The American Association for Disability Policy Reform
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The Evaluation of Pain, Fatigue, etc.
SUMMARY:
From their first days, the disability programs have been plagued by the fact that, except in extreme cases, no reliable method has ever been found for evaluating claims of pain, fatigue, depression, anxiety and the other subjective factors which affect a person's ability to work. In fact, we are probably no closer to having a reliable method for evaluating claims of pain, fatigue, etc. than we were 100 years ago (long before the disability programs began). With no reliable method, decision-makers are forced to rely on personal bias and to guess. Within the Social Security Administration there's an awful lot of guessing going on.
DETAILS:
The Social Security Administration tries to lead us to believe that it is able to evaluate subjective claims. In Title 20 of the Code of Federal Regulations, Section 404.1529 How we evaluate symptoms, including pain, we find the following: (The bullets are added.)
- ... we consider all your symptoms, including pain ...
- In evaluating the intensity and persistence of your symptoms, including pain, we will consider all of the available evidence... We will then determine the extent to which your alleged functional limitations and restrictions due to pain or other symptoms can reasonably be accepted ...
- ... we must then evaluate the intensity and persistence of your symptoms so that we can determine how your symptoms limit your capacity for work.
- In evaluating the intensity and persistence of your symptoms, we consider all of the available evidence ...
- We must always attempt to obtain objective medical evidence and, when it is obtained, we will consider it in reaching a conclusion as to whether you are disabled.
- ... we will carefully consider any other information you may submit about your symptoms.
- We will consider all of the evidence presented ...
- Factors relevant to your symptoms, such as pain, which we will consider include: (i) Your daily activities; (ii) The location, duration, frequency, and intensity of your pain or other symptoms; (iii) Precipitating and aggravating factors ; [Additional factors are listed: medication, treatments, measures used to relieve symptoms, functional limitations and restrictions.]
- We will consider the impact of your impairment(s) and any related symptoms, including pain, on your residual functional capacity.
The reader is then referred to Section 404.1545. In Section 404.1545 Your residual functional capacity, we find
- We will assess your residual functional capacity based on all the relevant evidence in your case record.
- We will assess your residual functional capacity based on all of the relevant medical and other evidence.
- We will consider any statements about what you can still do ...
- When we assess your physical abilities, we first assess the nature and extent of your physical limitations and then determine your residual functional capacity for work ...
- When we assess your mental abilities, we first assess the nature and extent of your mental limitations and then determine your residual functional capacity for work ...
- In assessing the total limiting effects of your impairment(s) and any related symptoms, we will consider all of the medical and nonmedical evidence, including the information described in Section 404.1529(c).
Nowhere does the Social Security Administration describe any reliable method for evaluating subjective factors such as pain. Nowhere does the Social Security Administration describe any reliable method for evaluating a person's ability to sustain work activities. It can't because no one has ever discovered any way to do those things. As a result, decision makers are forced to rely on personal bias and to guess.
The Social Security administration never tells us how they evaluate symptoms. The titles How we evaluate symptoms, including pain and Your residual functional capacity are misleading. The sections should be entitled How we have no reliable method for evaluating symptoms and How we have no reliable method for determining your residual functional capacity. Except in extreme cases, with no method for evaluating symptoms, or for evaluating a person's ability to work, decision-makers are forced to rely on personal bias and to guess. As a result, applicants are forced to play the disability lottery (details).
Last updated on 1/17/21.