Evaluation and proof of pain in a Florida Social Security disability claim

In my decades of pursuing Social Security disability benefits for Tampa Bay and other Florida residents, I have encountered claimants with widely varying levels of pain. How will a disability examiner view your pain?

Evaluation of pain in Florida Social Security disability cases

The Social Security Administration’s pain regulation contains this list of factors that will be considered when it evaluates pain:

• Your daily activities
• The location, duration, frequency, and intensity of your pain or other symptoms
• Precipitating and aggravating factors
• The type, dosage, effectiveness and side effects of any medication you take or have taken to alleviate your pain or other symptoms
• Treatment, other than medication, you receive or have received for relief of your pain or other symptoms
• Any measures you use or have used to relieve your pain or other symptoms (e.g., lying flat on your back, standing for 15 to 20 minutes every hour, sleeping on a board, etc.) and
• Other factors concerning your functional limitations and restrictions due to pain or other symptoms.

Evidence of pain

Although a Social Security disability decision-maker must consider all evidence in assessing your residual functional capacity, one of the Social Security Administration’s rulings provides a list of 11 factors for the adjudicator to consider:

1. Medical history
2. Medical signs and laboratory findings
3. The effects of treatment, including limitations or restrictions imposed by the mechanics of treatment (e.g., frequency of treatment, duration, disruption to routine, side effects of medication)
4. Reports of daily activities
5. Lay evidence;
6. Recorded observations
7. Medical source statements
8. Effects of symptoms, including pain, that are reasonably attributed to a medically determinable impairment
9. Evidence from attempts to work
10. Need for structured living environment, and
11. Work evaluations, if available

Testimony of pain

To accurately portray your pain in a Social Security disability hearing, I will ask you to detail your pain, the medication you take for it, any treatment other than medication, your functional restrictions, and your daily activities:

Description

1. Tell us about the pain in your [part of body affected].
2. What happened to cause you to have this pain?
3. How long have you had the pain?
4. Has there been any significant period since it started that the pain was in remission?

• What caused the period of remission, e.g., medication, surgery, physical therapy, etc.?
• How long did the remission last?

5. What does the pain feel like?
6. Is it tender to touch?
7. Does it limit the amount you can bend the affected joint? How much?
8. Is the quality of the pain always the same or is it sometimes different? If so, how and when is it different?
9. Show us where this pain is located. [Attorney then states, for example, “Let the record reflect that the claimant is pointing to his low back at the beltline.”]
10. Is this pain constant or does it come and go?
11. If it comes and goes:

• How often does it come?
• How long does it last?
• How many hours per day/days per month do you have this pain?
• What sorts of things bring on this pain?
• What relieves it?

12. Do you have muscle spasms?
13. How severe is your pain? If we use a ten-point scale with ten being the most severe pain you’ve ever had, how would you rank the pain you’ve been telling us about?
14. Is it always of the same intensity? If not, how often is it at each intensity?
15. What increases the intensity of your pain?

• Is it affected by movement, activity, staying in one position, environmental conditions or stress?

16. Does the pain ever radiate, such as going down one of your legs? If so:

• Which leg?
• What route does it travel? Be specific.
• What does it feel like when it goes down your leg?
• How often does this happen?

17. Is there any numbness or pins-and-needles feeling associated with this pain?
18. Are there any other symptoms associated with this pain, such as redness, swelling, heat, stiffness, crepitus (crackling noise heard when joint moves), muscle weakness, muscle atrophy, fatigue, appetite loss, weight loss?

Treatment

1. How often do you see your doctor?

• What does your doctor do for you?

2. How is the pain affected by medication?

• Do you have side effects from pain medication such as drowsiness, dizziness, lack of concentration, slow reflexes, nausea?

3. What treatment other than medication have you tried, such as transcutaneous nerve stimulator (TENS unit), physical therapy, massage, “back school” (training in back exercises and mechanics), bio-feedback, hypnosis, psychological therapy, chiropractic manipulation, acupuncture, Hubbard tank, traction, exercises, injections, pain clinic?

• How much have these things helped?

4. What home remedies have you tried, such as hot baths, heating pads, ointments?

• How much have these things helped?

5. Is the pain helped by limiting your activities, lying down, shifting positions frequently, sitting in a special chair, etc.?

Resulting restrictions

• How has this pain affected your life?
• Do you use assistive devices? (For example, cane, brace, cervical collar, special door handles, gripping devices, bathtub or shower bars, special chair.)
• Are your daily activities affected (including relationship with others, sleep, hobbies, etc.)?
• Are you irritable, depressed, worried, anxious, have difficulty concentrating, or remembering?
• How has the pain affected your capacity for work?

Tampa Bay and other Florida residents who have questions about how their pain affects their eligibility for Social Security disability benefits may contact my office for answers.
E-mail or 866-655-3136.