SSDI Eligibility Guidelines: Chronic Pain
1. Determine if an individual is working (engaging in substantial gainful activity) according to the SSA definition. Earning more than $1,170 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.
2. Conclude the chronic pain disability must be severe enough to significantly limit one’s ability to perform basic work activities needed to do most jobs. For example:
Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
Seeing, hearing and speaking
Understanding/carrying out and remembering simple instructions
Responding appropriately to supervision, co-workers and usual work situations
Dealing with changes in a routine work setting
3. The Social Security Administration is required to consider pain and the limitations imposed by pain in the adjudication of a disability claim. However, before pain may be considered, a medically determinable severe impairment must be established by medically acceptable clinical and laboratory diagnostic techniques. 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 evaluate the intensity, persistence and functionally limiting effects of the pain, i.e., how does the pain affect the individual’s ability to do basic work activities. Because symptoms, such as pain, sometime suggest a greater severity of impairment than can be shown by objective medical evidence alone, the adjudicator is required to carefully consider the individual’s statements about his/her pain with the rest of the relevant evidence in the case record. An individual’s statement about the intensity and persistence of pain or about the effect the pain has on his/her ability to work may not be disregarded solely because they are not substantiated by objective medical evidence.
The following factors are to be considered by the Social Security Administration in the assessment of pain:
The individual’s daily activities:
The location, duration, frequency and intensity of the individual’s pain (or other symptoms)
Factors that precipitate and aggravate the symptoms
The type, dosage, effectiveness and side effects of any medication the individual takes or has taken to alleviate pain (or other symptoms)
Treatment, other than medication, the individual receives or has received for relief of pain (or other symptoms)
Any measures, other than treatment, the individual 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 concerning the individual’s functional limitations and restrictions due to pain (or other symptoms)
Pain, if present, is a symptom that must be addressed in the adjudication of all disability claims.
4. Explore the ability of an individual to perform work they have done in the past despite their chronic pain. If the SSA finds that a person can do his past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.
5. Review age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine chronic pain disability, the SSA enlists medical-vocational rules, which vary according to age.
For example, if a person is:
Under age 50 and, as a result of the symptoms of chronic pain, unable to perform what the SSA calls sedentary work, then the SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.
Age 50 or older and, due to the chronic pain disability, limited to performing sedentary work, but has no work-related skills that allow him to do so, the SSA will reach a determination of disabled.
Age 55 or older and, due to the disability, limited to performing light work, but has no work-related skills that allow him to do so, the SSA will reach a determination of disabled.
Over age 60 and, due to the chronic pain disability, unable to perform any of the jobs he performed in the last 15 years, the SSA will likely reach a determination of disabled.
Any age and, because of chronic pain, has a psychological impairment that prevents even simple, unskilled work, the SSA will reach a determination of chronic pain disabled.
