For anyone seeking disability benefits for chronic pain, unique challenges may emerge due to the nature of the condition. Chronic pain is a widespread, complex, and often disabling disorder that affects millions of Americans.
Mr. M., an Iraq war veteran, is admitted to the hospital for intractable pain in his left arm. He suffered an acute crush injury 2 years ago while in combat. He has had multiple surgeries to repair damage but still suffers from chronic, unrelenting pain. He states that if a surgeon does not agree to amputate his arm, he has purchased a gun and is planning to kill himself. (1)
Worldwide, chronic pain and the burdens it creates are the leading cause of disability. However, these burdens are often misjudged or minimized. The extensive occurrence of chronic pain brings up questions about its acceptance as a disability.
And while you may genuinely qualify for long-term disability benefits, be ready for the chance that the disability benefits provider contests or denies your claim.
Our attorneys have a deep understanding of these issues and how they impact your chances of winning the disability benefits for chronic pain you deserve.
If you suffer from chronic pain and were unfairly denied disability benefits, or need help with your initial claim, please get in touch with us right away. We will do all that we can to help you obtain the compensation you need.
Call or text (800) 562-9830 or complete a Free Case Evaluation form
What Is Chronic Pain?
Chronic pain results from many causes, including trauma, surgeries, nerve damage, various diseases, and psychological conditions. Unfortunately, it can persist even after the core issue is addressed. Sometimes, the reason for chronic pain is unknown.
Chronic pain can persist for months or years. It can affect any part of the body, including mental health, as constant pain may lead to severe depression, anxiety, or other issues. Recent studies confirm a complex connection between pain and cognition. Pain plays an intricate role in cognitive functions, including attention, memory, processing, executive functioning, decision-making, and reaction time.
Common medical conditions that cause chronic pain include
- Arthritis
- Back pain (such as due to muscle strain, herniated discs, or degenerative conditions like spinal stenosis)
- Cancer-related pain
- Complex regional pain syndrome (CRPS)
- Degenerative disc disease
- Fibromyalgia
- Irritable bowel syndrome (IBS)
- Migraines or headaches
- Neuropathic pain (from conditions like diabetes (diabetic neuropathy) or multiple sclerosis
- Pelvic pain: Chronic pain in the pelvic region, often associated with conditions such as endometriosis, interstitial cystitis, or chronic prostatitis.
- Sciatica
For a free legal consultation, call (800) 562-9830
How Can I Get Disability Benefits for Chronic Pain?
You may be eligible for disability benefits for chronic pain from the following sources:
- The Social Security Administration (SSA)
- The U.S. Department of Veterans Affairs (VA)
- Long-term disability insurance benefits sold by insurance companies.
Depending on which agency is dispensing disability funds, the classification and definition of chronic pain vary.
- The SSA and the VA are government programs that offer disability benefits to qualified individuals and their families. The requirements for receiving benefits from each agency are very different, each having its own definitions and criteria:
- You cannot get Social Security disability benefits for a chronic pain diagnosis, because SSA does not consider chronic pain an actual medical diagnosis. However, SSA will pay disability benefits if you prove that another underlying medical condition causes your chronic pain symptoms.
- The VA provides disability benefits for chronic pain related to military service. The VA does not have a diagnostic code for chronic pain; however, it does provide benefits to veterans who suffer from it. As with any veteran’s disability claim, a service connection must be established.
- Long-term disability (LTD) insurance benefits protect your income if you become disabled and can’t work, and generally fall under two categories: Group long-term disability insurance and individual, or private, long-term disability insurance.
- Group disability insurance: your employer may sponsor long-term disability insurance coverage under a group disability plan (governed by federal ERISA law), or
- Private disability insurance: you purchased an individual, or private, disability insurance policy from an insurance agent. These policies are typically regulated under state contract law.
As you set out to obtain disability benefits for chronic pain, it’s essential to (1) know how chronic pain fits into each agency’s established definitions, and (2) understand thoroughly all the information they’ll need from you, and proceed from there.
The experienced legal team at Marc Whitehead & Associates is intimately familiar with the laws governing disability insurance and government-sponsored disability benefit programs. We understand your hardship and know this is no time for you to have to fight against your insurance company, or get lost in the appeals process with Social Security or the VA.
Social Security Disability Benefits for Chronic Pain
Chronic pain is not listed as a disabling medical condition in the SSA’s Listing of Impairments.
Nevertheless, the SSA will treat chronic pain as a symptom of an underlying medical condition that is in the Listing of Impairments. According to SSA rules, your medical evidence must establish that your condition has caused functional limitations for at least 12 months.
Conditions included in SSA’s listing that may cause chronic pain include:
- Certain cancers − chronic pain may result from tumors, spinal cord compression, bone pain, peripheral neuropathy, or side effects of chemotherapy and other cancer treatments.
- Neurological disorders − medical conditions affecting the nervous system, including the brain, spinal cord, and nerves)
- Back and spinal injuries
- Sympathetic Dystrophy Syndrome/Complex Regional Pain Syndrome (RSDS/CRPS)
- Inflammatory arthritis
- Chronic kidney failure or renal disease
- Inflammatory bowel disease (IBD)
- Mental impairments − if chronic pain leads to a listed mental disorder, such as depression or anxiety, and significantly impairs your ability to work, you may be eligible for disability benefits.
- Somatoform disorders − mental disorders where patients experience pain that can’t be linked to any physical cause.
SSA examines claims for chronic pain by comparing them with any relevant SSA listing to see if the underlying condition and the chronic pain are the “medical equivalent” of a listed impairment.
What does the medical equivalent mean? SSA’s Program Operations Manual System states:
An impairment(s) is medically equal to a listed impairment in the Listing of Impairments (Listings) if it is at least equal in severity and duration to the criteria of any listed impairment.
