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HOW SOCIAL SECURITY CONSIDERS CLAIMS UNDER RULE 16-3P

Social Security Rule 16-3P (SSR 16-3P) provides guidance to judges when evaluating medical signs, laboratory diagnostic findings and symptoms.  Administrative law judges (ALJs) hold hearings on claims that have been denied at the application level and again at the "reconsideration" level.  

The following are 3 very specific things the judge will consider:

  1. Medical signs: These are observations made by a doctor during a medical examination. They could include visible signs of a condition, such as swelling or redness, or other indicators like abnormal heart or lung sounds.
  2. Laboratory diagnostic findings: These are the results of medical tests, such as blood tests, imaging studies (like X-rays or MRIs), or other diagnostic procedures. These findings provide objective evidence of a medical condition.
  3. Symptoms: These are complaints reported by the claimant. Symptoms can include pain, fatigue, shortness of breath, or any other subjective experience related to the claimant’s condition.

It may surprise you to learn that Social Security will consider your symptoms--the way you experience a medical condition.  

However, Social Security cannot award benefits strictly on the basis of a claimant's complaints or symptoms.  There must be medical signs and/or laboratory diagnostic findings which make the symptoms medically reasonable.  In other words, symptoms must be consistent with medical tests and/or doctors' observations during examinations.

For example, a claimant has symptoms of severe shortness of breath, fatigue and chest pain - but there is no medical explanation for what's causing these symptoms.  Merely having these complaints will not move the case toward an approval if there is no supporting evidence.

On the other hand, a claimant complaining of shortness of breath, fatigue and chest pain has an echocardiogram and laboratory tests which diagnose ischemic heart disease.  Now, the claimant's complaints are supported by objective medical tests which explain and give credibility to the symptoms. These objective findings may move the claim toward approval.

Objective medical evidence that explains your complaints or symptoms is an absolute necessity.  I recently had a claimant who complained of severe debilitating migraine headaches.  These headaches were frequent and so severe that the claimant had missed work three or four days a month.  But the mere symptoms of headache will never get a disability award.

However, my client had actually been examined by his doctor during a migraine attack.  The doctor witnessed the results of the migraine, examined the claimant during the migraine attack and ran certain laboratory tests to rule out other causes.  Now, we not only had symptoms, we had medical findings and laboratory studies to explain the severe head pain.  

I advised my client to keep a journal or diary logging the date of each headache, how log it lasted and the specific symptoms.  The doctor's medical record also documented some of these same details.

By the time we got before a judge we had sufficient medical findings and laboratory diagnostic tests to satisfy Social Security that the claimant could not work due to the chronic and severe migraine headaches.

 


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