Chronic Pain Is Real – and So Is Your Case
Filing for chronic pain disability in Los Angeles means facing a system that wasn’t designed to handle subjective symptoms well. I hear some version of the same story in nearly every consultation. A person who has lived with relentless pain for years, who’s been to dozens of appointments, and who’s been told by the Social Security Administration that pain alone doesn’t qualify. The SSA isn’t entirely wrong – pain alone isn’t enough. But that doesn’t mean your case is hopeless. It means your case needs to be built correctly.
At Devermont & Devermont, we’ve helped Los Angeles residents with fibromyalgia, complex regional pain syndrome, degenerative disc disease, neuropathy, and other chronic pain conditions navigate the Social Security disability system. This article explains exactly what the SSA requires, where these cases fail, and what it takes to win.
How the SSA Legally Defines Disability
Under 20 C.F.R. § 404.1505, disability means an inability to engage in any substantial gainful activity due to a medically determinable physical or mental impairment that has lasted – or is expected to last – at least 12 months, or result in death. That 12-month duration requirement catches a lot of claimants off guard. You don’t have to have been disabled for 12 months before you apply, but the SSA must project that you will be.
The SSA runs every claim through a five-step sequential evaluation under 20 C.F.R. § 404.1520. For chronic pain claimants, the critical steps are four and five. Most do not meet a listing at step three, so the case turns on Residual Functional Capacity.
The Medically Determinable Impairment Requirement
Under 20 C.F.R. § 404.1529, the SSA won’t find you disabled based on symptoms – including pain – unless those symptoms are traceable to a medically determinable impairment (MDI). An MDI is established through objective medical signs and laboratory findings, not subjective reports alone.
This is the legal wall most chronic pain claimants run into. Your pain is real, but the SSA needs a diagnosis backed by clinical findings – imaging showing herniated discs or nerve damage, lab work documenting inflammatory markers, tender point examination results, or nerve conduction studies. Without an MDI in your record, the case stops there. If you’ve been managing pain without consistent specialist care, that documentation gap is something we address immediately.
How the SSA Evaluates Pain: SSR 16-3p
Once you’ve established an MDI, the SSA applies a two-step process under Social Security Ruling 16-3p. First: can the MDI reasonably produce the symptoms you’re reporting? Second: how intense, persistent, and limiting are those symptoms?
SSR 16-3p replaced the older SSR 96-7p in 2016, shifting from a “credibility” standard to a consistency and supportability standard. The question now is whether your reported symptoms are consistent with the objective evidence and the full record. In practice, the SSA considers:
- Your daily activities and how pain affects them
- The location, duration, frequency, and intensity of your pain
- What makes your pain worse – activity, position changes, stress
- Your medications, their effectiveness, and their side effects
- Other treatments you’ve tried, from physical therapy to injections
- Any other measures you use to manage pain
Every one of those factors should be documented in your medical records. In a chronic pain disability case in Los Angeles, if your file is thin, the SSA fills the gaps with assumptions that rarely favor you.
Fibromyalgia: SSR 12-2p
Fibromyalgia is one of the most mishandled conditions in the disability system. The claim that it “can’t be proven objectively” is wrong. SSR 12-2p establishes that fibromyalgia can be a medically determinable impairment when a physician documents widespread pain in all quadrants of the body. The physician must also show either at least 11 of 18 tender points on examination, or a pattern of widespread pain with repeated manifestations of six or more fibromyalgia symptoms such as fatigue, cognitive problems, depression, anxiety, or irritable bowel syndrome.
The key word is physician. The SSA requires an MD or DO – not a physical therapist, nurse practitioner, or chiropractor. If your fibromyalgia has been managed by a provider without that credential, you need to involve a rheumatologist or neurologist in your care and your claim.
Medication Side Effects Can Strengthen Your RFC
Here’s something that’s consistently underused in chronic pain cases: medication side effects. Many of my clients take opioid analgesics, gabapentin, pregabalin, or benzodiazepines. These medications carry real functional consequences – sedation, cognitive slowing, dizziness, balance problems. If your medication leaves you cognitively foggy for hours each day, or forces you to lie down in the afternoon, those are work-limiting functional limitations.
