In a recent post on the importance of claimant credibility, I made a point that your ability to effectively describe your physical pain at the hearing may play a role in helping you win your case. Since physical pain is common to many disability cases, I want to elaborate on this point. Not only should you be able to effectively describe your pain at the hearing, but also throughout the claims process and during doctor’s visits as well.
Pain is subjective and can be hard to describe
All individuals have experienced some degree of pain at some point throughout life. The intensity of pain can range from a dull headache, to an agonizing toothache, to the more severe type of pain commonly associated with chronic conditions such as migraine headaches, Fibromyalgia, and Reflex Sympathetic Dystrophy (RSD). Although pain is a symptom and we easily recognize it when we experience it, pain is nevertheless hard to describe. Fellow Blogger Tomasz Stasiuk, whose Colorado Social Security Disability Blog contains a wealth of information about the disability claims process, made note of this fact in his December 2009 article on how to describe pain in a Social Security Disability case.
As Thomas suggests, pain can be hard to describe because 1) it is subjective and cannot be felt by others and 2) it is not a visible condition. Thus, a judge assigned to your case may not fully understand the extent your pain if you merely state you have pain. Stating you have pain is not enough; in order to strengthen your chances of winning your disability case, you must learn how to effectively describe your physical pain so that the caseworkers, physicians, and even the ALJ (Administrative Law Judge) assigned to your case can understand what you experience each day and how your pain limits your functioning.
Your ability to effectively describe your pain to your doctors is also important. This is because their reports and records will be evaluated by the SSA. I have seen many medical records where during an office visit, a client replied only by saying “Fine” after being asked by the doctor “How are you doing?” In such cases, the client’s chart might reflect something like: “Patient stated that she is doing fine today.” The word “fine” does not win a social security disability case. In fact, some adjudicators will often seize on something like this to justify denying a claim. Choose your words cautiously – even while at the doctor – especially if your words relate to describing how you are feeling.
Tips on how to effectively describe your pain
As mentioned above, fellow blogger Tomasz Stasiuk has written on this topic as well and has offered some great tips on how to effectively describe pain in a disability case. Because his tips are so useful, I am republishing them here (with minor additions) for your convenience. The following are some guidelines suggested by Tomasz Stasiuk to help claimants be able to effectively describe their pain.
Nature of the pain: What is the pain like? Is it sharp or dull? Is the pain aching, shooting or throbbing? Does the pain burn? Is it a constant ache that progresses to spasms as it evolves? On a scale from one-to-ten, how does your pain rate?
Location: Where is the pain physically located on your body?
Frequency and Duration: It is painful all the time or just some of the time? How long does the pain last? Do you feel better in the morning? Alternatively, does it start bad in the morning and continue to worsen until you go to bed?
Triggers: What events trigger your pain, if any? Do events such as walking result in pain? Does looking at a computer screen for an extended period of time result in migraine headaches?
Effects of pain: Does the pain affect how much you can lift? Does the pain affect your ability to interact with your children or spouse? How long can you sit, stand or walk? Does your pain affect your ability to read any type of written correspondence, whether it be a book or letter?
Effects of medications: Do your medicines help? Does the pill or injections relieve all of the pain or just some of the pain? What do the medications help with? What pain does the medication not relieve?
Keeping a journal of your symptoms and pain may be useful
Again, pain must be described in other words than by just saying “I hurt.” As noted in earlier posts, keep a journal handy and write down your daily symptoms and experiences with pain. Something like: “A day in the life of X (your name).” It does not have to be in some fancy, formal writing style. Notes jotted down are just fine. Be sure to include things such as pain level, daily limitations, and medicines taken (and side effects). It can be hard to remember on your own how you feel each day. The disability process is long and enduring. Do yourself a favor and start journaling today.
