Social Security Disability or SSI for Shoulder Pain & Shoulder Problems
Social Security doesn't have a specific listing for shoulders; whether you'll get disability depends on the problem, the limitations it causes, and your prognosis.
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There are several different kinds of shoulder pain and problems that people can suffer from, and the disabling effects vary based on the type of shoulder pain or problem. If the impairments are severe enough, a person may be eligible for Social Security Disability (SSD or SSI) benefits.
Types of Common Disabling Shoulder Problems
Dislocation. The shoulder bones make a ball and socket joint; dislocations occur when the bone is either partially or fully removed from the socket. You will often know when your shoulder is dislocated because your arm appears to be out of place. Other indications that your shoulder is dislocated include pain, swelling, numbness, weakness, and bruising. Dislocations can cause tears and stretching in the ligaments or tendons in the shoulder, bone damage, and/or nerve damage.
Separation. Separation of the shoulder occurs when the clavicle (collar bone) separates from the scapula (shoulder blade). This is most often caused by a partial or complete tear in the ligaments that hold the shoulder together. Most shoulder separations cause shoulder pain and tenderness.
Tendinitis and Bursitis. Tendinitis is a swelling of a tendon, while bursitis is the swelling of the bursa sacs (fluid-filled sac. Symptoms of tendinitis in the shoulder include pain in the upper arm and shoulder that comes on slowly, and pain when lifting your arm away from your body or over your head.
Torn Rotator Cuff. Rotator cuff tendons are the muscles used to lift your arm over your head and lift heavy things. Torn rotator cuffs are a very common injury, especially as people age due to regular wear and tear. Often times, there is no pain or change in function with a torn rotator cuff. However, there can be significant pain, especially with tears caused by a specific injury.
Frozen Shoulder. Frozen shoulder occurs when the movement in your shoulder is severely limited due to the growth of tissue between the joints. Frozen shoulder generally happens when people stop using their shoulders due to pain. Certain diseases, such as diabetes, rheumatoid arthritis, and heart disease, can increase the likelihood that frozen shoulder will occur.
Shoulder Fracture. Breaks or cracks in the shoulder generally occur in the clavicle (shoulder blade) or the very top of the humerus, the bone in the upper arm that connects to the shoulder. Improperly treated fractures can lead to arthritis in the shoulder.
Arthritis. Arthritis in the shoulder can affect the joints as well as the surrounding muscles and tendons. Arthritis can limit the use of your shoulder and cause significant pain.
Diagnosis and Treatment of Shoulder Injuries
Shoulder problems are diagnosed in three stages.
- A medical history is taken that outlines problems with your shoulder.
- A physical examination is performed to determine physical limitations and pain levels.
- Tests are completed to confirm shoulder problems. Tests include x-rays, x-rays with dye injections, ultrasounds, and MRIs.
Treatment for the various kinds of shoulder problems and pain are generally similar. Immobilization of the shoulder by placing it in a sling or cast, rest, ice, pain medications, medications to control swelling, and physical therapy after the rest period are all commonly used treatments to control symptoms and to heal the shoulder. If an person’s shoulder does not get better after these treatments or the injury is too severe, surgery may be needed to correct the problem. Restoration of functioning is common with shoulder treatments.
Disability for Shoulder Problems
When Social Security is determining whether or not an individual is disabled and therefore eligible for disability benefits, the agency will look at whether a person meets the requirements of one of Social Security's disability listings in the Social Security “blue book” or if a person is able to return to any type of work.
Meeting or Equaling a Disability Listing
Shoulder problems and pain are not covered by a specific impairment listing for shoulders, but many shoulder problems may fall under by Listing 1.02: Major dysfunction of a joint. It is important to remember that your disabling impairment must have lasted 12 months, or be predicted to last for at least 12 months, to qualify for disability.
In order to meet this listing, you must have one of the following conditions that causes chronic pain and limits your ability to use your arm(s):
- partial shoulder dislocation
- partial or full fusing of the shoulder joints caused by growing of tissue between the joints, or
- shoulder instability due to continuous dislocations, shoulder separations, or weakness in the shoulder.
Additionally, there must be medical evidence of fusing of the joints, destruction of the bones in the shoulder, or narrowing of the space between the joints.
If your shoulder problem doesn't exactly meet the requirements of this listing, it is possible Social Security will consider your condition to be equivalent to ("equal") this listing if you can show that the shoulder problems you have are equally as severe and long lasting as the condition in the listing.
For example, if a dislocation of your shoulder occurs frequently and has lead to instability and limitations in your shoulder, but not a narrowing of the space between the joints, destruction of the bones, or fusing of the joints, you will not meet the requirements of listing. But your frequent shoulder dislocation might equal the listing because the effects are the same as impairments that do meet the listing.
Not Being Able to Return to Work
If your shoulder problems do not meet or equal a listing, it's possible to receive disability benefits based on the fact that your impairments prevent you from returning to any type of work. In determining whether you can return to any type of work, Social Security will use a Residual Functional Capacity (RFC) form to assess your physical and mental limitations. The RFC form, as well as your age, education, and work experience, are all considered in determining whether you can return to any kind of job (such as sedentary work, light work, medium work, and so on).
For those with shoulder problems or pain, the physical demands of working may not be possible to meet. The physical requirements of many types of jobs, such as lifting, carrying, pushing, or pulling, are often not possible due to shoulder movement limitations or pain. Even sedentary desk jobs can be unsuitable since they usually require arm movements (such as lifting a phone, typing, pressing buttons, reaching overhead) that may cause pain. Shoulder pain, depending on its severity, can also affect a person’s ability to concentrate on tasks at hand, which could affect their productivity at work.
For more information on how Social Security decides whether your RFC and physical limitations prevent you from doing certain types of jobs, see our section on when your RFC says you can return to work.
A Note on Shoulder Pain
With shoulder problems and pain, the existence of pain is a major factor in physical limitations. A person is not going to be able to participate in an activity that causes them increased, severe pain. Social Security acknowledges the limitations that pain can place on a person and will consider them in awarding disability. However, the evidence of your pain must go beyond your personal reports of pain.
In order to have pain considered as a factor in your impairment, you must show a "medical sign" or "laboratory finding" that could cause the pain symptoms you are experiencing. For example, an x-ray of a herniated disk would be sufficient proof to support why you have severe back pain.
Once a possible cause of the symptoms, such as frozen shoulderis identified through MRI imaging or other tests, Social Security will look at your entire medical record and the intensity, persistence, and limiting effects of your pain. Social Security will want to see consistency among the various reports of pain in your file -- your doctor's reports in your medical record, your own self-reporting, and reports of your pain by friends, caregivers, or employers -- especially with regards to your physical limitations based on pain.
Once Social Security decides how much consideration to give to your personal reporting of your shoulder pain, the agency is required to give specific examples of its reasons.