In recent issues, we have presented a series of articles setting out the specific medical criteria used to determine whether Social Security claimants with specific afflictions are disabled as a matter of law. What if your patient’s condition does not meet or equal the criteria of any of the Listings, but he or she simply complains of symptoms which interfere with work?
Your patient will be required to provide objective medical evidence of the impairment underlying his or her symptoms, but will not be required to provide objective medical evidence of the degree or severity of the pain or other symptoms.
The judge will then be required to assess the credibility of your patient’s claims, examining the entire record. Your records as treating physician will play a key role. Your understanding of this process is important to help ensure that your records and reports provide the information the judge needs.
In order for the Social Security judge to find your patient disabled due to pain and /or other symptoms, your patient must have a medically determinable physical or mental impairment which may reasonably be expected to produce at least some degree of the symptoms he or she claims to have.
There must be medical signs and laboratory findings that demonstrate the existence of the medically determinable physical or mental impairment.
Social Security defines an impairment as an “anatomical, physiological or psychological abnormality which can be shown by medically acceptable clinical and laboratory diagnostic techniques.”
A medical sign is defined as an observable fact which can be medically described. A laboratory finding is an anatomical, physiological or psychological phenomenon which can be shown by medically acceptable laboratory techniques such as chemical tests, electrophysiological studies (such as electroencephalograms, electrocardiograms, etc.), roentgenological studies (X-rays), and psychological tests, according to Social Security disability regulations.
So, before the Social Security judge will consider whether your patient is telling the truth about his/her disabling symptoms, your chart notes must show that your patient has an objectively demonstrated physical or mental impairment forming a reasonable basis for his or her symptoms.
Simply put, your records must say your patient has a pain-producing (or other symptom-producing) impairment confirmed by certain objective findings.
It is important to keep in mind that even though your patient must show objective medical evidence of an impairment which may reasonably cause his or her symptoms, a social security disability claimant does not need to show medical evidence of the degree or intensity of the symptoms. This is why the judge’s credibility assessment is often the most critical factor in the decision whether to award disability benefits.
Since objective medical proof of the degree of pain or other symptoms is not required, it is not necessary for you to state whether your findings do or do not objectively substantiate the intensity of your patient’s symptoms. In fact, such statements may raise unnecessary doubts about your claimant’s credibility.
It is better to state affirmatively that some degree of the symptoms may reasonably be expected to result from the objectively verified impairment, if that is the case. That is all the law requires.
Do you believe your patient’s pain is disabling? As your patient’s regular treating doctor, you are in a very good position to state, based on your numerous observations, whether you believe your patient is sincere in his or her complaints. That is, your credibility assessment is valuable information for the judge to consider in making his or her credibility assessment.
DRUG SIDE EFFECTS MAY BE DISABLING
In evaluating your patient’s credibility, the Social Security judge must consider the type, dosage, effectiveness and side effects of any medication your patient takes to alleviate pain and other symptoms. This information is especially critical with patients whose medications may control one disabling symptom, but have side effects which produce other disabling symptoms!
For example, your patient may be on Dilantin to prevent seizures. But does the dose required to effectively control disabling seizure activity interfere with the mental clarity and coordination needed for work activity? Your acknowledgment of the potential side effects will help the judge to properly address this “Catch 22.”
Another common example is pain medication which causes grogginess or interferes with alertness. The dosage you prescribe is based on your honest appraisal of your patient’s need. The potential for side effects is there, yet may vary with each individual. Again, as long as the symptoms (in this case, side effects) your patient complains of are reasonably based on the objectively verified potential side effects of the prescribed medication, your patient has provided all the medical proof necessary.
If you observe your patient caught between being in too much pain to work and being too drugged with pain medication to work, it is important to include this observation in your chart notes so the judge can properly assess the credibility of your patient’s disabling symptom testimony.
This article was prepared by Arthur W. Stevens III