I’ve been in such pain since 2006. And I’m feeling all alone in the world of chronic pain.(*)
In March of 2006 I fell down some stairs going down 25 steps to the ground.(*)
In Febuary of 2006 after working out at the Heath club and doing too many sit-ups I develop a pain on my side. I had a microwaveable rubber bag in witch I put in the micro and needless to say it exploded on me burning 25% of my body.(*) I’ve had chronic pain since and feel my Doctors are no longer listening to me. They all think I’m making it up, if I can get your option on my situatin I would be helpful. Alberto
As I read through all the questions, I have yet to find an answer, so here I will ask my question.
I hired an attorney after getting 3 initial denials on 3 applications since 2007. My lawyer wanted me to tell him just 1 medical problem I have. Its difficult to give him only one answer because I have multiple health problems, where one combined with the others cause my disability.
My question: Is it legal and ethical for my lawyer to charge me extra (above and beyond the 25%) for more medical records than what SSA already has? He said I would have to pay him regardless whether I win my appeal or not. I asked him how am I supposed to pay him if I have no money? he just shrugged. Also, how will I know what extra med records he has gotten? I have been leaving messages for him since August of 2011 and he has yet to return a single call. I have only met him once and during that visit, he belittled me to the point of me breaking down in tears. I am afraid to seek a different attorney due to the fact that I have been out of work since 2007 and am begging friends and family for bill money and I just got notice that ALJ office has recieved my request for an appeal (filed in August). Am I entitled to the CD of my records from SSA?
Sorry..I guess I had more than one question. Please give me insight on my situation.
Thank you for any help you can provide.
Julie, you are asking a number of questions – I will try to respond to each one:
1. can your lawyer charge you beyond the 25% for medical records? Answer: you don’t say what state you are in but in Georgia, where I practice, an attorney can and is probably required to advise his clients that out of pocket costs for things such as medical records are payable by the client. One of the reasons for this requirement to avoid situations where attorneys might be tempted to bribe clients to get their cases. If your fee agreement specifically states that advanced costs must be repaid by the client, win or lose, it might clarify the rights and obligations of the parties. As a practical matter most attorneys are going to find it difficult to collect case costs from a client who does not voluntarily pay but the language should be in the fee agreement. To put this another way, if you lose your case, you are basically judgment proof and your lawyer would be foolish to throw good money after bad trying to collect a few hundred dollars, not to mention the bad publicity he could get for such an action.
2. lawyer not returning calls – I do think it is reasonable for you to expect your lawyer to update you as to the status of your case. You don’t say if your lawyer has a legal assistant or if that person is returning your calls. In my office, for example, I generally do not get involved in collecting medical records – that is a task for my secretary. If you are getting no response from anyone, that is a problem.
3. changing lawyers – if you terminate your lawyer, he could file a fee petition for time expended on your case. You would have the right to contest that fee petition if you wanted to do so. I will also tell you that some lawyers will not accept cases where there has been a previous lawyer because filing a fee petition is time consuming and it delays payment of the fees. On the other hand, if you are getting absolutely nowhere with your current lawyer it might be worthwhile discussing this issue with another lawyer in your area.
Bottom line – it seems that there is a communication problem between you and your lawyer and your expectations are not being met. Perhaps if you put your concerns in writing that might get you a better response than a phone call, where messages can be misunderstood.
Thank you Mr. Ginsberg for clarifying my concerns. You answered my questions and I appreciate your prompt response.
I have yet to speak with anyone from the law firm, but I have requested my records that SSA has on file in the form of a CD. I should be getting the CD in a couple of weeks. That will help me in determining what more I am going to need.
Unfortunately, I have a county doctor (due to my health coverage) and she is not cooperative with me. She has even denied me antibiotics for a severe sinus infection. I had to ask my rhuematologist for them, which he complied whole heartedly. My dilema is the lack of appropriate health care in MICHIGAN. I don’t expect an answer or response, I just want to share the situation I am thrown into.
Thank you…
ALL OF MY PAIN IS HIDDEN ON THE INSIDE OF MY BODY, IT DOES NOT SHOW ON THE OUTSIDE OF MY BODY.
UNLESS YOU DON’T SUFFER FROM ARTHRITIS, YOU WON’T UNDERSTAND RA