Chronic pain can be debilitating and interfere with an individual’s normal day-to-day functioning. It is estimated that around 116 million adults in the USA suffer from chronic pain. Pain typically stems from an underlying cause such as fibromyalgia, arthritis, back problems, and inflammatory bowel disease among others. Often, chronic pain patients find it difficult to work even with treatment and care, and may need financial support in the form of disability benefits. The SSA (Social Security Administration)’s Blue Book does not list chronic pain as a disabling condition. So, eligibility determination may be made based on the medical problems included in their List of Impairments, which may be the cause of pain. Medical records and medical record analysis are therefore very important considerations in eligibility determination.
Medical Record Analysis Must Show Evidence of Pain and Its Possible Cause
To qualify for disability benefits with pain, the claimant will have to produce proof regarding the medical condition that is responsible for the pain. Lawyers representing clients with a chronic pain condition utilize medical review solutions to have a clear understanding of the particular underlying medical condition. This is essential when it comes to determining whether the claim is a valid one and preparing the case, if the claim is denied. On the part of the claimant, he/she has to focus on finding a doctor who understands the nature and impact of chronic pain. Only with a proper diagnosis from such a doctor and appropriate proof of treatment, can the claimant hope to receive SSD benefits.
In other words, the claimant or his/her attorney must show that he/she has a medically determinable mental or physical impairment (MDI) that is established by laboratory tests and objective symptoms.
- The claimant must have a diagnosis from a qualified medical professional.
- Produce results from lab tests, physical exams, and X-rays that demonstrate that there is a physical impairment causing the claimant’s symptoms.
- The claimant must show that the pain has lasted, or is expected to last for 12 months. This could necessitate repeated diagnoses from the treating physicians over a period of more than a year.
Among the various disorders listed in the SSA’s Blue Book are the following that could be the root cause of the claimant’s pain syndrome.
- Back injury
- Inflammatory arthritis
- Neurological disorders
- Somatic symptom and related disorders
- Inflammatory bowel disease
The claimant’s medical record must show evidence that he/she has a physical disability that could be reasonable expected to produce his/her symptoms. That is what the disability judge or claims examiner will be looking for. The claimant may be eligible for benefits also if the medical chart shows he/she has a mental impairment. For instance, psychological cause of pain such as a proper diagnosis of somatoform pain disorder (from a qualified medical doctor or psychiatrist) could meet the SSA’s requirement for a medically determinable impairment. The medical documentation should contain exam notes and opinions from the treating physicians, and various diagnostic test results.
Additional Disability Review Processes
Disability applications for pain may proceed through additional review processes such as residual functional capacity (RFC) analysis, reconsideration review, and appeal hearing.
- The RFC review requires the applicant to provide more details regarding how the pain syndrome affects his/her daily functioning including their ability to carry out routine tasks such as cooking, shopping, and housekeeping. The SSA will evaluate how the claimant’s symptoms affects his or her daily activities and ability to perform basic work activities. Among the factors they look for in the medical records are the following:
- Location, intensity, duration and frequency of the pain
- Medications prescribed to relieve pain and its side effects
- Factors that trigger the pain or intensify it
- Treatments used such as physical therapy or acupuncture, to reduce pain
- Other pain management techniques used
The SSA requires the claimant’s doctor’s opinion on his/her functional limitations and how long the pain is expected to limit the claimant’s abilities. They may send the claimant a form, the ADL (Activities of Daily Living) form, to review how the impairment affects the claimant’s ability to carry out common tasks like mowing the lawn, grocery shopping, dressing, and going to work.
- Only if the claim is denied initially, will the reconsideration review and appeal hearing processes happen. The claimant may have to file more paperwork and provide more documentation to establish the validity of the claim.
A Complete Medical Record Set Is Vital
It is clear that medical records are the deciding factor when it comes to getting disability benefits for chronic pain. Therefore, it makes perfect sense to continue collecting evidence and additional medical records even after submitting the disability application. The treating doctor should chart the claimant’s complaints of pain in his/her medical records. A medical chart showing continuous medical treatment is key to establish credibility for the claim. Copies of any new medical evidence and other documentation must also be forwarded to the SSA in a timely manner. Claimants represented by a social security disability attorney have a better chance of getting the disability benefits. Using the right medical review solutions, attorneys understand the medical facts clearly and then present the case in a convincing manner highlighting the genuineness of the claim and why it is important for their clients to receive the disability benefits.