Chronic pain can affect nearly every aspect of a person’s life. Persistent pain may interfere with sleep, concentration, mobility, employment, relationships, and everyday activities. For some, chronic pain is also accompanied by depression, anxiety, fatigue, or other symptoms that can make functioning even more difficult.
For veterans, establishing a connection between chronic pain and military service may be an important step toward obtaining VA disability compensation. If chronic pain or the condition causing it prevents you from maintaining substantial work activity, you may also qualify for Social Security Disability Insurance (SSDI), provided you meet Social Security’s separate eligibility requirements.
One important point is often misunderstood: the VA does not have a single diagnostic code that automatically assigns a disability percentage for chronic pain. Instead, the VA evaluates the diagnosed condition or conditions and the functional impairment associated with them.
What Is Chronic Pain?
Chronic pain generally refers to persistent pain, usually lasting over three months, accompanied by significant physical, psychological, or social effects that interfere with a person’s functioning and quality of life. Unlike acute pain, which usually serves as a warning of a recent injury or illness and improves as the underlying problem heals, chronic pain can continue long after the original injury or illness.
Chronic pain may affect virtually any part of the body. It can result from an identifiable injury or disease, or it may persist even after the original injury has healed.
Chronic pain can also be associated with:
- Sleep disturbances;
- Fatigue;
- Difficulty concentrating;
- Reduced physical activity;
- Anxiety;
- Depression;
- Irritability;
- Difficulty performing household activities;
- Reduced ability to work; and
- Withdrawal from social or recreational activities.
Is Chronic Pain a Disability?
It can be. But a diagnosis of chronic pain does not automatically establish entitlement to VA disability compensation or SSDI.
For VA purposes, the important question is whether there is a current disability and whether the evidence establishes the required connection to military service. The VA explains that an initial disability claim generally requires evidence of a current physical or mental disability, an in-service event, injury, or disease, and a link between the current disability and service.
Like the VA, the Social Security Administration (SSA) does not award Social Security Disability Insurance (SSDI) benefits based on pain alone. To qualify, you generally must show a medically determinable impairment, such as a spinal disorder, arthritis, neuropathy, fibromyalgia, or complex regional pain syndrome, supported by medical evidence. You must also demonstrate that your condition and resulting limitations prevent you from working full time.
Types of Chronic Pain Conditions That Qualify for SSDI
There is no single list of “chronic pain conditions” that automatically qualifies someone for SSDI. Social Security evaluates whether a medically determinable impairment, or a combination of impairments, prevents the claimant from performing substantial gainful activity and meets the applicable duration requirement.
Depending on the evidence, chronic pain may be associated with conditions such as:
- Fibromyalgia;
- Complex Regional Pain Syndrome (CRPS);
- Severe spinal disorders;
- Neuropathy and other neurological disorders;
- Arthritis and other inflammatory conditions;
- Major joint disorders;
- Musculoskeletal injuries;
- Certain headache disorders;
- Chronic pain associated with serious organ or systemic disease; and
- Mental health disorders associated with or contributing to functional limitations.
The applicable Social Security Listing depends on the underlying impairment. For example, Social Security’s musculoskeletal listings address certain disorders of the spine and major joints and specifically recognize pain as a potential contributor to functional loss.
A diagnosis by itself, however, is not enough to satisfy a Listing. Social Security requires the medical findings and other criteria specified by the applicable Listing.
What If Your Condition Does Not Meet a Social Security Listing Exactly?
Even if your condition does not fit a listing exactly, SSA considers whether your impairment or combined impairments are medically equivalent in severity and duration to a listed impairment. Federal regulations specifically provide for medical equivalence when an impairment does not meet a Listing or when multiple impairments, considered together, have a severity equivalent to a Listing.
If the impairment does not meet or medically equal a Listing, Social Security can still evaluate the claimant’s residual functional capacity (RFC) and determine whether the person can perform past relevant work or adjust to other work.
Social Security also considers symptoms such as pain when determining the effects of a medically determinable impairment. Pain alone does not establish disability, but when supported by a medically determinable impairment, its effects can be relevant to the claimant’s functional capacity.
VA Rating Code for Chronic Pain
There is no single VA diagnostic code titled “chronic pain” that automatically determines a veteran’s disability percentage.
Instead, the appropriate evaluation depends on the disability being claimed, the symptoms and functional limitations it produces, and the evidence supporting the claim.
Chronic Pain Claims Require More Than a Pain Score
Chronic pain has profound physical, emotional, and occupational consequences. For veterans, the absence of a single VA diagnostic code for “chronic pain” does not mean that chronic pain cannot support a disability claim.
The Federal Circuit’s decision in Saunders v. Wilkie is particularly important because it recognizes that pain can constitute a disability when it results in functional impairment affecting earning capacity. The key is to document that impairment and establish the required relationship to military service.
Saunders v. Wilkie and VA Chronic Pain Claims
In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit addressed whether pain, without an accompanying diagnosed condition, could constitute a disability for VA purposes.
The decision rejected the idea that a veteran must always identify a separate underlying diagnosis before pain can qualify as a disability. When pain causes functional impairment that affects earning capacity, it can satisfy the disability requirement.