Note! To win Social Security Disability benefits for chronic pain, a statement about chronic pain alone is not enough. There must be objective medical evidence that shows an underlying medical condition that can reasonably cause your pain and substantially limit your ability to work.
What if My Underlying Condition Does Not Meet a Specific Listing?
You can still qualify for SSDI if your condition, combined with other impairments, prevents you from performing past work or any other work in the national economy. This evaluation considers your residual functional capacity (RFC), as described below.
Residual Functional Capacity Assessment in SSDI Claims based on Chronic Pain
According to SSA guidelines, RFC determines what you are still able to do despite any physical or mental limitations. It evaluates your ability to perform work-related activities, which is essential for determining your eligibility for disability benefits due to chronic pain.
Our goal is to show the SSA that your chronic pain symptoms significantly limit your ability to function, making it impossible for you to engage in what SSA calls “substantial gainful activity.” We provide a practical analysis that demonstrates that, although you want and try to work, your chronic pain prevents you from holding any full-time employment.
SSDI claims examiners and judges also look for proof of your claim’s credibility.
Our Social Security disability claims attorneys and legal staff will compile and document your physician’s statements, prepare a coherent employment history plus a history of work attempts, assemble all relevant medical records and treatment history, and document your ongoing efforts to seek treatment, including your adherence to medication.
Our attorneys are skilled at providing the evidence needed during the administrative review process. We have often helped Administrative Law Judges and adjudicators at the Appeals Council better understand the complexities of disability related to chronic pain.
Winning Long-Term Disability Insurance Benefits for Chronic Pain
Are you in the early stages of filing your claim? Bringing an experienced disability lawyer in during your initial application for long-term disability benefits can significantly influence the outcome of your case. We will assist you in filing your claim from start to finish.
If your insurance company has denied your claim, our proven process for appealing wrongful LTD denials will improve your chances of securing the maximum benefits. Our long-term disability lawyers will develop a personalized strategy designed to address every point of the insurer’s denial.
- Individual Disability Claims: If your private disability insurance claim is denied, the policy is a personal contract between you and the insurer, making it subject to state contract laws. We will assist you in pursuing a breach of contract, bad faith litigation, or other insurance code violations in state court under state insurance law.
- Group Disability Claims: If your group disability insurance claim is denied, your appeal of the denial falls under strict federal law known as the Employee Retirement Income Security Act of 1974 (ERISA). Our firm will help you with every aspect of your denied claim under a group plan.
Our compassionate and experienced legal team will support you throughout the entire process, managing the specific and ongoing elements of your claim. We have also established a carefully chosen network of medical, vocational, and economic experts to assist our lawyers as needed.
My Insurance Company Denied My Claim for Chronic Pain Disability. Can They Get Away with It?
Disability insurance companies are profit-driven corporations. They handle thousands of claims annually, often denying valid disability claims to save costs and increase profits. Insurers use various tactics to deny claims, hoping the claimant will give up. Marc Whitehead & Associates can assist you in these cases.
When skilled legal counsel properly represents you, you often find that you’ll be treated much better by your insurance provider. At Marc Whitehead & Associates, our reputation among insurance companies as successful litigators is an asset to our clients, as the insurers often seek favorable resolutions early in the process.
Don’t guess your way through your long-term disability claim application or appeal. Wrongful claim denials have gone on for decades, and our law firm has taken on every major disability insurance company in the country. We welcome your call today.
Veterans in Need of Chronic Pain Disability Benefits
The VA defines pain as chronic if it lasts six months or more. Many veterans live with chronic pain, often for years or decades after active service. Chronic pain is frequently misunderstood and underrated within the VA disability program.
The VA recognizes chronic pain as a valid condition; however, the VA does not have a specific diagnostic code for chronic pain by which it assigns a VA rating. Rather, veterans are rated based on the underlying condition causing the pain, such as specific nerve, joint, or back pain.
The key to getting VA disability for chronic pain is proving a service connection and a functional impairment from the pain.
This means you must establish the link between your military service and the pain, and then document how that pain significantly affects your daily life, work, and overall functional ability.
A disability is considered service-connected if:
- You can prove it occurred as the result of injuries or sickness that you had while serving in the armed forces;
- Service connection can involve a condition you had before service that was made worse by the rigors of active duty;
- Conditions can also be established as “secondary” to a service-connected illness or disease.
- You must establish a nexus (medical link) between the in-service event and the current condition.
Demonstrating your functional impairment to the VA requires thorough evidence, including service records, medical records, a physician’s opinion letter (a nexus letter), lay evidence, and keeping a pain journal. It will likely involve a VA Compensation & Pension exam.
VA will establish the rating and resulting disability benefits for chronic pain based on your symptoms and limitations that arise from your pain. VA ratings for chronic pain range from 10% to 100% depending on the severity and impact on daily life.
If the VA denied your claim for chronic pain disability, there are several ways to continue your case and seek benefits. The three VA appeal options include:
- Supplemental Claim (if you have new, relevant evidence)
- Higher-Level Review (if there is an error regarding the decision)
- Appeal to the Board of Veterans Appeals (BVA)
If you are a veteran struggling with chronic pain, contact Marc Whitehead & Associates for a free consultation without delay. You can reach us toll-free at 800-562-9830. We’ll review your entire claim history and determine the most effective path towards getting the VA disability benefits you deserve.
The Accredited Veterans Claims attorneys at Marc Whitehead & Associates have the experience and skills to help you establish the reality of your disability, and we can fight for you at every step in the VA disability appeals process.
Attorneys for Disability Benefits for Chronic Pain
Whether you’ve been denied disability benefits or you’re just now filing, the right legal guidance can make a difference in your case. Learn more about how we help you prove your claim for chronic pain.
