Why Are There Inconsistencies in Social Security Disability Determinations?

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Inconsistencies in Social Security Disability Determinations

By James Pavisian
Attorney, PLF

Once a year, I attend a half-week long conference for Social Security disability attorneys and non-attorney representatives. One or more of the speakers will, undoubtedly, joke about an interaction with a client who demanded to know why they have to wait for their benefits while their neighbor—who works full-time, looks healthy, and does drugs—got their disability in a week. Without fail, every representative will nod their head and lean over to their neighbor to start sharing a similar experience.

Inconsistencies in Social Security Disability Cases

As a Social Security disability attorney, I rarely go a week without a client or prospective client asking me a similar question: why does it seem harder for me to get my benefits? There is no simple answer to this question because Social Security disability decisions are not math equations. Whether an individual is disabled is based, on large part, on the objective medical evidence.  But, there is still some subjectivity to the evaluation. For this reason, different people can come to different conclusions based on the same information.

Take, for example, an individual filing for disability based on back pain. In 2015, nearly 35% of individuals that filed for Social Security disability did so for musculoskeletal pain. That is nearly one million people. Only a handful of those people got their disability because their back was structurally damaged. I define structural damage as a severe spinal cord injury resulting in paralysis or dependence on a wheelchair or walker. More individuals won their claim by convincing the Social Security Administration that they had disabling pain.

Pain is subjective. There is no machine that can scan a body and provide an objective measure of pain. In recent studies about opioid addiction, the government indicated that approximately 100 million Americans suffer from chronic pain. That is one-third of our country.  Pain, in realistic terms, is a fact of life.

For these reason, an individual applying for Social Security disability based on chronic pain has a tremendous hill to climb. First, they must prove they have pain. Second, they must prove that the pain is as bad as they claim. Finally, they have to prove that the pain limits them as severely as they claim. For many, the first two steps are simple. It’s at the final step that most fail.

This is because medical evidence can only document so much before a judge has to make a leap of faith. In pain cases, there is little divergence between treatment. People in pain, living in a particular area, will visit the same doctors, see the same physical therapists, and take the same medication. At some point, the judge has to decide whether they believe the individual’s pain limits them as much as he or she claims. It is this subjective determination that can lead to different conclusions.