How does the SSA evaluate pain?

Submitted by Deanna on

Disability benefits are available through the Social Security Administration (SSA) to those who suffer from a disability that leaves them unable to work.

These benefits can be used to help cover the costs of medical bills and everyday living expenses. To apply for disability benefits, you must be both financially and medically eligible – but if you disability is centered on the pain you feel, how can the SSA determine your eligibility?

Medical Eligibility for Benefits Based on Pain

Pain and Getting Disability Benefits

Unfortunately, there is no official metric for the pain you feel. Therefore, to prove that you are eligible for disability benefits, you will rely heavily on doctor’s notes and an assessment of your residual functional capacity (RFC) for the SSA to make its determination.

First, you need to show the SSA that your physical or mental disability is severe and “medically determinable”. Your disability cannot be based on symptoms alone, and your medical records must contain x-rays, lab work, and physical exam results to prove that you suffer from some sort of physical impairment that could reasonably be related to the cause of your symptoms. Note that this could also be a mental impairment, not physical.

Second, you also need to establish that your disability and pain has lasted continuously for a period of no less than twelve months, or can be expected to last for twelve months.

RFC Assessment

According to federal law, the SSA must factor your pain symptoms into their determination of your ability to do work. Your RFC should include certain details such as:

  • Intensity, frequency, and location of your pain
  • How long your pain lasts
  • Activities that cause your pain or make it worse
  • The medication you take to treat your pain, including how much, how it works, and any side effects
  • Other symptom-relieving treatment
  • Any other ways you relieve your pain, such as laying down or resting

Your RFC should also include your job experience, work history, education level, and age. For example, if you have worked in a job involving physical labor for your entire career, and your pain makes it so that you are unable to work, you may be eligible for benefits based the fact that you can’t reasonably expected to learn a new form of work at your age and education level.

Equaling a Blue Book Listing

The Blue Book, a comprehensive list of conditions that the SSA uses to determine if you are medically eligible for disability benefits, contains many listings related to chronic pain. You may be able to “equal” one of these listings for your own pain. There are many diseases and impairments in the Blue Book that cause chronic pain, including:

  • Arthritis
  • Inflammatory bowel disease
  • Somatoform disorders
  • Chronic renal disease

If your symptoms equal the requirements of one of these listings, it may help you be approved for benefits by the SSA. Again, you will need extensive medical records and doctor’s notes documenting these symptoms as proof.

Hire a Social Security Disability Lawyer

If you believe that your pain qualifies you for disability benefits, consider seeking the help of a disability lawyer or advocate to help you understand your eligibility and get started with the application process.