man with chronic back pain
By Michelle Shvarts
Principal Attorney

Navigating the Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) application process can be challenging, particularly when it comes to chronic pain cases. Disability Advocates Group understands the unique struggles individuals in Florida face when seeking SSDI or SSI benefits due to chronic pain. In this blog post, we will explore common reasons for denials in such cases and unveil effective strategies to overturn these decisions. If you’re grappling with a denial, know that you’re not alone, and there is hope for a successful appeal.

Understanding Chronic Pain in SSDI and SSI Claims:

Chronic pain is a complex and often debilitating condition that affects millions of Americans. It can result from various underlying medical conditions, such as arthritis, fibromyalgia, or nerve damage. However, the subjective nature of pain makes it challenging to prove and, consequently, challenging to secure SSDI or SSI benefits.

Common Reasons for Denial:

1. Insufficient Medical Evidence: The Achilles’ Heel

One of the primary reasons for SSDI or SSI denials in chronic pain cases is often insufficient medical evidence. Disability Advocates Group stresses the importance of comprehensive documentation, including medical records, diagnostic tests, and statements from healthcare professionals that establish the existence and severity of the chronic pain.

2. Failure to Meet Listing Criteria: Addressing the Details

The Social Security Administration (SSA) has specific criteria, known as Listings, that outline the requirements for proving disability due to chronic pain. Failure to meet these criteria is a common cause of denials. Disability Advocates Group recommends a meticulous review of the Listings to ensure that all necessary elements are addressed in your application or appeal.

3. Inconsistent Statements: Building Credibility

Consistency in statements is crucial when presenting a chronic pain case. Discrepancies between your statements, medical records, and other evidence can raise doubts about the legitimacy of your claim. Disability Advocates Group emphasizes the importance of honest and detailed communication to build credibility and strengthen your case.

4. Failure to Follow Prescribed Treatment: Demonstrating Compliance

If the SSA determines that you have not followed the prescribed treatment for your chronic pain without a valid reason, it can lead to a denial. Disability Advocates Group advises clients to carefully document their compliance with treatment plans and, if there are reasons for non-compliance, provide clear explanations supported by medical evidence.

5. Inadequate Work History: Establishing Eligibility

SSDI benefits are contingent on having a sufficient work history and contributing to Social Security through payroll taxes. If an individual lacks the required work credits, they may be ineligible for SSDI. Disability Advocates Group encourages clients to verify their work history and explore alternative options, such as SSI, if SSDI is not viable.

Strategies for Success:

1. Comprehensive Medical Documentation: The Bedrock of Your Case

Disability Advocates Group emphasizes the importance of thorough medical documentation to support your chronic pain claim. This includes detailed records from healthcare professionals, diagnostic test results, and treatment history. Ensuring that your medical evidence aligns with the SSA’s criteria is essential for a successful appeal.

2. Pain Journals: Putting Your Experience into Words

Keeping a pain journal can provide a powerful and personal account of your daily struggles. Documenting the intensity, frequency, and impact of your chronic pain on your ability to perform daily activities can offer compelling evidence. Disability Advocates Group advises clients to be consistent and honest in their journal entries.

3. Expert Medical Opinions: Strengthening Your Case

Securing expert opinions from medical professionals who specialize in chronic pain can significantly bolster your claim. Disability Advocates Group collaborates with experienced medical experts to provide thorough assessments that align with the SSA’s criteria, reinforcing the legitimacy of your disability.

4. Legal Representation: Navigating the Appeals Process

Disability Advocates Group recognizes that the appeals process can be daunting. Seeking legal representation ensures that your case is handled with expertise and care. An experienced disability lawyer can guide you through the complexities of the appeals process, increasing your chances of a favorable outcome.

5. Testimonials and Statements: Adding a Personal Touch

Statements from friends, family, and coworkers can offer additional perspectives on how chronic pain impacts your daily life and ability to work. Disability Advocates Group encourages clients to gather testimonials that provide insight into the challenges they face, contributing to a more comprehensive narrative.

If you’ve faced a denial for SSDI or SSI benefits due to chronic pain in Florida, know that there are strategies to overcome these setbacks. The knowledgeable Social Security Disability attorneys at Disability Advocates Group are dedicated to helping individuals throughout Florida navigate the intricacies of the appeals process and secure the benefits they deserve. By focusing on comprehensive medical documentation, leveraging expert opinions, and seeking legal representation, you can enhance your chances of success. Your journey is unique, and Disability Advocates Group is here to be your ally.  Whether you live in Fort Myers or St. Petersburg, we will advocate for your rights and ensure that your chronic pain claim is presented with the utmost professionalism and diligence.

About the Author
Ms. Shvarts and the rest of the team at Disability Advocates Group are dedicated to assisting individuals in Florida obtain Social Security Disability Benefits (SSDI) and Supplemental Security Income (SSI) benefits.