How Social Security Evaluates Chronic Pain in Disability Claims

Chronic pain is ongoing or recurrent pain that continues longer than expected; that is, longer than the usual length of an injury, or more than three to six months.

Chronic pain can occur in any area and can cause back pain, headaches, joint pain, or generalized muscle or nerve pain. It can be related to an injury or illness, or it can have no known cause. If you have pain for longer than six months, you might be diagnosed with a pain disorder such as:

• chronic regional pain syndrome
• somatoform pain disorder,
• reflex sympathetic dystrophy (RSD).

Or you could be diagnosed with a disorder that is known to cause long-term, hard-to-treat pain, such as:

• peripheral neuropathy
• fibromyalgia
• arthritis
• ilioinguinal neuralgia
• carpal tunnel syndrome, or
• tendinitis.

Is Chronic Pain a Disability?

Chronic pain can cause disability, meaning it can keep you from doing a substantial amount of activity. For the Social Security Administration (SSA) to find you disabled, your medical records need to show that you have a severe "medically determinable" impairment (MDI) that causes your chronic pain. This means that your records must include medical evidence that proves you have a loss of function.

In other words, to be considered a disability, your impairment can't be established on the basis of symptoms alone. Merely telling the Social Security Administration that you have disabling chronic pain is not enough.

Pain—even severe chronic pain that is disabling—won't qualify you for disability benefits unless your medical record includes things like lab tests, x-rays, and/or the results of a physical exam. The claims examiner or disability judge will be looking for evidence that you have 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, since everyone experiences pain differently, just that there is a physical impairment that is likely to produce pain.

Alternatively, your records 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 a psychiatrist.

What Are the Technical Requirements for Disability Benefits?

You must establish that your impairment has lasted (or is expected to last) for a continuous period of 12 months or more. With chronic pain, it's 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 have long-term, chronic pain that's caused by an MDI, Social Security will assess whether your impairment qualifies for Social Security disability insurance (SSDI) or SSI disability benefits. There are two ways to qualify for benefits: under a disability "listing" and by showing your loss of function is so great that you can't do any type of full-time work.

How Do You Qualify for Benefits Under a Disability Listing?

Social Security's Blue Book, the listing of impairments that may automatically qualify you for disability benefits, doesn't include a listing for chronic pain. The Blue Book does include some diagnoses that are often related to chronic pain, 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 injuries (listing 1.15 or listing 1.16)
• chronic renal disease (listing 6.02), or
• inflammatory bowel disease (IBD) (listing 5.06).

But for the most part, chronic pain sufferers don't meet a listing in the Blue Book and must try to qualify for benefits through a "residual functional capacity," or "RFC," assessment.

How Do You Qualify for Benefits Through an RFC Assessment?

In an RFC assessment, a disability claims examiner at Disability Determination Services (DDS) will assess your physical and mental limitations. Your RFC is a paragraph describing your maximum physical and mental capabilities. Your RFC might include limitations on how long you can sit, stand, and walk, as well as how much weight you can lift and carry. The claims examiner will then use your RFC to determine whether your disability limits you so much that you can't work full-time. (For more information, see our section about how Social Security uses your RFC to determine disability.)

Unfortunately, claims examiners don't always take claims of severe pain seriously when they create your RFC. One reason for this is that a disability applicant's complaints of pain are subjective and hard to prove. Another reason is that doctors who actually treat disability applicants (the "treating physicians") commonly do a poor job of including your levels of pain in their treatment notes and explaining the effects of your pain on your ability to engage in daily activities.

But federal court cases have held that disability examiners must evaluate the intensity, persistence, and limiting effects of your pain symptoms on your ability to do basic work activities. They need to consider the following factors:

• the location, duration, frequency, and intensity of your pain
• how pain affects your daily activities
• the factors that trigger your pain and make it worse
• the type, dosage, effectiveness, and side effects of medication that you take for pain
• other treatments you've used to relieve symptoms, such as acupuncture or physical therapy, and
• other ways you relieve pain, such as lying down or applying ice.

Your doctor should include information on the above factors in their treatment notes so that they appear in your medical record. Your doctors should also include their opinions 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. (For more information, see our article on why your doctor needs to document your functional limitations.)

Telling Social Security How Your Pain Limits Your Ability to Work

As part of your application, Social Security will ask you to fill out a disability report. In the remarks section of this form, you can share how your chronic pain limits you physically. But this can be tricky. For instance, 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. How do you describe this for Social Security?

When filling out your information, you need to be realistic about how your pain would limit you in full-time employment. If you can only stand or walk for two hours a day by ignoring a great deal of pain, you probably can't stand or walk for two hours every day to do a job. In that case, you might not want to say you can stand or walk for two hours.

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're 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 many 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.

Telling Social Security About Your Activities of Daily Living

In assessing whether your claims of pain are consistent with the other evidence in your file, claims examiners will consider how you handle your "activities of daily living" (ADLs). As part of the application process, Social Security will ask you to provide information about what you're 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 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.

When you fill out the application or the ADL questionnaire, 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's important to be honest with yourself and with Social Security 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 the Mental Effects of Chronic Pain Can Limit You

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 important to establish disability through the RFC assessment. (Even 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 difficult to live with, the emotional effects of your pain should also be considered. Living with chronic pain may cause depression and anxiety. And 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 treatments for mental illness in your disability application.

Keep Receiving Medical Treatment

Going to the doctor regularly and receiving continuous medical treatment is important to establishing your credibility. If you haven't sought treatment for your pain on an ongoing and continuous basis, Social Security might doubt that you have really been in severe pain.

Social Security will consider all forms of treatment, including 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.

What If Social Security Doesn't Believe Me?

In general, pain isn't 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. That's why it's important not to purposefully exaggerate your symptoms, and to be consistent across all of the forms you fill out.

But 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.)

Getting Legal Help

Unless you apply for disability benefits for multiple medical impairments, it can be difficult to get disability benefits for chronic pain. Social Security will likely deny you benefits at the initial application stage, and you'll 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.

_{Updated July 6, 2022}