How Social Security Evaluates Chronic Pain in Disability Claims
Social Security will consider your reports of pain as long as there is some evidence of a physical or mental impairment.
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Chronic pain is ongoing or recurrent pain that continues longer than the usual course of acute illness or injury, or more than three to six months. Chronic pain may manifest in any area, including back pain, headaches, joint pain, or generalized muscle or nerve pain. It may be related to an injury or illness, or it may have no known cause. You may get diagnosed with a pain disorder such as chronic regional pain syndrome, somatoform pain disorder, or reflex sympathetic dystrophy (RSD), or a disorder that causes chronic pain, such as peripheral neuropathy, tendinitis, carpal tunnel syndrome, fibromyalgia, arthritis, or ilioinguinal neuralgia.
Can Chronic Pain Qualify You for Disability Benefits?
To qualify for Social Security or SSI disability benefits, you must first show the Social Security Administration (SSA) that you have a severe “medically determinable” physical or mental impairment. This means that your impairment must be established by medical evidence that includes objective symptoms and lab tests. To be considered a disability, your impairment cannot be established on the basis of symptoms alone. In other words, merely telling the Social Security Administration that you have disabling chronic pain is not enough.
Therefore, pain—even severe chronic pain that is disabling—will not qualify you for disability benefits unless your medical record includes things like lab tests, x-rays, and/or the results of a physical exam that show there is a physical impairment that could reasonably be expected to produce your symptoms. For example, if a doctor examines you and finds you have widespread pain and 11 out of 18 possible tender point sites, this would establish that you have fibromyalgia. Your objective medical findings don't need to support the severity of your pain, just that there is a physical impairment that is likely to produce pain.
Alternatively, your record could show that you have a mental impairment; a properly diagnosed psychological cause of pain, such as somatoform pain disorder, can meet Social Security's requirements for a medically determinable impairment. The important thing is to get a diagnosis from a qualified medical professional such as a medical doctor or psychiatrist.
Secondly, you must establish that your impairment has lasted or can be expected to last for a continuous period of not less than 12 months. It is therefore helpful to have not just one diagnosis, but repeated diagnoses based on examinations by one or more doctors over a period of more than a year.
If you can pass these threshold tests, Social Security will assess whether your impairment qualifies for disability benefits.
Qualifying for Benefits Under a Disability Listing
Chronic pain is not a listed impairment in Social Security’s blue book, the listing of impairments that may automatically qualify you for disability benefits. There are some diagnoses that are often related to chronic pain, however, including:
- inflammatory arthritis (listing 14.09)
- neurological disorders (listing 11.00), and
- somatoform disorders (listing 12.07).
If your chronic pain is caused by another diagnosed impairment, you may qualify under that listing. For instance, chronic pain is sometimes caused by:
- back injury (listing 1.01)
- chronic renal disease (listing 6.02), or
- inflammatory bowel disease (listing 5.06).
But for the most part, chronic pain sufferers must try to qualify for benefits through the "residual functional capacity,” or “RFC,” assessment.
Qualifying for Benefits through an RFC Assessment
In an RFC assessment, disability claims examiners assess your physical and mental limitations to determine whether your disability limits you so much that you can't work full-time. Unfortunately, the claims examiners at Disability Determination Services often give short shrift to pain. One reason for this is that a disability applicant's complaints of pain are subjective and hard to prove. And doctors who actually treat disability applicants (the "treating physicians") commonly do a poor job of referencing their patients' levels of pain in their treatment notes and inferring what the resulting effects might be on the patient's ability to engage in normal daily activities. It doesn't help matters that Social Security medical consultants, who work in conjunction with disability examiners to make initial determinations on claims, never meet the disability claimants whose medical records they read and evaluate.
However, federal court cases have held that Social Security must evaluate the intensity, persistence, and limiting effects of your pain symptoms on your ability to do basic work activities. The following factors should be considered:
- the location, duration, frequency, and intensity of your pain
- how pain affects your daily activities
- factors that precipitate and aggravate your pain
- the type, dosage, effectiveness, and side effects of medication taken to alleviate pain
- other treatments used to relieve symptoms, such as acupunture or physical therapy
- other ways you relieve pain, such as lying down or applying ice.
Your doctor should include information on the above factors in his notes so that they appear in your medical record. In addition, Social Security will want to know your doctor's opinion on the functional limitations you have that are caused by your pain and how long your chronic pain is expected to limit your ability to function.
