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4 Common Ways Social Security Disability Claims Get Denied When They Could Be Approved – Part 3

Tuesday, 26 April 2016 09: 00
Written by Joni B. Bailey
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Claims are frequently denied because the claimant’s allegations of pain are not properly evaluated.

Judges must follow a certain process when evaluating whether a claimant’s pain interferes with work:

1st step:

Determine whether there is an underlying physical or mental impairment that can be shown by medically acceptable clinical and laboratory diagnostic techniques that could reasonably be expected to produce the claimant’s pain (or other symptoms).  If so, then the process moves to:

2nd step:

Evaluate the intensity, persistence, and limiting effects of the claimant’s symptoms to determine the extent to which they limit the claimant’s functioning.

But what if the statements about the intensity, persistence, or functionally limiting effects of pain or other symptoms are not substantiated by objective medical evidence?

Then the judge will make a finding on the credibility of the statements based on a consideration of the entire case record.

Judges will review the medical records and function reports looking for activities that are inconsistent with the claimant’s description of his or her pain and other symptoms.

Here are some activities that judges have mentioned in unfavorable decisions:

  • helped care for dogs,

  • was able to go to the pharmacy, and run errands

  • went for a two-hour wagon ride,

  • was able to be out in the sun,

  • went to Disneyworld with family on vacation,

  • did not need consistent narcotic pain medication,

  • was able to do his own yard work, house work, shopping and meal preparation,

  • used hand tools, including a chain saw,

  • maintained a vegetable garden,

  • had a medical card but didn’t use it,

  • didn’t fill prescriptions because of the copays but still smokes a pack of cigarettes a day,

  • went hiking with friends and kept up,

  • cared for grandchildren in the home.

If the judge thinks the claimant is exaggerating his or her complaints of pain or other symptoms, the whole case can fall apart.

At the hearing, a skilled Southern Illinois Social Security Disability representative--familiar with the claimant and the record--will go into topics like these at the hearing to bolster claimant’s description of his or her pain:

  • The pain and risk of the medical procedures the claimant was willing to endure to get relief from pain,

  • The family activities that the claimant had to miss out on because of pain,

  • The help the claimant received from others for ordinary activities,

  • The bad days that followed good days when the claimant tried to do more than usual,

  • The time and expense involved in pursuing different treatment modalities to get relief from the pain,

  • The type and amount of medication the claimant’s doctor prescribed for the pain.

There is one more post in this series addressing common ways claims get denied when they could be approved:

4.  The claimant does not have sufficient evidence to prove their impairment.


Many claimants make the mistake of thinking the Social Security Disability claim is a simple process, so they go all the way through the process and attend their hearing without a Southern Illinois Social Security disability attorney representing them.  Many are shocked when they receive a denial based on the ALJ’s finding that their impairments do not limit or restrict their ability to function enough to qualify them for benefits.  Then they have to decide whether to appeal or start a new claim.  See parts 1 and 2 in this series about the common reasons claims get denied and this earlier blog article about how many claims get denied at the hearing level.

Even though it is a “non-adversarial” hearing and the Agency has some responsibility to help develop the record, it is the claimant’s job to build a record that supports a favorable decision.  Most claimants need the experienced, dedicated representation of a Southern Illinois Disability attorney to accomplish that.

Joni Beth Bailey is a Southern Illinois Social Security attorney.


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