Shoulder Pain and Social Security Disability Benefits

Applying for Social Security Disability Benefits with Shoulder Pain

Shoulder pain is a very common condition that affects millions of Americans, as many as 8 million or 2.5 percent of the population, a study done by the University of Granada reported. There are a variety of different causes, including liver disease, heart disease, dislocation, rotator cuff tear or disease, frozen shoulder, bursitis, fractures, and arthritis.

If your have severe shoulder problems that keep you from working, the Social Security Administration (SSA) may be able to help. The SSA is a government organization that offers benefit programs for those unable work due to disabilities.

The Financial Costs of Shoulder Pain

According to the same University of Granada study, shoulder pain costs the United States $7 billion in healthcare expenses. That averages out to about $1,000 per person, though the cost can be much higher depending on the severity of the impairment.

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The study explained that shoulder problems are also the cause of 13 percent of missed work days in the United States, which adds thousands in lost productivity costs. Because of the high amount of sick leave, patients may find it hard to sustain a job or financially support themselves.

Medically Qualifying for Benefits with the Blue Book

The Blue Book is the SSA's manual of disabilities that qualify for benefits, and the SSA uses it to evaluate disability claims. If you can meet or equal a listing a medical listing in the Blue Book, you will be approved for benefits.

There is no specific listing for shoulder pain in the Blue Book, but there are a number of conditions that can cause shoulder pain:

  • Section 1.02—Major dysfunction of a joint that causes a serious deformity in the shoulder, such as a partial or full dislocation, distortion of muscular tissue, or stiffening of the joint due to the unnatural joining of tissue or bone, with pain and stiffness that causes limitation of or abnormal large or fine movements in both shoulders.
  • Section 1.04—Disorders of the spine in the neck, such as a herniated disk, spinal arachnoiditis, (inflammation and pain of one of the nerve membranes surrounding the spinal cord), spinal stenosis. (narrowing of the spine), osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture, that causes nerve root or spinal cord compression.
  • Section 1.07—Fracture of an upper extremity in the shoulder that isn't expected to be restored within 12 months despite being under continuing surgical management directed toward restoration of functional use.
  • Section 1.08—Soft tissue injury of the shoulder that restricts major function and isn't expected to be restored within 12 months, despite continuing surgical management directed toward the salvage or restoration of major function.
  • Section 4.04—Ischemic heart disease: A deficiency of blood supply due to blockage in the veins (ischemia) with depression, low systolic pressure, three ischemic episodes requiring hospitalization in one year, or a severe coronary artery disease.
  • Section 9.05—Diabetes that causes adhesive capsulitis, or frozen shoulder, which causes pain and stiffness to the point that the shoulder is immovable or diabetic peripheral neurovascular disease.
  • Section 11.04—Central Nervous System Vascular Accident (stroke) that results in significant and persistent limitations in motor function in both shoulders, resulting in sustained disturbance of large and fine movements, such as frozen shoulder.
  • Section 14.09—Persistent inflammatory arthritis, with:
    • Causing deformity in one or more major peripheral joints in both shoulders, resulting in the inability to effectively perform fine and large movements.
    • Inflammation or deformity in one or more shoulder joints, with involvement of two or more organs/body systems and two or more constitutional symptoms (severe fatigue, fever, malaise, or involuntary weight loss).
    • Repeated manifestations of inflammatory arthritis, with at least two of the constitutional symptoms and limitation of activities of daily living, social functioning, or completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

If your shoulder pain is keeping you from working, talk to your doctor. He or she can help you decide is disability benefits are right for you.

Qualifying Without Meeting a Medical Listing

If you have another condition that causes shoulder pain, such a bursitis or tendonitis, or just don't meet a Blue Book listing, there is another way to be approved for benefits. If you can show your shoulder pain is limiting enough to stop you from working, you may be approved with a medical-vocational allowance.

As with all disability claims, your shoulder problems should have lasted or be expected to last 12 months or more and you must be unable to earn what the SSA considers the minimum monthly wage, or substantial gainful activity (SGA), which in 2016 is $1,130.

The SSA uses the symptoms and limitations reported by your doctor, medical evidence, and your education and work history to place in you in jobs they believe you can do or be reasonably trained to do, using their grid rules. This placement is called your residual functioning capacity (RFC).

It can be hard to be approved for benefits with shoulder pain, because the SSA can't verify how much pain you're in. You need to provide medical evidence of a condition affecting the shoulder that is causing restriction of movement and pain.

It will be easier to get approved with an RFC if you worked in labor intensive jobs, like automotive, electrical, moving, manual labor, or construction than a sedentary or light job. However, if your pain or stiffness is severe enough, your chances of approval are higher.

How to Apply for Social Security Disability Benefits

Talk to your doctor before you start the application for disability benefits. Even qualifying conditions can take months or years before they're approved, so if your doctor is unsure of your chances, it may not be worth the long wait time, effort, and appeals.

If you do choose to apply, whether with the Blue Book or an RFC, make sure you include all of the needed medical evidence with your application. 70 percent of disability applications are denied, and many only because the applicant didn't submit the correct medical information to show proof of their condition and limitations.

Important medical evidence for shoulder pain may include:

  • Medical imaging tests, like an X-ray, MRI, ultrasound, PET scan, or CT scan.
  • An electrocardiogram (EKG/ECG) to test the electrical activity of your heart, whether it be at rest, while exercising (exercise tolerance test/stress test), or while performing normal activities (Holter monitoring).
  • Blood tests.
  • Echocardiogram, which uses sound waves to create images of the heart.
  • A thorough physical examination, with joint manipulation.
  • Reports of any surgeries or hospital stays.
  • Descriptions of any treatments and their outcomes.
  • A detailed report from your doctor describing the severity of your pain and restriction of movement.

For most disability applications, you have the choice to apply online on the SSA's website or at your local SSA office. For Supplementary Security Income (SSI) applications only, you must make an appointment to apply at an SSA office. Before applying, be sure to bring all the proper documentation.

Whether applying in person or online, look over your application at least once before submitting it. If you miss any questions or make any mistakes, this could make it hard or impossible for the SSA to fully understand the scope of your disability or find the medical information they need, which could cause them to delay or deny your application.

Make sure to contact the SSA immediately if your shoulder pain worsens, causes new symptoms, or changes in any way. The more evidence you have of how your impairment limits you, the more likely you are to be approved for benefits.

If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance.