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How SSA Evaluates Back Pain in a Michigan Disability Claim
A lumbar MRI shows a disc. It does not show pain, and the rules Social Security applies to a Michigan disability claim are written around that gap. The agency has a two-step method for weighing pain that a scan does not fully explain, and a claim that is not built to that method tends to be decided on the scan alone.
The method is in 20 C.F.R. § 404.1529. First, the record must contain objective medical evidence of an impairment that could reasonably be expected to produce the pain alleged. Second, once that impairment is shown, the agency evaluates the intensity and persistence of the pain against all of the evidence, and the regulation says in terms that it will not reject a claimant’s statements about pain solely because the objective medical evidence does not substantiate them.
That second sentence is the one a back pain claim has to hold the agency to. It is where Neumann Law Group starts when a Michigan Social Security Disability claimant from Traverse City or Detroit arrives with a denial that recites the imaging and stops.
Step One Asks Only Whether the Impairment Could Cause the Pain
A medically determinable impairment is a physical or mental abnormality shown by medical signs or laboratory findings established through medically acceptable clinical or laboratory diagnostic techniques. Under § 404.1529(b), statements about pain will not be found to affect the ability to work unless such an impairment is present, and the impairment must be one that could reasonably be expected to produce the pain alleged. Degenerative disc disease, a herniation contacting a nerve root, and spinal stenosis all clear this step on ordinary imaging.
The step is deliberately limited. The regulation states that the finding that an impairment could produce the pain does not involve any determination about the pain’s intensity, persistence, or functionally limiting effects. A claimant does not have to show at step one that the disc explains every symptom, only that it is the kind of impairment that produces symptoms of that kind. Where physical findings do not substantiate an impairment capable of producing the pain, the regulation directs the agency to develop evidence of a possible mental impairment, so a chronic pain claim with thin imaging can end up evaluated partly under the mental listings.
Step Two Weighs the Statements Against Seven Factors
Once step one is met, § 404.1529(c) governs how much the pain limits work. Objective evidence such as reduced joint motion, muscle spasm, sensory deficit, or motor disruption is described as a useful indicator that the agency must always try to obtain. The same paragraph then states that the agency will not reject statements about the intensity and persistence of pain, or about its effect on the ability to work, solely because the objective evidence does not substantiate them. The regulation lists the factors that carry the rest of the analysis.
- Daily activities.
- The location, duration, frequency, and intensity of the pain.
- Precipitating and aggravating factors.
- The type, dosage, effectiveness, and side effects of medication.
- Treatment other than medication.
- Measures used to relieve the pain, with lying flat, standing for 15 to 20 minutes every hour, and sleeping on a board given as the regulation’s own examples.
- Other factors concerning functional limitations due to pain.
Social Security Ruling 16-3p, republished at 82 FR 49462 in October 2017, governs how adjudicators apply this. It rescinded the earlier ruling that framed the question as the claimant’s credibility, removed that word from agency policy, and states that symptom evaluation is not an examination of an individual’s character. The ruling is binding on every component of the agency, including the administrative law judges who hear Michigan cases.
Most denials in pain cases quote the imaging and the examination findings and say little about the seven factors. A denial that reads that way has left the second step of its own rule undone, and the omission is where the appeal begins. One call is usually enough for us to tell you where things stand. Call us at (800) 525-6386.
What Pain Testimony Cannot Do
The regulation is equally direct about the limit. Under § 404.1529(d)(3), the agency will not substitute allegations of pain for a missing or deficient sign or laboratory finding in order to raise an impairment to listing-level severity. The four paragraphs of Listing 1.15, laid out on our back and spinal injuries page, are documentary requirements, and the documented medical need for a two-handed assistive device in paragraph D cannot be supplied by testimony about how hard walking has become.
Where the listing is not met, § 404.1529(d)(4) sends the pain evidence into the residual functional capacity assessment under 20 C.F.R. § 404.1545, which is where most back claims are actually decided. There the seven factors do their work, because a limit on how long a person can sit or stand before pain forces a change of position is a residual functional capacity finding, and it is a finding the vocational analysis at steps four and five has to respect.
A Treatment Note That Speaks to All Seven Factors
A treating provider’s notes carry the factors only if the visit records them, and a note reading “back pain, continue current regimen” records almost none of them. Visits that document where the pain is, how long it lasts, what brings it on, what the medication does and what it does to concentration, and what the patient does at home to get through the day produce a chart that answers the regulation’s questions in the regulation’s order. Statements from nonmedical sources count as well. The regulation names them alongside medical sources as evidence of how symptoms affect daily living and work.
Consistency is the other half. Section 404.1529(c)(4) directs the agency to consider inconsistencies between the claimant’s statements and the rest of the evidence, including statements by medical sources and other persons. A function report completed early in the claim and testimony given later at the disability hearing are read against each other, so a contemporaneous record of bad days, kept as they happen, is worth more than a reconstruction offered from the stand.
When the Chart and the Pain Do Not Match
A back claim denied on the imaging has usually been evaluated at one step of a two-step rule. Claimants across Michigan bring those denials to us at Neumann Law Group, and reading a denial against § 404.1529 is something we do before anything is filed. We are glad to talk through any of these questions. Call (800) 525-6386 or send us a message and we will get back to you.