Importance of Consistency

There must be a medically determinable impairment (MDI) that could reasonably produce the reported loss of function.

  • Objective medical evidence establishes a MDI through a combination of diagnostic studies and objective physical findings.
  • Once a MDI is established that could reasonably produce loss of function, adjudicators consider all the objective medical and non-medical evidence to determine a level of severity.
  • Adjudicators quantify (mild, moderate or severe) and cross reference the degree of abnormalities on diagnostic testing and objective physical findings with the level of function reported by the claimant.
    • “Objective” is important because anyone can act as if they can’t grip, pick up small objects, or walk without an assistive device.
    • Objective medical evidence must exist to support behaviors such as poor grip, poor dexterity or an impaired gait.
        • Does the MRI show minimal DDD or does it show a herniated disc with significant nerve root impingement?
        • Does the X-ray show mild joint space narrowing or does it show obliteration of the joint space?
        • Does the EMG/NCS show mild carpal tunnel syndrome or severe carpal tunnel syndrome?
        • Does the joint exam show full range of motion and a normal appearing joint, or does the exam show significant loss of motion and a deformed joint?
        • Does the exam shows normal muscle bulk and good tone, or does the exam show significant muscle atrophy and poor tone?
      • There must be consistency in the reported level of function throughout your claimant’s file.
        • If the claimant reports they can barely walk across the room because of back and leg pain, and a treating source’s medical records consistently document a normal gait, that raises a red flag for the adjudicator.
        • A common inconsistency in disability claims is when a claimant has no difficulty walking and standing at a Field Office interview, but shows up at a consultative examination limping and using a cane.
          • This inconsistency may be due to a flare of the claimant’s medical condition, but objective findings should provide objective evidence of a flare.
        • Another common inconsistency is when the claimant reports severe pain causing loss of function, but tells the consultative examination doctor they don’t take any pain medications, not even over-the-counter medications.

        Note: Abnormal diagnostic studies don’t dictate a set level of function, but can support a reported or observed level of function.