Social Security Disability Benefits for Shoulder Pain

If you are suffering from debilitating shoulder pain, you may be eligible for Social Security disability benefits. The Social Security Administration (SSA) administers the Social Security Disability Insurance (SSDI) program. In order to be eligible for SSDI, you have to have worked enough to earn sufficient credits and to have paid enough taxes in to the SSA.

If you are approved for Social Security disability benefits, you may have certain dependents who are also eligible to receive benefits. These monthly benefits are designed to help compensate you so you can address your family’s needs because of your inability to work and earn a substantial monthly income. There are several things that can cause severe shoulder pain.

Many different injuries and medical conditions can cause problems that result in shoulder pain that can lead to disability. Chronic illnesses, degenerative disorders, joint injuries, joint diseases, nerve damage, compression issues, and many other things can lead to this debilitating pain that renders you unable to perform your daily tasks or work duties. In addition to the pain that is experienced with shoulder conditions, you may suffer from tingling, numbness, headaches, loss of movement, and loss of range of movement.

Shoulder pain can be so severe that it impacts your ability to handle your regular daily tasks, such as cooking, doing laundry, and dressing yourself. When your condition is that severe, you obviously cannot perform your regular work duties. You can be approved for disability in one of two ways. You can either meet the requirements of a listing in the Blue Book, which is the SSA's medical guide that contains a list of potentially disabling conditions, or by providing supporting documentation that shows you meet a medical-vocational allowance because of the severity of your symptoms.

The Cost of Treating Shoulder Pain

The cost of treating shoulder pain varies due to the cause of the pain. According to News Medical Life Sciences and Medicine, about 25 out of every 1,000 visits to the family doctor in the United States are related to shoulder pain. It results in about 13% of sick leaves and costs the American health system $7 billion per year.

According to the Burden of Musculoskeletal Diseases in the United States, the costs include prescriptions, doctor visits, x-rays and scans, and physical therapy. The average cost for shoulder pain treatment is $2,500 per person per year, but if you proceed with surgical intervention, such as rotator cuff surgery, the cost can increase into the thousands of dollars.

Is Shoulder Arthritis a Disability?

Yes, arthritis in the shoulder is a disability. If you can’t work and you meet a Blue Book listing, the SSA may consider you disabled. This medical condition comes under the Social Security Administration’s Blue Book listing 14.09. This covers inflammatory arthritis which is when you experience a persistent inflammation or persistent deformity of one or more key joints in the upper extremity of your body including your shoulders. You will need to provide medical documentation proving your inability to use your shoulders to sustain movement to the extent that you are unable to complete work-related activities.

You have to show that the inflammatory arthritis is severe and persistent which leads to fever, severe fatigue, malaise, or unplanned weight loss which limits your activities on a daily basis as well as limiting your ability to work for at least the next 12 months and socialize with others. 

When you apply for disability benefits you will be asked to include a complete medical history that describes your shoulder problems, you will also be required to include notes from a physical examination that describes the level of pain you are experiencing. Your physicians should indicate your outlook once you have undergone treatment for your shoulder arthritis. 

If your shoulder arthritis does not seem to meet the criteria found in the Blue Book, your physical and mental ability can be assessed by taking part in a Residual Functioning Capacity (RFC) carried out by your doctor or a physician appointed by the SSA. This assessment assesses your ability to move, sit, stand and carry heavy objects as well as how well you are able to communicate with others.

If you have shoulder pain, you may qualify for Social Security disability benefits.


The SSA Evaluation and Medical Qualifications

The SSA’s medical guide, which is the Blue Book, has listings for different body systems and different conditions. Each condition has specific requirements or criteria that have to be met in order for an individual to be approved for Social Security Disability benefits.

all While there is no set listing for shoulder pain, there are listings for underlying shoulder disabilities that cause shoulder pain and shoulder problems. Your medical records and documentation should prove and focus on the underlying cause of your shoulder pain. That medical condition is what the Disability Determination Services will sue to match with your records during the claim process to determine if you do meet the eligibility criteria to be approved for disability benefits.

There are several sections in the Blue Book that could apply to the cause of your shoulder pain. Here are just a few of those listings:

Section 1.02 – Major dysfunction of a joint

Section 1.07 – Fracture of an upper extremity

Section 1.08 – Soft Tissue Injury

Section 4.00 – Heart Disease

Section 9.00 – Heart Disease

Section 14.09 – Rheumatoid Arthritis

Regardless of the true cause of your shoulder pain, you need to include detailed information to support your claims. You need to include a detailed medical history that outlines all of your shoulder problems, physical examination notes that describe the pain level, detailed notes pertaining to your physical limitations, diagnostic exams and test results that confirm the causes of your shoulder problems, records of all kinds of treatment you have undergone including medication and physical therapy, statements from your medical providers detailing your symptoms and their severity.

Other information that should be included are doctor notes regarding how long your symptoms last and the frequency of occurrence, documentation from your physicians indicating your outlook and prognosis, records that prove your shoulder pain and problems have not improved even after you have undergone prescribed treatment regimen, and complete details regarding any other medical conditions that you may have in conjunction with the shoulder pain.

Qualifying for Disability Benefits Using a Residual Functioning Capacity and Medical-Vocational Allowance

If your shoulder pain does not meet the criteria set forth in the Blue Book, you can have them reviewed as a medical-vocational allowance. You will still be required to include extensive medical records with your application. The more documentation you can provide, the stronger your case.

Using this approach, the SSA will check to see that your shoulder issues keep you from doing a different kind of job, such as lighter duty sedentary work. Your age, education level, work experience, training, and any transferable skills are taken into consideration with your medical conditions.

The residual functioning capacity (RFC) will indicate your limitations. As an example, if your shoulder pain keeps you from reaching above your head that must be listed. If you cannot grasp items or control your fine motor skills as in the past, that should be indicated as well.

If you have to reposition frequently because of the pain, your doctor should note that. If you are unable to lift or carry things because of your shoulder condition that should also be indicated on the RFC. The limitations should be clearly indicated so your case can be given full consideration and the Disability Determination Services can understand the severity of your case.

Applying Specific Medical Tests to Your Case for Disability

Your shoulder pain and condition will involve extensive testing including blood tests, x-rays, MRI scans, ultrasounds, CAT scans, and physical examinations. All of this documentation needs to be included when you apply for benefits.

The SSA may order at their expense a medical evaluation for additional information regarding your situation and the severity of your condition. This is for informational purposes only. A mental evaluation may also be ordered to see if you suffer from anxiety, depression, or stress that impacts your ability to work.

Your SSDI application process can be lengthy and may involve denials and appeals. However, you can eventually request a hearing before an administrative law judge for a ruling on your case. Remember, the more documentation that you can provide, the stronger your case.

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