How Social Security Assesses Chronic Pain for Disability Claims

Chronic pain is defined as persistent or recurring pain that lasts longer than expected; that is, longer than the average length of an injury, or more than three to six months.

Chronic pain can manifest itself in any place, causing back pain, headaches, joint pain, or generalized muscle or nerve discomfort. It could be the result of an injury or sickness, or it could have no known cause. 

If you have been experiencing pain for more than six months, you may be diagnosed with a pain disorder such as chronic pain syndrome, reflex sympathetic dystrophy, and somatoform pain disorder (RSD).

Or you could be diagnosed with a condition known to produce chronic, difficult-to-treat pain, such as peripheral neuropathy, fibromyalgia, arthritis, or ilioinguinal neuralgia.

Is Chronic Pain Linked to Disability?

Chronic pain might render you disabled, preventing you from engaging in strenuous exercise. Your medical records must prove that you have a serious “medically determinable” impairment (MDI) that causes your chronic pain for the Australian Social Security to pronounce you disabled. This means that your records must contain medical documentation proving your loss of function.

In other words, your impairment must be proved just on the basis of symptoms to be termed a disability. Simply informing the Australian Social Security that you suffer incapacitating chronic pain is insufficient.

Pain, even severe chronic pain that is disabling, will not qualify you for disability payments unless your medical record contains lab testing, x-rays, and/or physical exam results. The claims examiner or disability judge will be searching for proof that you have a physical impairment that is likely to cause your symptoms. 

For example, if a doctor analyzes you and discovers that you have broad pain and 11 out of 18 probable tender point sites, you are diagnosed with fibromyalgia. Because everyone feels pain differently, your objective medical findings do not need to support the level of your discomfort, simply that there is a physical disability that is likely to cause pain.

A correctly diagnosed psychological source of pain, such as a somatoform pain condition, can meet Social Security’s requirements for a medically determinable impairment. The most crucial thing is to obtain a diagnosis from a skilled medical practitioner, such as a doctor or a psychiatrist.

What Technical Requirements Are There for Disability Benefits?

You must demonstrate that your impairment has persisted (or is expected to last) for 12 months or more. With chronic pain, it’s beneficial to have not just one, but multiple diagnoses based on examinations by one or more specialists throughout a year.

If you have long-term, chronic pain caused by an MDI, Social Security will determine if your impairment qualifies you for SSDI or SSI disability benefits. There are two methods to qualify for benefits: through a disability “listing” and by demonstrating that your loss of function is so severe that you are unable to work full-time.

How Do You Get Benefits Through a Disability Listing?

Chronic pain is not listed in Social Security’s Blue Book, which is a list of ailments that may automatically qualify you for disability benefits. 

You may be eligible if your persistent pain is caused by another diagnosed impairment. Chronic pain can be caused by, for example, back injuries chronic renal illness, or inflammatory bowel disease (IBD).

However, most chronic pain patients do not fulfill a Blue Book classification and must try to qualify for benefits through a “residual functional capacity,” or “RFC,” examination.

How Does an RFC Assessment Help You Qualify for Benefits?

A disability claims examiner from Disability Determination Services (DDS) will evaluate your physical and mental limits during an RFC examination. Your RFC is a paragraph that describes your peak physical and mental talents. Your RFC may specify time limits for sitting, standing, and walking, as well as weight limits for lifting and carrying. The claims examiner will then use your RFC to decide if your impairment prevents you from working full-time. (For additional details, visit our section on how Social Security determines disability based on your RFC.)

Unfortunately, claims examiners do not often take extreme pain claims seriously when creating your RFC. One reason for this is because pain statements from disability applicants are subjective and difficult to substantiate. Another factor is that doctors who actually treat disability applicants (the “treating physicians”) frequently fail to include your pain levels in their treatment notes and describe how your pain affects your ability to engage in everyday activities.

However, federal court decisions have maintained that disability examiners must consider the intensity, persistence, and limiting consequences of your pain symptoms on your ability to do basic employment tasks. They must take the following variables into account:

• 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.

In order for the following characteristics to appear in your medical record, your doctor should add information about them in their treatment notes. Your doctors’ opinions on the functional limits imposed by your pain and how long your chronic pain is projected to impair your capacity to function should be included.

Informing Australian Social Security How Your Pain Impairs Your Work Ability

Social Security will ask you to complete a disability report as part of your application. You can describe how your chronic pain physically limits you in the remarks area of this form. However, this can be difficult. 

For example, you might be able to stand or walk for an hour without stopping if you grit your teeth against the discomfort. Or maybe a long stroll feels good at the time, but you pay for it later with achy muscles or tiredness. How would you put this in terms of Social Security?

When filling out your information, be honest about how your pain would impede your ability to work full-time. 

If you can only stand or walk for two hours a day while ignoring severe discomfort, you probably won’t be able to stand or walk for two hours every day to accomplish your job. You might not want to suggest you can stand or walk for two hours in that situation.

Don’t forget to keep track of everything you do to relieve your pain during the day. Do you have to put your feet up on a regular basis? Do you need to sleep or lie down every day? Is it critical that you can stand up and stretch your legs whenever you want? Is it necessary to use heat or cold packs throughout the day? 

You must list these physical limitations in your application because they impede your ability to work several full-time jobs. Remember, if you don’t write it down (and your doctor doesn’t either), Social Security won’t know all the ways your pain limits you.

How Chronic Pain’s Mental Effects Can Limit You

Don’t overlook the mental and emotional consequences of chronic pain. In order to prove impairment through the RFC exam, you may need to include information about how your pain impairs your mental capacity.

Even if Social Security determines that the physical effects of your suffering confine you to sedentary labor, there will still be plenty of jobs available to you, unless you can demonstrate that you lack the mental capacity for sedentary work.

Chronic pain frequently causes difficulty with concentration and memory. When you are distracted by discomfort, it might be difficult to acquire and retain new knowledge. Chronic pain might also make you irritated and impatient, making it difficult to get along with coworkers and superiors.

Because chronic pain can be difficult to live with, you should also examine the emotional implications of your suffering. Chronic pain can lead to sadness and anxiety. Furthermore, psychological stress may exacerbate discomfort. 

Follow up with your medical doctors if they have ever indicated that you seek counseling or a psychological examination. Include any mental illness diagnosis or treatments in your disability application.

Finally

For more information on chronic pain management, pain disorders, chronic pain resources, psychogenic pain, effective chronic pain treatment options or other physical therapy, you should book a consultation session with a specialist at Chronic Therapy today, to give you professional advice that will suit your personal experience.

Also, for people with chronic pain who are constantly worried on how to treat chronic pain or get their chronic pain treated, our specialist at Chronic Therapy have made huge success over the year in recommending reliable resources to manage chronic pain from nerve pain or any other developing chronic pain conditions.