Can Chronic Pain Qualify You for Social Security Disability Benefits? The Sequential Process

Can Chronic Pain Qualify You for Social Security Disability Benefits?

How Social Security Evaluates Pain and Other Symptoms

Part Seven of Powell & Denny’s Guide to Social Security Disability Benefits

“My MRI doesn’t look terrible, but I hurt every single day. Can I still qualify for Social Security Disability benefits?” 

If you’ve asked yourself that question, you’re not alone.  Many people living with chronic pain become discouraged after hearing comments like: “We can’t find anything seriously wrong.”

After hearing those words, many people assume Social Security will never believe them, but that is not how disability claims are supposed to be decided.

The law recognizes something doctors have known for years.

Not every disabling medical condition can be measured by an MRI, X-ray, CT scan, or blood test.  Some conditions produce pain that is far greater than imaging studies alone might suggest.

Others produce symptoms that simply cannot be measured with objective testing.

That doesn’t make the pain any less real.

Where We Are in the Disability Process

The Powell & Denny Guide to Social Security Disability

✓ Part One

How Social Security Decides Disability

✓ Part Two

Can You Work?

✓ Part Three

Severe Impairment

✓ Part Four

Listings

✓ Part Five

Residual Functional Capacity

✓ Part Six

Other Work

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► PART SEVEN

Pain and Other Symptoms

═══════════════════════════════

Part Eight

Burden of Proof

Pain Alone Isn’t Enough

Let’s begin with an important point.

Simply telling Social Security, “I hurt” is not enough.

Before Social Security evaluates your pain, there must first be evidence of a medically determinable medical condition capable of producing the symptoms you describe.

That’s an important safeguard.

Social Security isn’t evaluating pain in the abstract.  They are evaluating pain that is connected to an actual medical condition.

The Law Doesn’t Require an MRI to Explain Every Symptom

Federal courts have long recognized that some medical conditions naturally produce symptoms that cannot always be measured objectively.

Think about conditions like:

• Fibromyalgia
• Complex Regional Pain Syndrome (CRPS)
• Chronic neuropathy
• Migraine headaches
• Certain spinal disorders

The absence of dramatic imaging studies does not automatically mean a person is exaggerating or that the pain isn’t real.

Recommended Reading: Complex Regional Pain Syndrome (CRPS)

How Does Social Security Evaluate Pain?

The law generally requires two things.  First-there must be evidence of an underlying medical condition.  Once that is shown, the medical evidence must either:

• support the severity of the symptoms you describe, or
• demonstrate that your medical condition could reasonably be expected to produce those symptoms.

Notice something important.

The law does not require objective testing to prove every degree of pain you experience.  Instead, it recognizes that some medical conditions naturally produce symptoms that cannot always be fully measured.

Figure 1

Medical Condition

│

▼

Could This Condition

Reasonably Produce Pain?

 

│

YES

▼

SSA Evaluates:

• Your testimony

• Medical records

• Physician observations

• Treatment history

• Daily activities

• Medication effectiveness

• Other evidence

Your Testimony Matters

One of the biggest myths in disability law is: “Only MRIs matter.”  That is wrong.

No MRI can tell a judge:

• how often you must lie down;
• whether you can sit through an eight-hour workday;
• whether medication makes you sleepy;
• how pain affects your concentration;
• whether you miss work because of flare-ups.

Only you—and your treating physicians—can describe those limitations.  That is why your testimony becomes an important part of your disability claim.

What About Good Days and Bad Days?

One of the challenges of living with chronic pain is that symptoms often fluctuate.

Some days are manageable.

Others are overwhelming.

Many people worry that having an occasional “good day” means they cannot qualify for disability benefits, but that’s simply not true.

The question isn’t whether you occasionally feel better, the question is whether you can perform full-time work on a regular and continuing basis.

That is an important difference.

Conditions Commonly Associated With Chronic Pain

Pain may arise from many different medical conditions, including:

• Degenerative disc disease
• Failed back surgery syndrome
• Arthritis
• Rheumatoid arthritis
• Fibromyalgia
• CRPS
• Peripheral neuropathy
• Cervical spine disorders
• Migraine headaches

Every case is different.

The diagnosis itself does not determine the outcome.  The focus remains on how those conditions affect your ability to function.

Recommended Reading: Why your Restrictions are More Important than Your Diagnosis

Powell & Denny Practice Tip

Don’t simply tell your doctor “I hurt.”  Explain how the pain affects your life.

For example:

• How long can you sit?
• How long can you stand?
• How often do you need to change positions?
• Do you have to lie down?
• Does pain interrupt your sleep?
• Does medication affect your concentration?
• How often would you miss work?

Those answers often become much more valuable than simply rating your pain as an “8 out of 10.”

The better question is: How does pain affect your ability to work eight hours a day, five days a week?

That is the question Social Security is ultimately trying to answer.

The Bottom Line

Pain is real.

The law recognizes that, but disability claims are not decided by pain alone.  Instead, Social Security evaluates whether a medically determinable medical condition produces symptoms that prevent you from sustaining regular, full-time employment.

That is why documenting your limitations—not simply your diagnosis—is so important.

“Legal Authority.”

• Holt v. Sullivan
• Hale v. Bowen
• MacGregor v. Bowen

Coming Next…

Who Has the Burden of Proof in a Social Security Disability Claim?

Many people assume Social Security must prove they are able to work.

Actually, that’s only partly true.

In the final article of this series, we’ll explain who has the burden of proof at each stage of the disability process, when that burden shifts to Social Security, and why understanding that shift can make a tremendous difference in evaluating a disability claim.