Getting Social Security Disability for Severe Coccyx Pain (Coccydynia)

Coccydynia is the medical term for pain in your coccyx, or tailbone, the bony structure at the very bottom of your spine. Coccyx pain is often caused by some type of trauma, like falling backward, that causes your tailbone to be bruised, dislocated, or fractured (broken).

With coccydynia, the pain in your tailbone can range from a dull ache to severe, sharp pain. Coccydynia can also be accompanied by other symptoms, such as:

• swelling
• pain in your lower back
• pain if you lean back while sitting
• extreme pain when seated in a car or airplane
• pain during bowel movements, and
• tingling in the legs.

Chronic coccyx pain can disrupt your daily activities, including your ability to function at work. But can you qualify for disability based on severe coccydynia? Maybe.

Causes of Tailbone Pain

In addition to falling, which can cause a tailbone fracture or dislocation, any of the following can cause injury to the coccygeal structures and bring on coccydynia:

• childbirth (especially during a difficult delivery)
• infection
• pressure from prolonged sitting
• degenerative joint changes
• a mobile coccyx, or
• a tumor.

Treating Coccydynia Symptoms

Coccydynia is often a persistent, achy pain that can get much worse when you:

• sit down
• go from sitting to standing, or
• stand for prolonged periods.

Fortunately, the pain from coccydynia generally resolves in a few weeks or months. And there are some things you can do that can help with your pain, such as:

• avoiding sitting or standing for prolonged periods
• sitting upright or on an orthopedic ring cushion (donut-shaped pillow)
• applying heat or ice, and
• taking over-the-counter pain medications.

But it's sometimes difficult to get relief for coccyx pain, especially if your job requires you to spend a lot of time sitting or driving. For tailbone pain that doesn't go away on its own, additional treatments might include:

• physical therapy
• medication, including injections into the tailbone, or
• surgery to remove a damaged portion of the coccygeal vertebrae or a tumor (if one is present).

If your coccydynia doesn't go away with treatment (lasting at least 12 months), and the pain makes it difficult for you to function at work, you might qualify for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits.

Qualifying for Social Security Disability Benefits

Because coccydynia often goes away on its own or can be relieved with treatment, it's not easy to receive disability benefits based on this impairment alone. But you might qualify for disability benefits under Social Security's rules and requirements if your pain:

• is very severe
• isn't responding to treatment, and
• affects your functioning.

The Social Security Administration (SSA) didn't include coccydynia or tailbone injuries in the listings for broken bones in the "Blue Book" (a list of impairments that can automatically qualify for disability benefits). Instead, the SSA will evaluate how your condition affects your ability to work and whether there's any work you can do.

How Your Coccydynia Affects Your Physical Ability to Work

To decide if you're disabled, Social Security must determine what you can and can't do given your medical condition. The SSA will evaluate your physical abilities and limitations using a physical residual functional capacity (RFC) assessment.

Social Security will give you an RFC rating based on the kind of work you can still do. For example, a rating for "sedentary work" means you can do a sit-down job that involves some walking or standing, while a "light work" rating means you can do work that involves mostly standing or walking, with some light lifting.

Severe pain can affect your ability to perform the physical requirements of a job. So, your RFC rating will indicate the most you can be expected to do given the limitations your pain causes.

For instance, if you can't stand or walk for prolonged periods, you can't do "light work," like factory work or waiting tables, so you'd likely get a rating for sedentary work. But if you can't sit for long and need to get up frequently, you might not be able to perform a desk job either, and you might be rated for "less than sedentary" work, which means you'll be approved for benefits.

How Your Coccyx Pain Can Cause Mental Limitations

In addition to physical limitations, pain can also cause mental limitations. If your physical pain is severe enough, it can affect your ability to focus on your work and complete your assigned tasks. The SSA will evaluate your mental abilities and limitations using a mental residual functional capacity (RFC) assessment.

Adding mental limitations to physical restrictions can mean the difference between an approval and a denial. For example, your physical limitations might still allow you to do sedentary work if you can change your position occasionally. But your mental limitations—like the inability to focus—could keep you from performing a desk job on a regular and sustained basis.

If Social Security finds that you can't do even sedentary work, you should qualify as disabled. Learn more about getting disability by showing that you can't do sit-down work.

Are There Any Jobs You Can Still Do?

If your limitations prevent you from doing your old job, Social Security will check to see if there's another type of job you can be expected to learn to do. This determination is based on medical factors, including your age and vocational factors like education and work experience.

If there's no other work you can do (or be expected to learn to do), you'll receive disability benefits based on a "medical-vocational allowance."

(Learn more about qualifying for a medical-vocational allowance.)

How Social Security Assesses Unusual Pain

It can be difficult to get disability for coccydynia and similar injuries because the disability claim rests almost entirely on your reports of pain. While Social Security will consider pain as a part of your overall impairment, you have to show a medical reason for the source of the pain.

Sometimes, X-rays can show a tailbone fracture in the past, which can cause significant chronic pain from sitting. X-rays can also show whether the coccyx is curved or has a bone spur—both of which can cause severe pain. If you have dysfunction or inflammation of your sacrococcygeal joint (which connects your tailbone to your lower spine) or sacroiliac (SI) joint (which connects your lower spine to your pelvis), it might be identified in a clinical exam or show up on an MRI.

To get SSDI or SSI disability benefits, or both, you'll need some kind of objective evidence like this to show that you have a "medically determinable" physical condition that causes your limitations. (20 C.F.R. §  404.1529(b).) So, your doctor's written opinion should say that you have a structural abnormality that could cause your chronic pain and that it can be seen on some kind of objective test, like:

• an X-ray,
• an MRI, or
• a clinical test.

But sometimes, there's no way for doctors or medical tests to corroborate your pain. If your X-rays or MRIs don't show an abnormality, it might be hard to show that your pain is caused by a "medically determinable" physical condition. That makes getting disability benefits based on coccydynia or tailbone pain extremely challenging.

Learn more about how Social Security considers pain when assessing disability.

_{Updated November 30, 2023}