Opioid Pain Medication and Disability Benefits: What to Know

Living with chronic pain is a reality for more than 50 million U.S. adults, according to the National Health Interview Survey. That’s more than diabetes, heart disease, and cancer — combined. And for many of them, the pain is so bad it limits their ability to work. Researchers at the National Bureau of Economic Research found that chronic pain is one of the top reasons for work disability and a primary reason for seeking Social Security disability benefits. If you’re one of these people, you may use opioid pain medication to help you manage. To make your life a little easier, we gathered the information you need to know about pain medication and disability.

What SSA Policy Says About Pain Medication and Disability Claims

Since opioids are highly addictive and people abuse them often, the Social Security Administration (SSA) requires staff to evaluate claims to identify potential substance use disorders. If they determine you might work again if you stopped taking your medication, then they can deny your claim. Disability Determination Services (DDS) in your state must document their claim denial rationale in your case. That way, other reviewers can understand the prior decision regarding your current pain medication and disability claim.

U.S. Pain Foundation data shows claim reviewers issue technical denials in about 30% of SSD claims for chronic pain. However, a study by the U.S. Government Accountability Office found those denials happened regularly without a complete evaluation.

According to the report, “staff in five of the six offices GAO visited in three states were confused about when to evaluate substance use disorders, and nine of 15 case files that GAO reviewed in which an evaluation was conducted did not have a documented rationale.” That means they denied more than half of disability claims without proper consideration!

IMPORTANT: While the SSA implements GAO recommendations to improve the disability claims process, they still deny many people benefits in error. Get a free consultation with a Social Security attorney to find out when you should appeal your pain medication and disability denial.

Does Opioid Use or Pain Medication Dependency Qualify as a Disability?

Substance use disorders or addiction alone cannot qualify you for Social Security disability benefits. However, the SSA won’t automatically deny your claim if you have a history of substance abuse. They also cannot reject your application if you take opioid pain medication exactly as your doctor prescribes.

Learn more about addiction and disability benefits.

Facts About Pain Medication and Disability Claims

Opioid pain medications can interfere with your ability to do your job. The SSA is more likely to approve your pain medication and disability claim if you have a documented medical condition.

REMINDER: If either of the following is true, then the SSA will automatically deny your pain medication and disability claim:

• You are not taking legally prescribed drugs exactly as your doctor directs for a documented medical condition.
• You could return to work again if you completely stopped taking any opioids or other pain meds.

The Role Opioid Side Effects Play in Disability Claim Reviews

Opioids can seriously impair your ability to do your job. According to the National Institute on Drug Abuse, the most common side effects from taking pain medications are as follows:

• Drowsiness
• Confusion
• Nausea
• Constipation
• Euphoria
• Slowed breathing
• Short- and long-term psychological and neurological issues

Several court cases found that disability claims administrators must consider medication side effects when reviewing SSD claims.

So, if one of them fails to factor this in, then it’s possible to reverse your denial when you appeal.

One recent court case to address this issue is Quezada v. Lincoln Life Assurance Company of Boston. Mr. Quezada took an opioid pain medication four times per day to treat lower back and hip pain. The side effects forced him to leave his warehouse job. Mr. Quezada’s application for disability benefits failed, so he filed suit against the insurer in district court. The court ruled that his health plan didn’t consider the mental and cognitive effects from his pain medication. Ultimately, a judge overturned Mr. Quezada’s pain medication and disability claim’s denial to award him benefits.

Additionally, drug side effects can sometimes help strengthen your case when it comes to your underlying medical condition. The theory is, nobody would choose to live with issues like confusion or constipation unless their pain is truly severe.

What’s more, lawyers in the past successfully tried this theory out in court and won. In the Carradine v. Barnhart decision, the judge noted how unlikely it was that Ms. Carradine would have endured the harmful side effects of opioids and treatment just to make her chronic pain complaints more believable to the SSA. Her willingness to live with the daily impacts of opioid drug use simply reinforced her case. Thankfully, Ms. Carradine had an experienced attorney.