Veterans pursuing a chronic pain claim should therefore carefully document functional impairment. Evidence may include limitations involving standing, walking, sitting, lifting, bending, concentrating, sleeping, completing household tasks, or maintaining employment.
For SSDI, chronic pain may also support a disability claim when it results from a medically determinable impairment and prevents substantial gainful activity for the required duration. A condition does not necessarily have to match a listing word-for-word; Social Security also considers medical equivalence, combinations of impairments, and residual functional capacity.
Physical Conditions Causing Chronic Pain
If chronic pain results from a service-connected physical condition, the VA may evaluate the underlying condition under the diagnostic code applicable to that disability.
Examples can include:
- Back and neck conditions;
- Arthritis;
- Joint injuries;
- Nerve conditions;
- Radiculopathy;
- Fibromyalgia;
- Residuals of traumatic injuries; and
- Other musculoskeletal or neurological conditions.
The applicable rating criteria depend on the specific disability and the evidence demonstrating its severity.
Mental Health Conditions Associated With Chronic Pain
Chronic pain can also contribute to depression, anxiety, or other mental health conditions.
If a veteran has a separately diagnosed mental health condition that is related to military service or is caused or aggravated by a service-connected disability, that condition may potentially be service connected and rated under VA’s General Rating Formula for Mental Disorders.
For example, Diagnostic Code 9434 applies to major depressive disorder. The rating schedule evaluates mental disorders according to the resulting level of occupational and social impairment. The important issue is the actual diagnosis and resulting impairment—not simply the fact that a veteran experiences chronic pain.
Symptoms of Chronic Pain
Symptoms vary depending on the underlying condition and the individual. Common symptoms of chronic pain can include:
- Persistent or recurring pain;
- Burning, aching, stabbing, throbbing, or shooting pain;
- Increased sensitivity to touch;
- Muscle weakness or reduced range of motion;
- Numbness or tingling;
- Fatigue;
- Sleep problems;
- Difficulty concentrating;
- Anxiety or depression;
- Irritability;
- Reduced mobility;
- Difficulty sitting or standing for extended periods;
- Difficulty lifting, carrying, bending, or reaching; and
- Difficulty completing ordinary daily activities.
For a disability claim, it is especially important to document how these symptoms affect functioning.
A veteran who experiences pain every day may have learned to live with it and may unintentionally minimize its effects when speaking with a healthcare provider or examiner. Instead of simply reporting that pain is “bad,” explain the impact of the pain on your everyday life.
For example: How long can you sit? How long can you stand? How far can you walk? How often do you need to lie down? Does pain interrupt your sleep? Do medications affect your concentration? Can you perform household chores without taking breaks?
These details can help create a more complete record of functional impairment.
What Causes Chronic Pain?
Chronic pain can have many causes. Some common causes include:
- Traumatic injuries;
- Back and neck injuries;
- Arthritis;
- Nerve damage;
- Neuropathy;
- Fibromyalgia;
- Complex Regional Pain Syndrome;
- Headaches and migraines;
- Joint disorders;
- Surgical complications;
- Autoimmune or inflammatory conditions; and
- Other chronic illnesses.
Sometimes the original injury or illness is readily identifiable. In other cases, pain continues even after the original condition has healed, or multiple conditions contribute to the person’s symptoms.
How to Treat Chronic Pain
Treatment depends on the cause, severity, and individual circumstances. Chronic pain is often managed through a combination of approaches rather than one treatment.
Depending on the condition, treatment may include:
- Physical therapy;
- Occupational therapy;
- Exercise or movement programs;
- Medications;
- Behavioral health treatment;
- Pain-management programs;
- Nerve blocks or other interventional procedures;
- Treatment for sleep problems;
- Treatment for depression or anxiety associated with chronic pain; and
- Other procedures or therapies recommended by a qualified healthcare provider.
Those suffering from chronic pain should discuss treatment options with their healthcare providers and follow an appropriate treatment plan. Treatment records can also provide important evidence of the persistence and severity of a disability.
A lack of successful treatment does not necessarily mean a condition is not disabling. Some chronic pain conditions remain symptomatic despite treatment.
How Chronic Pain Can Affect Your Ability to Work
For both VA and Social Security claims, the functional effects of chronic pain can be extremely important, although the legal standards are different.
Chronic pain may affect the ability to:
- Sit for prolonged periods;
- Stand or walk;
- Lift and carry objects;
- Bend, stoop, kneel, or climb;
- Use the hands or arms;
- Maintain concentration;
- Maintain a regular schedule;
- Sleep consistently;
- Complete tasks without unscheduled breaks;
- Maintain an acceptable pace;
- Attend work consistently; or
- Perform full-time work on a sustained basis.
For SSDI, Social Security ultimately considers whether the claimant’s impairments prevent substantial gainful activity for the required duration. The impairment must be expected to last at least 12 months or result in death.
Steps to Prove Your VA Disability Claim for Chronic Pain
Proving a VA claim for chronic pain requires evidence addressing both the disability and its relationship to military service.
1. Obtain a Thorough Medical Diagnosis
The first step is to obtain appropriate medical evaluation.
