Leading 1st Circuit Social Security case on pain and the factors to be considered in analyzing pain in the disability determination process.

pain; RSD; objective medical findings

Somatoform Disorder. Pain. Credibility. Severity. Ramos v. Barnhart, No. 02-1687,2003 WL 1411959 (1st Cir. 3/21/03). Unpublished. In a per curiam decision, the First Circuit reversed and remanded where the ALJ improperly concluded that the claimant did not have a severe mental impairment (somatoform disorder) and that pain did not pose a significant functional limitation for the claimant. The case has a good explanation of the difference between somatization disorders, which are a specific subset of somatoform disorders, and the broad category of somatoform disorders. Because this distinction was lost on the ALJ, he misinterpreted the medical evidence and erroneously substituted his own lay opinion. The decision also contains a useful discussion of the relationship between somatoform disorders and pain. The ALJ discounted the claimant’s complaints of pain, in part, because of the minimal objective medical findings to account for his subjective complaints. Rejecting this analysis, the court stated: the very diagnosis of a somatoform disorder means that claimant’s symptoms of pain ‘are not fully explained by a general medical condition.’ In other words, an individual with a diagnosis of somatoform disorder will not have hard test results or a physical impairment that can fully account for all of that person’s credible, subjective complaints. Also available on First Circuit website at http://www.ca1.uscourts.gov.

Because a determination whether an impairment(s) is severe requires an assessment of the functionally limiting effects of an impairment(s), symptom-related limitations and restrictions must be considered at this step of the sequential evaluation process, provided that the individual has a medically determinable impairment(s) that could reasonably be expected to produce the symptoms. If the adjudicator finds that such symptoms cause a limitation or restriction having more than a minimal effect on an individual's ability to do basic work activities, the adjudicator must find that the impairment(s) is severe and proceed to the next step in the process even if the objective medical evidence would not in itself establish that the impairment(s) is severe.

The purpose of this Ruling is to clarify SSA policy on the evaluation of symptoms in the adjudication of claims. No symptom or combination of symptoms can be the basis for a finding of disability, no matter how genuine the individual's complaints may appear to be, unless there are medical signs and laboratory findings demonstrating the existence of a medically determinable physical or mental impairment. A symptom in itself is neither exertional nor nonexertional. Rather, it is the nature of the functional limitations or restrictions caused by an impairment-related symptom that determines whether the impact of the symptom is exertional, nonexertional, or both.

This Ruling supersedes Social Security Ruling (SSR) 95-5p. The purpose of this Ruling is to clarify when the evaluation of symptoms, including pain, under 20 CFR 404.1529 and 416.929 requires a finding about the credibility of an individual's statements about pain or other symptom(s) and its functional effects; to explain the factors to be considered in assessing the credibility of the individual's statements about symptoms; and to state the importance of explaining the reasons for the finding about the credibility of the individual's statements in the disability determination or decision.