Questions about social security disability.

Many of our patient’s have suffered significant injuries which lead to chronic pain, which may preclude them from gainful employment, and I am often asked questions regarding the process of applying for disability.  This blog is intended to provide general guidance, but should not be considered legal or medical advice.

Chronic pain affects an estimated 116 million American adults—more than the total affected by 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 reaching retirement age.

SSDI is a payroll tax-funded, federal insurance program established in 1954.  It provides a monthly benefit for people who have worked in the past, paid Social Security taxes and are unable to work for a year or more because of their disability.

Applying for Social Security disability benefits can be difficult, due to how long a claim may take and the high chance of being denied, and many patient’s are improperly denied disability, because of documentation errors.

It is also my personal opinion that some individuals are granted SSDI inappropriately, and are in fact quite capable of gainful employment. Disability insurance takes too many workers out of the job market prematurely, reducing 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.

 

There are five significant steps in determining if a patient with chronic pain qualifies for SSDI:

Step 1.  Is the individual presently “working (engaging in substantial gainful activity)” according to the SSA definition. Earning more than $1,010 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.

 

Step 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

 

Step 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.

 

Because chronic pain is not a directly listed impairment in Social Security’s blue book, another medically determinable severe impairment must be established first, (which are related to chronic pain), 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 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.

 

Step 4.  The ability of an individual to perform work they have done in the past despite their chronic pain is next evaluated. 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.

 

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.

 

Other key elements include:

 

Additionally, quality 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, such as workers’ compensation or your own disability insurance. The time period that a person is eligible for benefits differs among various types of policies; it can range from a few months to a lifetime.