Chronic Pain Syndrome and Qualifying for SS Disability Benefits

It’s estimated that 50 million people in the United States suffer with chronic pain, resulting in $80 billion in lost wages and $300 billion in lost productivity annually. Chronic pain is the number one reason people see a doctor, and though people of any age or gender can experience chronic pain, more women than men are affected. If you are suffering from the effects of chronic pain you may qualify for disability benefits.

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In order to be eligible for SS disability benefits with chronic pain syndrome it must be expected to last for one year and you must have medical evidence.

Pain is the body’s normal reaction to an injury; as the body heals, pain usually goes away.

Sometimes pain is even a good thing, letting us know something is wrong. But when pain continues long after the cause is gone – i.e., three to six months or more – it becomes chronic pain syndrome. Experiencing pain day after day can wear down a person’s physical and emotional health. The symptoms of chronic pain syndrome go way beyond pain, causing depression and anxiety and interfering with an individual’s daily activities.

Chronic pain syndrome frequently begins with an injury or a painful medical condition, like any of those listed below:

•    Osteoarthritis or rheumatoid arthritis
•   Fibromyalgia
•   Back pain
•   Cancer
•   Inflammatory bowel disease or irritable bowel syndrome
•   Surgery
•   Headaches
•   Muscle strains and sprains
•   Repetitive stress injuries, such as carpal tunnel syndrome
•   Nerve damage
•    Lyme disease
•   Broken bones
•   Endometriosis

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from chronic pain. If you have been denied disability don’t give up!

Some experts believe that people with chronic pain syndrome have a problem with the nerves and glands the body uses to handle stress, making them feel pain differently.

Others suspect that CPS is a learned response, that when a person is in pain they may repeat certain bad behaviors even after the pain has subsided.

Over time, pain will impact a person’s physical health, emotions and social life and lead to other symptoms, including:

•    Depression and anxiety;
•   Fatigue;
•   Irritability;
•   Poor sleep;
•    Drug and/or alcohol abuse;
•   Relationship problems;
•   Job loss;
•   Suicidal thoughts.

When a doctor diagnoses chronic pain syndrome, they will ask about injuries or illnesses that may have caused the patient’s pain.

Imaging tests such as x-rays, CT scans and MRIs may be ordered to locate the source of the pain. They will also ask some questions about the type of pain the patient is feeling and how long the pain has lasted, such as:

•    When did the pain start?
•   Where does it hurt:
•   What does the pain feel like? Is it throbbing, pounding, shooting, sharp, pinching, stinging or burning?
•    How severe is the pain on a scale of 1 to 10?
•   What makes the pain worse?
•   What makes the pain better?

Treatment will depend on the source of pain and can be from a primary care provider, a specialist who deals in painful medical conditions such as a rheumatologist, or a pain clinic. Some therapies commonly used include:

•    NSAIDs, muscle relaxants, antidepressants and anti-seizure medications;
•   Physical therapy including heat and ice packs;
•   Nerve blocks;
•   Massage therapy and occupational therapy;
•   Biofeedback;
•   Spinal cord stimulation;
•   Braces;
•    Surgery to treat the condition.

Qualifying for Disability for Chronic Pain Syndrome

Chronic pain syndrome can force people to retire early or severely limit their daily activities.

In many cases, people have pain that is not curable. The Social Security Administration does not consider chronic pain to be a disability and chronic pain syndrome is not listed as an impairment in the Blue Book. Unfortunately, pain is subjective and hard to prove – just stating you have pain is not enough. In order to qualify for Social Security Disability Income, you must show you have a medically determinable mental or physical impairment (MDI) that is established by objective symptoms and laboratory tests.

You must have a diagnosis from a qualified medical professional and provide results from lab tests, x-rays and physical exams that confirm there is a physical impairment causing your symptoms.

Alternatively, you could provide evidence of a mental impairment, such as somatoform pain disorder (a form of mental illness that causes one or more bodily symptoms, including pain), to meet the MDI requirement. Additionally, you must show that the pain has lasted, or is expected to last 12 months. For that reason, it is beneficial to provide repeated diagnoses from one or more doctors over a period of more than one year.

A claimant’s best chance for obtaining SSDI with chronic pain syndrome may be providing evidence that their chronic pain stems from another medical condition or applying for disability with multiple medical impairments.

Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. Though chronic pain syndrome is not considered an impairment, there are several disorders listed that are related to or cause chronic pain, among them:

•   Back injury (Section 1.01);
•    Neurological disorders (Section 11.00);
•    Inflammatory arthritis (Section 14.09);
•   Inflammatory bowel disease (Section 5.06);
•   Somatic symptom and related disorders (Section 12.07);

Other applicants with chronic pain syndrome may try to qualify for benefits through a “residual functional capacity or “RFC,” assessment.

Social Security will evaluate how your symptoms affect your daily activities and ability to perform basic work activities. Among the factors Social Security will consider are:

•    The location, intensity, duration and frequency of your pain;
•   Factors that trigger your pain or make it worse;
•   Medication you take to relieve pain and their side effects;
•   Treatments used to reduce pain such as physical therapy or acupuncture;
•   Any other practices, such as applying ice or lying down, you use to manage pain.

Your doctor’s notes should include information on the above factors so they appear in your medical record.

Social Security will want to see your doctor’s opinion on your functional limitations and how long your chronic pain is expected to limit your abilities. Social Security may also send you an ADL (Activities of Daily Living) form to gauge how your impairment affects your ability to perform common tasks like grocery shopping, mowing the lawn, and dressing as well as going to work. Chronic pain syndrome often leads to frequent absences from work. A person who misses too many days of work because of chronic pain may not be able to maintain a full-time job and may not be employable.

It is important to be realistic and honest when applying for disability benefits.

Write down all the ways chronic pain impacts your daily life and all the things you do to manage pain; if you don’t include it, Social Security won’t know how chronic pain limits you. But don’t exaggerate – credibility is important. Be sure to continue regular medical treatments, including non-medical and non-traditional therapies.

Filing for SSDI with chronic pain syndrome presents many challenges because the cause and severity of pain is often difficult to ascertain.

Because initial claims are often denied, your best chance for success is to consult a qualified disability attorney who can review your case, gather the medical evidence you need and avoid needless mistakes that may delay the process.

LTD Chronic Pain Claims

Our client, from Euless, had long term disability insurance with Lincoln Financial. He was diagnosed with Severe Legg-Perthes disease and chronic pain. He could not sit for more than 15 minutes before experiencing severe pain and could not walk for more than five minutes before his pain increased. He had exhausted all surgical options and was on long-term pain management. He was denied benefits by Lincoln Financial, but we were able to reach a settlement agreement for him.

We represented a client for her short and long term disability claims.

She suffered from failed back surgery syndrome, lumbar radiculitis, fibromyalgia, severe sleep dysfunction, moderate to severe depression and, quite probably, rheumatoid arthritis. She had been instructed by her primary care physician to “discontinue the workforce” for at least the next several years, but also advised that her condition was unlikely to change. This diagnosis was supported by another physician. She had multiple surgeries as well as diagnostic tests objectively verifying the pathology responsible for her chronic pain. She was awarded benefits from the Social Security Administration, but eventually denied by AT&T’s LTD plan administrator. We were able to get her benefits reinstated.

In order to qualify for Social Security Disability, you will need to satisfy a few specific requirements in two categories as determined by the Social Security Administration.

The first category is the Work Requirements which has two tests.

1.   The Duration of Work test.   Whether you have worked long enough to be covered under SSDI.
2.   The Current Work Test.   Whether you worked recently enough for the work to actually count toward coverage.

The second category is the Medical Eligibility Requirement.

1.   Are you working?   Your disability must be “total”.
2.   Is your medical condition severe?    Your disability must be “severe” enough to interfere with your ability to perform basic work-related activities, such as walking, sitting, and remembering.
3.   Is your medical condition on the List of Impairments?   The SSA has a “List of Impairments” that automatically qualify as “severe” disabilities. If your disease is not listed this does not mean you cannot get disability, it means you must prove you cannot maintain employment due to your limitations.
4.   Can you do the work you did before?   SSDI rules look at whether your medical condition prevents you from doing the work you did prior to developing the condition.
5.   Can you do any other type of work?   If you cannot do your prior work, an evaluation is made as to whether you can perform any other kind of work.

More details can be found on our Qualifying for Disability page.