How Functional Limitations Limit the Type of Work You Can Do
Determining how your chronic pain limits you physically can be tricky. You may be able to stand or walk for an hour without resting, but only by gritting your teeth against the pain. Or perhaps a long walk feels fine at the time, but you pay for it later with sore muscles or exhaustion. When applying, you need to be realistic about how your pain would limit you in full-time employment. If you can only stand or walk an hour at a time by ignoring a great deal of pain, you probably cannot stand or walk an hour at a time every day to do a job. (This would mean that you are limited to doing sedentary work, or even "less than sedentary" work.)
And don’t forget to write down all the things you do to relieve your pain throughout the day. Do you have to put your feet up periodically? Do you need to lie down or nap every day? Is it important that you are able to stand up and stretch your legs when whenever you want? Do you have to apply heat or cold packs throughout the day? These are physical limitations that affect your ability to work some full-time jobs, so you need to include them in your application. Remember, if you (and your doctor) don’t write it down, Social Security won’t know all the ways your pain limits you. (For more information, see our article on why your doctor needs to document your functional limitations.)
In general, pain is not something that can be established by objective testing or observation. Only you can know whether and how much it hurts. For this reason, your credibility is very important to establish disability based on chronic pain. This is why it's important not to exaggerate your symptoms. However, if Social Security denies you benefits because it doesn't believe your symptoms are as bad as you say they are, the agency must have clear and convincing reasons to reject the claims in your application or your testimony. (Read more about how Social Security assesses credibility in general.)
How Activities of Daily Living Affect Your Credibility
The most important thing that Social Security considers to evaluate your credibility is your activities of daily living (ADLs). In the application process, you will provide information about what you are able to do despite your disability. For example, are you able to cook, clean, do yard work, shop, and care for children? Social Security may also send you an ADL questionnaire to fill out or make an ADL call to your friends and relatives to ask whether you can do certain activities.
Be sure to consider how your chronic pain makes everyday life difficult. For example, you may be able to do the same household chores you always did, but perhaps they take three times as long because you have to stop and rest so much. When you go shopping, do you have to have someone come along to carry the bags? What about your social life – do you still go out to see friends, or has it been months since you left your house except to see the doctor?
It is important to be honest with yourself about how limited your life has become. If your activities of daily living appear normal, Social Security will find it hard to believe that your chronic pain is disabling.
How Medical Treatment Affects Your Credibility
Receiving continuous medical treatment is also very important to establish your credibility. Social Security will doubt that you have really been in severe pain if you have not sought treatment for your pain on an ongoing and continuous basis.
Treatment may include non-medical or non-traditional methods such as acupuncture, massage, physical therapy, exercise, yoga, meditation, and herbal supplements. Be sure to document everything you do to relieve your pain in your application for disability benefits. If you haven't been able to afford to see a doctor, see our article on applying for disability without regular doctor visits.
How the Mental Effects of Chronic Pain Limit Your Ability to Work
Don’t forget to consider the mental and emotional effects of chronic pain. Including information about how your pain affects your mental capabilities may be very important to establish disability through the RFC assessment. (If Social Security finds that the physical effects of your pain limit you to sedentary work, there will still be plenty of jobs you can do unless you can show that you don't have the mental capacity for sedentary work.)
Mental effects of chronic pain often include difficulties with concentration and memory. It can be hard to learn and retain new information when you are distracted by pain. Chronic pain may also make you impatient and irritable, making it difficult to get along with supervisors and coworkers.
Because chronic pain can be very difficult to live with, the emotional effects of your pain should also be considered. Living with chronic pain may cause depression and anxiety. Psychological stress may cause increased pain. If your medical providers have ever suggested that you seek therapy or a psychological evaluation, be sure to follow up. Include any diagnoses or treatment for mental illness in your disability application.
How Social Security Uses the RFC Assessment to Determine Disability
After doing a physical and mental RFC assessment on you, Social Security applies a formula that includes your age, education, and job skills to determine whether you qualify for disability. For more information, see our section about how Social Security uses your RFC to determine disability.
Getting Legal Help
Unless you apply for disability benefits for multiple medical impairments, chronic pain can be difficult to get disability benefits for. You will no doubt be denied benefits at the initial application stage and need to go to a hearing in front of an administrative law judge. A disability lawyer can help you prepare for your disability hearing so that your testimony supports your case and can cross-examine the vocational expert to rule out jobs that you can do. You can use our disability attorney locator to find an lawyer in your area.