The Social Security Administration SSA does not include chronic pain on the list of impairments. However, an applicant’s request for disability for chronic pain may be approved if his or her impairment meets the criteria shown in the SSA’s Blue Book, a guideline for medical conditions that qualify for benefits.

Causes of Chronic Pain

Pain can be caused by a variety of health conditions, such as headaches, earaches, toothaches, scrapes, cuts and burns, sprained ankles and wrists, broken or fractured bones, surgical procedures, or a sudden blow to the head. While some of these conditions can be easily managed with pain medications and rest, more serious conditions can take a long time to heal and cause severe or chronic pain for the injury victim.

When dealing with medical conditions, pain is usually broken down into two categories: acute pain and chronic pain. The main difference between the two is that acute pain comes on suddenly and usually goes away within a few weeks or months, while chronic pain is ongoing and lasts longer than six months. In some cases, it can last for years, or even a lifetime, subjecting the injured victim to constant pain and a major lifestyle change.

Once acute pain goes away, the victim can resume his or her normal life, but chronic pain signals can remain active in the nervous system for years, even after injuries have healed. Doctors believe this type of chronic pain occurs when nerves are damaged or become overactive, causing them to send false pain messages to the brain. Doctors define chronic pain as pain that lasts for at least 12 weeks and can occur in any part of the body.

Some of the most common causes of chronic pain and disability include the following conditions:

  • Cancers
  • Degenerative disc disease
  • Head, back, and neck trauma
  • Migraines
  • Neuropathy and nerve pain
  • Osteo, psoriatic, and rheumatoid arthritis

While there are many health conditions that cause chronic pain, not all chronic pain disorders will qualify as a disability for chronic pain based on the SSA’s Blue Book guidelines. Social Security defines disability in part as an illness or injury that prevents a person from being able to work for at least one year. Guidelines for disabilities are strict and applicants must answer a variety of questions and undergo physical exams and lab tests to verify a doctor’s diagnosis and prove a health condition causes chronic pain.

If you are approved for disability benefits, the SSA will conduct a periodic check-in called a continuing disability review (CDR) to ensure that you still have a condition that keeps you from working and earning a living from gainful employment. If your condition improves to the point where you can go back to work, your benefits will be scheduled to stop.

In a CDR, a disability examiner and medical consultant from Social Security will review your case to see if there has been any medical improvement since you began receiving disability benefits, or since your last review. You will be required to provide specific medical information, including details on recent medical exams and treatments, contacts for all doctors seen, and patient record numbers for medical centers and hospitals that treated you. The disability examiner will also ask if you have been working while receiving benefits, and how much money you have earned. The frequency and timing of CDRs depend on how SSA categorizes your long-term prognosis for your disability.

  • Medical Improvement Expected – If improvement is expected, a CDR will take place within 6 to 18 months after disability benefits begin
  • Medical Improvement Possible – If improvement is possible, a CDR will usually take place every three years after the initial benefits date
  • Medical Improvement Not Expected – If no improvement is expected, CDRs are typically scheduled every seven years after the initial benefits date

What Medical Conditions Qualify for Disability Benefits?

There is an extensive list of medical conditions that qualify for disability benefits under the SSA’s Blue Book guidelines. Not all of these conditions are categorized as chronic pain, but many disabling conditions do cause pain. To evaluate medical conditions and meet the guidelines for approval of disability benefits, the types of disabilities are broken down into two categories: Adult Listings (Part A) and Child Listings (Part B).

Medical conditions that qualify for disability benefits include both physical impairments and cognitive impairments. The SSA evaluates these types of disability based on their origin, extent of impact, duration, types of treatments required, medical diagnosis of the patient, and medical prognosis for the patient’s recovery. The Blue Book disability listings under Part A include:

Cancer (Malignant Neoplastic Diseases)

Cancers, except certain cancers associated with human immunodeficiency virus (HIV) infection, quality for disability benefits. Approved cancers include: breast cancers, esophagus or stomach cancers, bladder and liver cancers, soft tissue cancers of the head and neck, soft tissue sarcoma, skin cancers, leukemia, lymphoma, multiple myeloma, pancreatic cancer, and prostate cancers.

Cardiovascular System Impairments

The SSA guidelines define cardiovascular system impairments as any disorder that affects the proper functioning of the heart or the circulatory system, including arteries, capillaries, lymphatic drainage, and veins. The disorder can be either congenital or acquired. Approved cardiovascular impairments include: aneurysm of the aorta or major branches, chronic heart failure, ischemic heart disease, heart transplants, peripheral arterial disease, recurrent arrhythmias, and symptomatic congenital heart disease.

Endocrine Disorders

Endocrine disorders are medical conditions that cause a hormonal imbalance within the body and the major glands, including the adrenal, thyroid, parathyroid, pancreas, and pituitary glands. When an endocrine gland functions abnormally, producing either too much of a specific hormone (hyperfunction) or too little (hypo-function), the hormonal imbalance can cause various complications in bodily functions. The SSA evaluates endocrine disorders based on the damage that’s caused to internal organs and the long-term complications that may arise.