Your medical records should document the nature of your condition, the symptoms you experience, the treatment you have received, and the functional limitations caused by the condition. If you have an underlying condition causing chronic pain, that condition should be properly documented as well.
2. Establish the Connection to Military Service
A VA claim may involve direct service connection when the condition is related to an injury, disease, or event during service.
Evidence may include:
- Service treatment records;
- Military medical records;
- Personnel records;
- Documentation of an in-service injury;
- Medical records shortly after discharge;
- Current treatment records;
- Medical opinions; and
- Lay or buddy statements.
VA explains that an original service-connection claim generally requires evidence of a current disability, an in-service event, injury, or disease, and a link between the current condition and service.
3. Consider Secondary Service Connection
Chronic pain may also be related to another disability that VA has already determined is service connected.
For example, a veteran may have a service-connected orthopedic injury and later develop another condition that is caused or aggravated by that disability. VA recognizes secondary claims for a new physical or mental condition linked to an already service-connected disability. Medical records or medical opinions may be particularly important in establishing that relationship.
4. Submit Lay Statements
Statements from people who know you can provide valuable information about observable symptoms and changes in your functioning.
Potential witnesses include:
- Spouses or other family members;
- Friends;
- Coworkers;
- Fellow service members; and
- Other people who have observed your symptoms.
VA specifically identifies supporting statements from family members, friends, and people who served with the veteran as potential evidence. The strongest statements generally provide specific examples rather than simply saying that the veteran is in pain.
5. Document the Impact on Daily Life
Keep track of how chronic pain affects your everyday activities.
Consider documenting:
- How long you can sit, stand, or walk;
- How frequently you need rest periods;
- Whether you need assistive devices;
- How pain affects sleep;
- Whether medication causes side effects;
- How often you miss work or medical appointments;
- Whether you have difficulty concentrating;
- Which household tasks you can no longer perform; and
- How your condition has changed over time.
This information can help demonstrate the functional impairment discussed in Saunders v. Wilkie.
6. Prepare for the C&P Examination
A Compensation & Pension (C&P) examination may be scheduled as part of the VA claims process. Be prepared to explain:
- Your diagnosis and medical history;
- When your symptoms began;
- How frequently symptoms occur;
- What treatment you have received;
- How treatment has affected your symptoms;
- Your worst symptoms and how often they occur;
- Your ability to perform physical activities; and
- How your condition affects employment and daily life.
Be accurate and consistent. Do not exaggerate your symptoms, but do not minimize them simply because you have become accustomed to living with chronic pain.
How to Apply for VA Disability Benefits for Chronic Pain
Veterans can file a VA disability compensation claim online, by mail, in person, by fax, or with assistance from an accredited representative. VA also allows veterans to submit supporting medical records and other evidence.
If you file online, VA explains that you generally do not need a separate Intent to File because the effective date is established when you begin completing the online application. If you are not ready to file a claim, an Intent to File may help preserve a potential effective date while you gather evidence.
After filing, veterans can continue providing relevant evidence. VA states that evidence may include medical records, test results, doctors’ reports, and supporting statements.
If VA schedules a C&P examination, it is important to attend the examination and provide an accurate description of your condition.
How to Apply for Social Security Disability Benefits for Chronic Pain
SSDI is a separate federal disability program administered by the Social Security Administration. Eligibility depends on Social Security’s requirements, including sufficient work credits and a disabling medical condition that prevents substantial gainful activity and is expected to last at least 12 months or result in death.
You can apply for disability benefits online through the Social Security Administration. If you cannot complete the application online, SSA also provides an option to apply by telephone and make an appointment.
When applying, be prepared to provide information about:
- Your medical conditions;
- Healthcare providers and treatment facilities;
- Medications and treatments;
- Medical testing;
- Symptoms and functional limitations;
- Work history;
- Education and training; and
- How your medical conditions affect your ability to work.
It is particularly important to explain the combined effect of all of your impairments. Social Security’s regulations require consideration of the combined impact of multiple impairments, even when no single impairment would be sufficiently severe on its own.
VA Disability and SSDI Are Separate Claims
Veterans should understand that VA disability compensation and SSDI use different legal standards. A VA rating does not automatically establish entitlement to SSDI, and an SSDI award does not automatically establish a particular VA disability rating.
However, medical records and other evidence developed for one claim may sometimes provide useful evidence for the other. Veterans should make sure the information in their claims is accurate and consistent and should identify all significant medical conditions and functional limitations.
Our VA Disability and SSDI Attorneys Are Here To Help
If you are seeking VA disability compensation or SSDI benefits because chronic pain prevents you from working or substantially limits your daily life, careful preparation can make an important difference. Medical records, service records, medical opinions, lay statements, treatment history, and detailed evidence of your functional limitations can help establish the full impact of your condition.
If you need assistance pursuing VA disability compensation or SSDI benefits for chronic pain, Kerr Robichaux & Carroll can help you understand your options and evaluate the evidence supporting your claim.
Contact us today to speak with a VA disability lawyer or a Social Security disability attorney by submitting an online form or calling our office at (503) 255-9092 for a free case evaluation.