Medical Evidence That Helps Support Your Pain Medication and Disability Claim

The key to making a successful claim is proper documentation. The more you can show that the medication is related to your underlying condition, prescribed by your doctor, and taken as directed, the better your chances of securing monthly benefits.

According to the U.S. Code of Federal Regulations, you need to provide evidence that shows how:

1. Your condition “could reasonably be expected to produce … pain or other symptoms” of a certain level of intensity and persistence. To decide how your symptoms affect your ability to work, the SSA looks at your medical history, medical records and test results, and statements about how your symptoms impact your job tasks.
2. A “medically determinable impairment” caused pain and other symptoms severe enough to keep you from working. The results of clinical or laboratory diagnostic tests must show the anatomical, physiological, or psychological issues that produce your pain and other symptoms.
3. The intensity and persistence of your pain seriously affects your ability to work. SSA staff will look at information from medical professionals and others to understand your pain’s impact on your daily life and work.

The SSA relies on two kinds of evidence: objective medical evidence and subjective information from you and other sources.

Objective Medical Evidence

Most of the SSA evaluation depends on objective medical evidence. Information from medically acceptable clinical and laboratory diagnostic tests are just a few examples. This can include the verified presence of a reduced range of motion or joint function, muscle spasms, and sensory deficit or motor disruption.

A key document in making your pain medication and disability case is called the Residual Functional Capacity Form:

This form includes the evidence that your pain makes it impossible for you to work for at least 12 months. It shows what you can and cannot do, and specifically because of your pain and underlying condition. This helps the SSA determine if you can perform certain work tasks or cannot maintain gainful employment for at least one year.

IMPORTANT: Your doctor must complete this form with you.

Subjective Evidence From Yourself and Other Credible Sources

Those same regulations are careful to point out, however, that the SSA “will not reject your statements about the intensity and persistence of your pain or other symptoms or about the effect your symptoms have on your ability to work solely because the available objective medical evidence does not substantiate your statements.”

That’s why you should track your symptoms, how they interfere with daily tasks, and your ability to earn a living.

The best way to do that is with a symptom tracker called a pain diary. It helps you chart important information, such as:

• Describe your pain, where in the body it occurs, and the approximate time and date.
• How long your symptoms last and what circumstances seem to trigger them.
• How those symptoms limit your ability to do daily activities, both at home and at work.
• When your job reduced your hours, or if you recently quit working because of your condition.
• Which of your symptoms are strictly medication side effects vs. those resulting from your diagnosed medical condition.
• What medications you take, how often, your dosage, and what you notice about how each drug affects you.
• Whether you think your pain medication is helping manage your condition.

PRO TIP: Ask your care team or caseworker for a printed or digital diary to fill out. If they don’t have one, there are many free templates available online.

Pain Medication and Disability Applications: Statistics and Outcomes

According to U.S. Pain Foundation estimates, 36 million people miss work every year because of a pain-related condition. Almost 2 million seek monthly Social Security disability benefits.

The NBER researchers found that opioid use among people applying for SSD dropped from 33% in 2013 to 24% in 2018, regardless of age, sex, and education. That’s even though the number of applicants reporting musculoskeletal issues that cause chronic pain did not change. Areas with the most opioid prescriptions (or smaller drops in use) had more Social Security disability applications in general. These areas also filed more disability claims that mentioned opioid use.

Take Opioids or Other Drugs for Chronic Pain? Talk to a Disability Attorney for Free Before You File Your Claim

A skilled disability attorney makes sure you have the right evidence to support your claim beyond your dependency on opioids. Without one, it’s a lot harder to get benefits — no matter what kind of health problem you have. In fact, your pain medication and disability claim’s nearly 3 times more likely to pay you benefits within 6 months!

Ready to see if you may qualify? Click the button below to start your free online benefits quiz now:

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