, we will consider all of the available evidence, including your medical history, the medical signs and laboratory findings and statements about how your symptoms affect you. (Section 404.1527 explains how we consider opinions of your treating source and other medical opinions on the existence and severity of your symptoms, such as pain.) We will then determine the extent to which your alleged functional limitations and restrictions due to pain or other symptoms can reasonably be accepted as consistent with the medical signs and laboratory findings and other evidence to decide how your symptoms affect your ability to work.

Two-step test

This regulation provides for a two-step test for evaluating any symptom. At the first step, there must be objective evidence of some sort showing the claimant has a “medically determinable impairment” that could cause the symptom. To satisfy this first step, if the claimant alleges pain, there must be a medically determinable impairment that could cause some pain, any pain. This first-step finding does not address the “intensity, persistence, or functionally limiting effects” of the symptom. That comes later.

At the first step, a mere allegation of pain or other symptoms is insufficient. A Detroit Social Security disability claimant must have a medically determinable impairment “which could reasonably be expected to produce the pain or other symptoms alleged.” This threshold requirement is the only point where objective medical evidence is absolutely required.

At the second step, the determination as to the intensity, persistence and functionally limiting effects of pain or other symptoms is made. For this, the decision-maker must evaluate the evidence in the record as a whole. At the second step objective evidence of the degree of symptoms is not required. All the evidence must be evaluated, including the objective medical evidence. So while objective medical evidence does not drop out of consideration for the second step, a claimant’s allegations about symptoms may not be discredited solely because they are not substantiated by objective evidence. Nevertheless, allegations about symptoms need not be accepted to the extent they are inconsistent with the available evidence, including objective evidence of the underlying impairment.

Assistance With These Complex Regulations

One of the ways I help metro Detroit Social Security disability claimants is by digging deep into the Social Security regulations like those outlined above to uncover the strongest way to present your claim to SSA.

If you want my assistance with your claim, give me a brief description of your situation using the form to the right. Or call my office at (888) 282-0719 or e-mail me.