What does Social Security look at in an RFC assessment for chronic pain?
A functional capacity evaluation measures what your body and mind can still do at work. In a Social Security disability claim, it is called the residual functional capacity (RFC) assessment. What your doctor writes down about your pain, daily activities and treatment shapes the result.
In an RFC assessment, disability claims examiners look at your physical and mental limits. They decide whether your disability limits you so much that you can’t work full-time. Sadly, the claims examiners at Disability Determination Services often brush pain aside. One reason is that an applicant’s pain is self-reported and hard to prove. And doctors who actually treat disability applicants (the “treating physicians”) often do a poor job of noting their patients’ pain levels in their notes. They also often fail to spell out what the pain might do to the patient’s normal daily life. It doesn’t help that Social Security medical consultants never meet the people whose records they read. Those consultants work with disability examiners to make the first decisions on claims.
However, federal court cases have held that Social Security must evaluate the intensity, persistence, and limiting effects of your pain symptoms on your ability to do basic work activities. The following factors should be considered:
- the location, duration, frequency, and intensity of your pain
- how pain affects your daily activities
- factors that precipitate and aggravate your pain
- the type, dosage, effectiveness, and side effects of medication taken to alleviate pain
- other treatments used to relieve symptoms, such as acupuncture or physical therapy
- other ways you relieve pain, such as lying down or applying ice.
Your doctor should cover the factors above in his notes so they show up in your medical record. Social Security will also want your doctor’s opinion on the functional limitations your pain causes. It will want to know how long your chronic pain is expected to limit what you can do.
How does chronic pain limit the type of work you can do?
Figuring out how your chronic pain limits your body can be tricky. You may be able to stand or walk for an hour without resting, but only by gritting your teeth. Or maybe a long walk feels fine at the time, but you pay for it later with sore muscles or deep tiredness. When you apply, be realistic about how your pain would limit you in a full-time job. Say you can only stand or walk an hour at a time by ignoring a great deal of pain. Then you probably cannot do that every day to hold a job. (This would mean that you are limited to doing sedentary work, or even “less than sedentary” work.)
And write down all the things you do to ease your pain during the day. Do you have to put your feet up now and then? Do you need to lie down or nap every day? Is it important that you are able to stand up and stretch your legs whenever you want? Do you have to apply heat or cold packs throughout the day? These are physical limits that affect your ability to work some full-time jobs. Include them in your application. Remember, if you (and your doctor) don’t write it down, Social Security won’t know all the ways your pain limits you.
In general, pain cannot be shown by objective tests or by watching you. Only you can know whether and how much it hurts. So being believed is key when your disability claim rests on chronic pain. That is why you should not exaggerate your symptoms. However, if Social Security denies you benefits because it doesn’t believe your symptoms are as bad as you say they are, the agency must have clear and convincing reasons to reject the claims in your application or your testimony.
How do your daily activities affect your disability claim?
The most important thing Social Security looks at to judge if you are believable is your activities of daily living (ADLs). When you apply, you will explain what you can still do despite your disability. For example, are you able to cook, clean, do yard work, shop, and care for children? Social Security may also send you an ADL form to fill out. Or it may call your friends and family to ask whether you can do certain things.
Think about how your chronic pain makes everyday life hard. For example, you may be able to do the same chores you always did. But maybe they take three times as long because you have to stop and rest so much. When you go shopping, do you have to have someone come along to carry the bags? What about your social life – do you still go out to see friends, or has it been months since you left your house except to see the doctor? Be honest with yourself about how limited your life has become. If your daily activities look normal, Social Security will find it hard to believe your chronic pain is disabling.
Why does ongoing medical treatment matter for your claim?
Steady medical treatment also matters a great deal for being believed. Social Security will doubt that you have really been in severe pain if you have not kept getting treatment for it. Treatment may include non-medical or non-traditional methods such as acupuncture, massage, physical therapy, exercise, yoga, meditation, and herbal supplements. Be sure to document everything you do to relieve your pain in your application for disability benefits.
How do the mental effects of chronic pain limit your ability to work?
Don’t forget the mental and emotional effects of chronic pain. Showing how your pain affects your mental abilities may be very important to establish disability through the RFC assessment. (If Social Security finds that the physical effects of your pain limit you to sedentary work, there will still be plenty of jobs you can do unless you can show that you don’t have the mental capacity for sedentary work.)
Mental effects of chronic pain often include trouble with focus and memory. It can be hard to learn and hold on to new things when pain pulls at you. Chronic pain may also make you short-tempered. That can make it hard to get along with bosses and coworkers. Because chronic pain can be very hard to live with, the emotional effects of your pain count too. Living with chronic pain may cause depression and anxiety. Mental stress may cause more pain. If your medical providers have ever suggested therapy or a mental health evaluation, follow up. Include any diagnoses or treatment for mental illness in your disability application.
How Social Security Uses the RFC Assessment to Determine Disability
After doing a physical and mental RFC assessment on you, Social Security applies a formula that includes your age, education, and job skills to determine whether you qualify for disability.
Related reading: applying for SSDI with chronic pain and common disability claim mistakes; see also repetitive strain injury and a knee injury at work.
Frequently asked questions
What is done during a functional capacity evaluation?
In a Social Security RFC assessment, disability claims examiners review your physical and mental limits to decide whether you can work full-time. They weigh where your pain is, how long it lasts, how often it comes and how bad it is. They also weigh what triggers it, your medicines and their side effects, other treatments, and how you ease the pain. Social Security medical consultants read your records but never meet you. So your medical record carries your case.
Why is chronic pain hard to prove in a disability claim?
Pain cannot be shown by objective tests or by watching you. Only you know whether and how much it hurts. Claims examiners often brush pain aside. Treating doctors often fail to record pain levels and how pain affects daily life. That puts your believability, your daily activities and steady treatment at the center of the claim. It is also why you should never exaggerate your symptoms.
What should my doctor document for an RFC assessment?
Your doctor’s notes should cover where your pain is, how long it lasts, how often it comes and how bad it is. They should cover how it affects your daily activities and what makes it worse. They should list the dose, results and side effects of your medicines, plus the other treatments and steps you use for relief. Social Security also wants your doctor’s opinion on the functional limitations your pain causes and how long it is expected to limit you.
What happens after the RFC assessment?
After a physical and mental RFC assessment, Social Security applies a formula that includes your age, education and job skills to decide whether you qualify for disability. Say the physical effects of your pain limit you to sedentary (seated) work. Plenty of jobs may still remain, unless you show you lack the mental capacity for sedentary work. That is why the mental effects of pain belong in your application.
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine.
