Can you get disability for chronic pain?
Chronic pain qualifies for Social Security disability (SSDI) only through another impairment. Chronic pain is not a listed impairment. So a medically determinable severe impairment, such as a back injury, must be established first. The SSA then weighs how the pain it causes limits your ability to work.
Many of our patients have suffered significant injuries that lead to chronic pain. That pain may keep them from holding a paying job. I am often asked about the process of applying for disability. This blog is meant to give general guidance. It should not be considered legal or medical advice.
Chronic pain affects an estimated 116 million American adults. That is more than heart disease, cancer and diabetes combined, according to a recent Institute of Medicine report. Disability is more common than many people realize. According to the Social Security Administration, a 20-year-old worker has a three in 10 chance of becoming disabled before retirement age.
SSDI is a federal insurance program paid for by payroll taxes. It was set up in 1954. It pays a monthly benefit to people who have worked in the past and paid Social Security taxes. They must be unable to work for a year or more because of their disability.
Applying for Social Security disability benefits can be hard. A claim may take a long time, and the chance of being denied is high. Many patients are wrongly denied disability because of documentation errors.
It is also my personal opinion that some people are granted SSDI when they should not be. They are in fact quite able to hold a paying job. Disability insurance takes too many workers out of the job market too early. That lowers their lifetime income and slows American economic growth. Keep in mind that disability insurance payments, which account for almost $1 out of every $5 spent by Social Security, are growing about 5.6 percent a year after inflation in the last two decades, compared with just 2.2 percent for other Social Security spending. The government made $128.9 billion in insurance payments to 10.6 million disabled workers and their family members in 2011, 25 percent more than it received from payroll taxes.
How does Social Security decide if chronic pain qualifies for SSDI?
Step 1. Is the person “working (engaging in substantial gainful activity)” by the SSA definition? Earning more than $1,010 a month as an employee is enough to disqualify you from Social Security disability benefits.
Step 2. The chronic pain disability must be severe enough to significantly limit your ability to do the basic work activities most jobs need. For example:
- Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling.
- Seeing, hearing and speaking.
- Understanding, carrying out and remembering simple instructions.
- Responding well to supervision, co-workers and usual work situations.
- Dealing with changes in a routine work setting.
Step 3. The Social Security Administration is required to consider pain, and the limits pain causes, when it decides a disability claim. However, before pain may be considered, a medically determinable severe impairment must be established. That has to be done by medically acceptable clinical and lab diagnostic techniques.
Chronic pain is not directly listed as an impairment in Social Security’s blue book. So another medically determinable severe impairment related to chronic pain must be established first. Examples include:
- inflammatory arthritis.
- neurological disorders.
- somatoform disorders.
- back injury.
- chronic renal disease.
- inflammatory bowel disease.
Once a medically determinable severe impairment is established, then the established impairment must reasonably be expected to produce the pain.
The Social Security Administration is required to judge the intensity, persistence and functionally limiting effects of the pain. In other words: how does the pain affect the person’s ability to do basic work activities? Symptoms such as pain sometimes suggest a greater severity of impairment than objective medical evidence alone can show. So the decision-maker (the adjudicator) is required to carefully weigh the person’s statements about his/her pain with the rest of the relevant evidence in the case record. A person’s statement about how strong and lasting the pain is, or how it affects his/her ability to work, may not be disregarded just because objective medical evidence does not back it up.
What factors does Social Security consider when it assesses pain?
The person’s daily activities:
- Where the pain (or other symptoms) is, how long it lasts, how often it comes and how strong it is.
- Things that bring on the symptoms or make them worse.
- The type, dosage, effectiveness and side effects of any medication the person takes or has taken to ease pain (or other symptoms).
- Treatment, other than medication, the person gets or has gotten for relief of pain (or other symptoms).
- Any steps, other than treatment, the person uses or has used to relieve pain (or other symptoms) (e.g., lying flat on his/her back, standing for 15 to 20 minutes every hour or sleeping on a board).
- Any other factors about the person’s functional limits and restrictions due to pain (or other symptoms).
Pain, if present, is a symptom that must be weighed in the decision on every disability claim.
Step 4. The SSA next looks at whether you can still do work you have done in the past, despite your chronic pain. If the SSA finds that a person can do his past work, benefits are denied. If the person cannot, the process moves to the fifth and final step.
Step 5. Review age, education, work history and physical/mental condition to decide what other work, if any, the person can do. To decide chronic pain disability, the SSA uses medical-vocational rules, which vary by age.
Also, to qualify for Social Security disability benefits, you must have worked for:
- 1.5 years if you are younger than age 28.
- 4 years if you are age 38.
- 6.5 years if you are age 48.
- 9 years if you are age 58.
- 9.5 years if you are age 60.
Social Security pays disability benefits if your doctor expects your medical condition to last at least one year, or if your condition is terminal, as with some cancers. If your condition might not last a full year, you can look into other programs for short-term help. Examples are workers’ compensation or your own disability insurance. How long a person can get benefits differs between types of policies. It can range from a few months to a lifetime.
Related reading: mistakes that sink a disability claim.
Frequently asked questions
Is it hard to get disability for chronic pain?
It can be. A Social Security disability claim can take a long time, and the chance of denial is high. Many patients are wrongly denied because of documentation errors. Chronic pain adds one more hurdle. It is not a listed impairment in Social Security’s blue book. So a related medically determinable severe impairment has to be established before the pain itself is considered.
At what point does chronic pain become a disability?
For SSDI, the pain has to come from an established impairment. It must be severe enough to significantly limit basic work activities. Examples are walking, sitting, lifting, following simple instructions or getting along with coworkers. You cannot be engaged in substantial gainful activity. Your doctor must expect the condition to last at least a year. And the SSA must find you cannot do your past work or other work.
How long do you have to have worked to qualify for SSDI?
It depends on your age: 1.5 years if you are younger than 28, 4 years at age 38, 6.5 years at age 48, 9 years at age 58 and 9.5 years at age 60. SSDI is a federal insurance program paid for by payroll taxes. So it pays people who have worked in the past and paid Social Security taxes.
How long can a person stay on disability?
It depends on the program and the policy. Social Security pays disability benefits when your doctor expects your condition to last at least one year, or when the condition is terminal. If your condition might not last a full year, workers’ compensation or your own disability insurance may cover the short term. Across policy types, eligibility can run from a few months to a lifetime.
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine.
