Serving Central California Since 1995

Question: I am a 57-year-old woman with chronic pain. I have had a broken shoulder that is poorly healed, herniated discs in the lumbar spine, joint pain and some neuropathy in my hands and feet from diabetes. This has been going on for more than 6 months. My doctors tell me I am not a candidate for surgery and have only offered opioid pain medication and physical therapy. I have not been able to work in 3 years. Now I am having problems with depression and anxiety. My memory is shot. I can’t remember simple things that were once a part of my daily routine. I’m tired all the time but at night I can’t sleep due to pain. Nobody believes me that I can no long work, especially my family. I have a hearing coming up for disability. How can I convince a Judge that I can’t work?

Ask the Advocate: The Social Security Administration has always had problems with any disease whose primary symptom is pain. Chronic Pain Syndrome is the most difficult to understand. Pain cannot be measured. It cannot be tested. There is no simple relationship between the underlying pathology and the amount of pain a person experiences.

Obviously, pain is the primary symptom. However, there are also psychological effects of pain as well. Chronic Pain Syndrome can have severe effects on a person’s ability to concentrate due to the side effects of depression. Depression produces difficulties in social interaction and quality of life.

While the evidence of severe underlying pathology helps in proving disability, the lack of evidence of severe underlying pathology does not mean that a person is not suffering severe pain. It is helpful if the person is undergoing psychiatric treatment or is going to a pain clinic. I would strongly suggest that you talk to your primary doctor for a referral to either mental health or pain management.

Before you talk to the Judge, make sure all of the medical evidence is in the file. At the hearing focus on social interaction and daily activities such as personal relationships and employment status. Talk about sleep issues especially sleep disturbance. Talk about the effects of your medications, particularly narcotic medications. If you have hypertension, make sure that it is well documented.

Social Security will look at the diagnosis and the opinions of your treating physicians to determine if your condition is severe enough to prevent ordinary work on a regular and sustained basis. A “regular and continuing basis” means 8 hours a day, for 5 days a week or an equivalent work schedule. The claimant must have both the mental and physical abilities to perform sustained work activities. When the evidence supports a finding that the claimant has had a substantial loss of ability to meet the demands of basic work-related activities on a sustained basis, the unskilled sedentary occupational base is significantly eroded, and a finding of disability is justified under the Social Security Rules.