Pain and Disability Benefits:

Understanding How the Social Security Administration Analyzes Pain in Determining Your Entitlement to Disability Benefits

Determining an individual’s eligibility for disability benefits can be very complex. One of the most complex aspects of this process is the evaluation of pain, a subjective symptom that lacks the clear, objective measurement often associated with other medical conditions. Given that pain can significantly impact an individual’s ability to work, Social Security applies a comprehensive framework to analyze and assess claims where pain is a primary or secondary disabling factor.   

How to talk about your pain for a disability claim:

When I am counseling my clients on how to best present information about their pain in a disability claim, I advise them to not merely state that they suffer pain, but rather to focus on the limitations that the pain creates.  For example, rather than saying “I can’t walk much because of my pain,” it’s much more helpful to state “I can only walk about 10 minutes and my pain increases to the point I need to sit down for about 10 minutes before I can continue.”  

Likewise, rather than just stating that the pain prevents you from working, give some detailed information.  For example,  “my pain is severe enough that I can’t focus or concentrate on my work tasks.”  It’s important to provide this information to your doctors as well as to individuals working on your disability claim.  

How does SSA evaluate pain? 

The SSA’s evaluation of pain is guided by several key regulations and rulings, notably the Social Security Act, specific sections of the Code of Federal Regulations (CFR), and pertinent Social Security Rulings (SSRs). A pivotal regulation is 20 CFR § 404.1529, which outlines how symptoms, including pain, are considered in determining disability. Additionally, SSR 16-3p provides guidance on evaluating the intensity, persistence, and limiting effects of an individual’s symptoms.

The SSA recognizes that pain cannot be solely validated through objective medical evidence. Therefore, while objective evidence of a medical condition that could reasonably be expected to produce pain is essential, the intensity and persistence of pain, as reported by the claimant, are also critically assessed.

The SSA employs a two-step process to evaluate pain:

1. Step One: The SSA determines whether there is an underlying medically determinable physical or mental impairment that could reasonably be expected to produce the individual’s pain or other symptoms. This step focuses on the presence of a condition that could logically cause pain, based on medical evidence.
2. Step Two: Once an underlying condition is established, the SSA evaluates the intensity, persistence, and limiting effects of the pain to determine the extent to which it affects the claimant’s ability to perform work-related activities. This assessment involves a comprehensive analysis of both medical evidence and the statements made by the claimant.  

To assess the intensity and persistence of pain, the SSA considers several factors:

• Daily Activities: The extent to which pain limits the claimant’s daily activities, such as personal care, household tasks, and hobbies.
• Treatment and Medication: The type, dosage, effectiveness, and side effects of any pain treatments or medications the claimant is using. Consistency and adherence to prescribed treatments are also examined.
• Other Measures: Any other methods the claimant uses to alleviate pain, such as physical therapy, use of assistive devices, or alternative therapies.
• Functional Limitations: How the pain affects the claimant’s physical and mental capabilities, including mobility, concentration, and endurance.

The SSA places significant weight on medical opinions and reports from treating physicians, given their ongoing relationship with the claimant. However, these must be supported by clinical findings and consistent with the overall medical evidence.

Pain Evaluation Requires Credibility and Consistency

A critical component of the SSA’s analysis is evaluating the credibility of the claimant’s statements regarding their pain. This involves assessing the consistency of the claimant’s statements with the medical evidence and other information in the case record. The SSA looks for consistency over time and across different contexts, such as medical appointments and the claimant’s reported activities.

Factors that may affect credibility include:

• Consistency: Are the claimant’s descriptions of their pain consistent with the medical records and other evidence?
• Behavior: Does the claimant’s behavior and demeanor during medical examinations align with their reported level of pain?
• Work History: A claimant’s work history prior to the onset of disability can provide context for evaluating the credibility of their pain reports.

SSA Pain Evaluation Third-Party Statements

Statements from family members, friends, and former employers can also provide valuable insights into the claimant’s condition. These third-party statements can corroborate the claimant’s accounts of their pain and its impact on their daily life and work capacity.

Residual Functional Capacity (RFC) Assessment

Once the intensity, persistence, and limiting effects of the pain are established, the SSA conducts a Residual Functional Capacity (RFC) assessment. This assessment determines what the claimant can still do despite their pain and other impairments. The RFC considers the claimant’s ability to perform various work-related activities, such as sitting, standing, walking, lifting, carrying, and interacting with others.

The RFC is pivotal in deciding whether the claimant can return to their past work or adjust to other work that exists in the national economy. If the pain significantly restricts the claimant’s ability to perform basic work activities, they may be deemed disabled and eligible for benefits.

Conclusion

The SSA’s process for analyzing pain in disability determinations is multifaceted and thorough, reflecting the complexity of assessing a subjective symptom. By considering medical evidence, treatment history, claimant statements, and third-party observations, the SSA aims to make fair and accurate determinations regarding an individual’s eligibility for disability benefits. Understanding this process helps claimants better prepare their applications and provides clarity on how their pain will be evaluated in the context of their disability claim.  Additionally, the assistance of an experienced and skilled attorney who specializes in disability claims can be extremely helpful in articulating the ways that pain disrupts your ability to work. 

To learn more about how the Social Security Administration evaluates pain for disability claims, here are some resources: 

• How Does the SSA Determine Disability
• Disability Benefits: https://matchdisabilitylaw.com/category/disability-benefits/ 
• Medical impairments, ailments and other disorders: https://matchdisabilitylaw.com/category/medical-ailments-impairments-disorders/ 
• https://www.ssa.gov/OP_Home/cfr20/404/404-1529.htm § 404.1529. How we evaluate symptoms, including pain.
• https://www.ssa.gov/OP_Home/cfr20/416/416-0929.htm Code Of Federal Regulations:  § 416.929. How we evaluate symptoms, including pain.
• https://www.ncbi.nlm.nih.gov/books/NBK219244/  Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. – 3 Disability Determination and the Role Of Pain
• https://www.ncbi.nlm.nih.gov/books/NBK219248/ Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. SUMMARY

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