Immune System Disorders

Immune system disorders often result in recurrent and unusual infections, inflammation, and dysfunction of the body’s own tissues. They are commonly associated with severe fatigue, fever, involuntary weight loss, and musculoskeletal pain which can be listed as a disability due to extreme physical limitations. Common immune system disorders include: connective tissue disease, degenerative disc disease, osteoarthritis, psoriatic arthritis, rheumatoid arthritis, systemic lupus, systemic sclerosis, and Sjogren’s syndrome.

Mental Disorders

The SSA’s Blue Book listings for mental disorders fall into 11 different categories. Each category is evaluated according to an applicant’s medical criteria and mental functioning capabilities in a work setting such as concentration, applying information, memory, and interaction with others. Mental disorders include: autism spectrum disorder, eating disorders like anorexia and bulimia, problems with anxiety, bipolar disorders, and depression, obsessive-compulsion, personality disorders, problems with impulse control, schizophrenia and psychotic disorders, and stress-related trauma.

Filing for SSDI or SSI Benefits

If you need to file for Social Security disability benefits, you should understand which type of benefits you need and the requirements for filing. Both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs provide assistance to individuals who meet the SSA requirements for disability.

Social Security Disability Insurance (SSDI)

SSDI pays disability benefits to workers and their family members when the worker has worked long enough to pay Social Security taxes and has accumulated a sufficient number of work credits. SSDI benefits are financed with Social Security taxes paid by workers, employers, and self-employed individuals.

To qualify for SSDI benefits, you must earn work credits based on your taxable work history. If benefits are approved, they are payable to 1- disabled and blind workers under 65 years old, 2- a claimant’s spouse or widower, 3- a claimant’s children, and 4- any adult family members disabled since childhood. Your Social Security earning record will determine your monthly disability benefits. After receiving disability insurance benefits for two years, you will automatically receive Medicare coverage.

Supplemental Security Income (SSI)

Supplemental Security Income (SSI) is based on financial needs, rather than your prior work history and work credits. SSI benefits are available to low-income individuals who have a prior work history or who have no work history at all. This program is financed through general tax revenues and does not relate to Social Security taxes.

To qualify for SSI benefits, you must be a United States citizen or national and you must have limited income and resources. If your benefits are approved, they are payable to persons who meet the basic requirements and are 1- adults who are 65 years old or older, 2- adults who are disabled or blind, and 3- children who are disabled or blind. Your monthly benefit payment can vary up to the maximum federal benefit rate, which may be supplemented by your state. In most states, people who receive SSI benefits are automatically eligible for Medicaid.

What Information Is Needed to File for a Disability Claim for Chronic Pain?

If you’re struggling with chronic pain and need to file a claim for disability benefits, you need medical records to establish proof of your condition. Documented medical records from a licensed medical professional that show a diagnosis and treatment plan for chronic pain will be important for the approval of your benefits.

A disability for chronic pain must show that your pain has lasted a while. The SSA’s Blue Book guidelines define a long-term disability as an illness or injury that prevents a person from being able to work for at least one year.

To boost your chances for an approved disability claim, you need to create a record that shows your medical history. This record should include the following information:

  • Medical appointments (dates and times)
  • Doctors’ names, addresses, and phone numbers (primary care and specialists)
  • Medical exams and treatments (include dates)
  • Lab tests such as X-rays, MRIs, and ultrasounds (include dates)
  • Evidence of chronic pain (pain medications, assistive devices)
  • Medical diagnosis and prognosis of disability and pain

Long-term disability claims that involve chronic pain need a clear medical diagnosis and prognosis supported by diagnostics studies like CT scans, MRIs, and other tests that can indicate nerve damage. To combat the challenges associated with chronic pain, you need compelling medical evidence.

See the Right Doctors and Specialists

When dealing with chronic pain, it’s best to seek medical attention from doctors and specialists who understand and specialize in pain management. For instance, if you have chronic back pain, your medical team should include orthopedic doctors, neurologists, neurosurgeons, and certified pain management specialists. The SSA will require in-depth medical evidence to approve your disability benefits, so it’s important to keep a file that documents all your medical evidence. It will be one of the first things the SSA asks for when you file your claim. If you don’t have it, your claim may be considerably delayed until you can provide it.

Don’t Abuse Your Pain Medications

If you’re experiencing chronic pain, your scans and tests may not explain all of your symptoms, but it’s likely that you’re taking pain medications. If your medical history shows a pattern of going to the emergency room or urgent care for early refills or overusing your pain medications, you will run into problems with your long-term disability claim. If the SSA suspects any type of abuse with pain medications, it’s a red flag and a likely indicator that your disability benefits will be denied. Long-term disability plans limit or exclude claims that may appear as substance abuse.

Consult a Disability Lawyer

If you need help filing your disability claim, consult a disability lawyer who can help you fill out your application, gather your medical records for evidence, and work with the SSA on follow-up procedures. Disability claims are often complicated and difficult to navigate, but a disability lawyer knows what’s required from the SSA. A lawyer can make the process less stressful and boost your chances of an approved disability claim, especially when you’re filing a claim that involves a disability for chronic pain.