How the SSA Evaluates Pain in Disability Cases

Evaluation wording

The Social Security Administration currently uses a two-pronged process to evaluate chronic pain when making disability determinations. It involves identifying if claimants’ have medically determinable impairments and assessing the limitations resulting from claimants’ pain. While chronic pain is subjective is not easily quantified through diagnostic testing, it can profoundly affect people’s quality of life. Suffering from debilitating pain alone may not qualify people for SSDI benefits but this symptom complaint may factor into their level of impairment.

Identifying a Medically Determinable Impairment

The SSA only considers pain, and the associated limitations, resulting from medically determinable impairments. Although a medically recognized condition, chronic pain syndrome is not listed among the SSA’s qualifying impairments in the blue book. Therefore, to qualify for disability, claimants must submit evidence supporting a diagnosis of a qualifying condition, such as medical records and statements from their physicians. Some of the most common qualifying diagnoses that may cause chronic pain include inflammatory arthritis, back injuries, inflammatory bowel disease, neurological disorders, and somatoform disorders.

The objective medical findings submitted by claimants do not have to back the severity of their pain. Rather, claimants’ medical records must only show the diagnosis of an underlying impairment that could be reasonably expected to cause the pain.

Assessing Evidence of Pain-Associated Impairment

After establishing a qualifying underlying condition, the SSA evaluates the persistence, intensity, and limiting effects of claimants’ pain. To this end, the agency examines claimants’ objective medical evidence, personal statements about the severity and extent of the pain, and statements and other information given by medical sources or others who can speak to how claimants’ pain has impacted their lives. In analyzing the objective medical evidence, Social Security looks for medical signs and laboratory findings consistent with claimants’ statements about the functional effects of their conditions and the associated pain. For example, clinical testing may show a person has reduced muscle strength and signs of muscle wasting, which in turn supports the claimants’ statement that he or she is unable to stand or walk for more than several minutes without enduring increased pain and later suffering from residual effects.

When the SSA cannot make a determination based on the objective medical evidence alone, it considers statements from the claimants themselves, medical sources, and others. Claimants may report details regarding the location of their symptoms, how often and for how long the experience the pain, and activities that make their chronic pain worse or better to their healthcare providers or directly to the SSA. In addition to providing opinions, diagnoses, and prognoses, medical professionals may report on claimants’ histories, responses to treatments, daily activities, and efforts to work. Statements from non-medical sources, such as family, friends, Social Security personnel, and educational personnel, may also be considered. These sources may provide personal observations about the claimants’ symptoms and the associated effects.

Understanding Chronic Pain

Chronic pain is an ongoing unpleasant feeling, such as an ache, burn, tingle, sting, or prick, that persists beyond the typical healing period for an injury or illness. Such pain can plague people for weeks, months, or years. The sensation may be dull or sharp and localized to one area of the body, or it may be felt all over. In some cases, chronic pain is caused by another condition, such as arthritis, a prior injury or infection, or cancer. For others, however, there is no clear cause to which they can attribute their chronic pain.

People who suffer from chronic pain may experience a range of physical and emotional effects. Chronic pain often causes tense muscles, limited mobility, and lack of energy. Additionally, people may experience anger, anxiety, depression, or a fear of re-injury as a result of living with chronic pain. These effects may impede people from engaging in their everyday, leisure, and work activities.

Evaluating Claimants’ Ability to Perform Work-Related Activities

Based on the evidence and statements provided, the SSA concludes whether it is likely that claimants’ chronic pain-involved disabilities are significant enough to affect their ability to perform basic activities necessary for doing most jobs, including walking, sitting, standing, lifting, pulling, pushing, and carrying. The factors Social Security considers when making such decisions include the following:

  • The location, frequency, duration, and intensity of claimants’ pain
  • The type and effectiveness of treatments claimants’ have tried or use to alleviate their symptoms
  • Claimants’ daily activities
  • Factors that come before or aggravate the pain

The SSA looks at these factors to consider the intensity and persistence of claimants’ symptoms, and the degree to which these symptoms limit their capacity to perform work-related activities. In order to qualify for benefits, Social Security must find that claimants’ conditions and pain prevent them from doing the work they did before and impede their ability to adjust to other work.

Categories:
Social Security Disability

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