Ask your prescribing physician to document the functional impact of your medication regimen in the medical record. For anyone pursuing chronic pain disability in Los Angeles, that documentation can shift the outcome at an ALJ hearing.
Building the RFC That Wins a Chronic Pain Disability Case in Los Angeles
Your Residual Functional Capacity is the SSA’s assessment of what you can still do despite your limitations. For most chronic pain claimants, the case comes down to whether the RFC accurately captures your functional picture. A well-built chronic pain RFC should include:
- Limits on sitting, standing, and walking
- Need for positional changes at will
- Restrictions on lifting, carrying, bending, and reaching
- Concentration deficits from pain or medication
- Off-task time due to pain flares
- Need for unscheduled breaks or elevated absenteeism
A functional capacity evaluation (FCE) combined with a detailed RFC opinion from your treating physician is usually the strongest evidentiary package. For more on building that record, see our guide on evidence needed to win a disability claim in Los Angeles. The treating physician’s opinion carries weight under 20 C.F.R. § 404.1520c because the SSA must consider how well an opinion is supported by that provider’s own records. A pain management physician who has treated you monthly for three years can document your functional decline in a way no one-time consultative examiner can match.
The ALJ Hearing in Los Angeles
If you’ve been denied and requested a hearing, your case will go to the SSA’s Office of Hearings Operations in downtown Los Angeles. The national ALJ allowance rate for fiscal year 2023 was 57 percent – more than half of claimants who reach a hearing win. That’s far better than the initial or reconsideration stages.
At the hearing, a vocational expert testifies about what jobs exist in the national economy. Challenging that testimony – questioning job numbers, outdated DOT code citations, or flawed assumptions about your RFC – is often where chronic pain cases are won or lost. As we explain in our guide on chances of winning disability with a lawyer in Los Angeles, represented claimants win at significantly higher rates than unrepresented ones. The cases I take to hearing are prepared with updated records, a treating physician RFC opinion, FCE results where available, and a fully developed theory of the case.
What Representation Costs on a Chronic Pain Case
Chronic pain cases often require more preparation than other disability claims – additional medical opinions, coordination with pain management specialists, detailed RFC development. Despite that, you pay nothing for our work unless we win. The fee is set by federal law: 25% of past-due benefits, with a $9,200 ceiling (POMS GN 03940.003). SSA deducts it from your back pay and sends it to us. No invoices, no hourly billing, no retainer.
Frequently Asked Questions
Can chronic pain qualify as a disability for Social Security purposes?
Yes, but not on its own. Chronic pain must be traceable to an MDI established through objective medical evidence. Once the MDI is established, the SSA evaluates the intensity, persistence, and limiting effects of your pain under SSR 16-3p. It’s the functional limitations caused by your pain – not the pain itself – that determine whether you qualify.
What if my condition, like fibromyalgia, doesn’t show up on imaging?
Fibromyalgia is explicitly recognized as a potential MDI under SSR 12-2p. The standard relies on clinical examination findings – tender points or widespread pain with repeated fibromyalgia symptoms – not imaging. A rheumatologist or neurologist familiar with SSA’s requirements must establish the diagnosis and document it thoroughly.
How does the SSA evaluate pain that can’t be measured objectively?
Using SSR 16-3p’s two-step framework. First, the SSA determines whether your MDI could reasonably produce your reported symptoms. Second, it evaluates whether those symptoms are consistent with the full record – your treatment history, daily activities, medication regimen, and reported limitations. Consistent, detailed documentation throughout your treatment is what makes or breaks this analysis.
Will my pain medication side effects help my case?
They can. Sedation, cognitive impairment, and dizziness from opioids, anticonvulsants, and similar medications are legitimate functional limitations that belong in your RFC. If those effects prevent you from sustaining concentration or working a full schedule, your prescribing physician should document that impact in the record. It can directly affect whether a vocational expert can identify work you’re able to perform.
My pain management doctor supports my claim. Why isn’t that enough?
A general statement of support isn’t what SSA evaluates. Under 20 C.F.R. § 404.1520c, the agency weighs medical opinions on supportability and consistency. Your pain specialist needs to provide a specific RFC opinion: how long you can sit, stand, and walk; how pain affects concentration; how often flares would cause you to miss work. “My patient has chronic pain and cannot work” gets discounted. “My patient cannot sit more than two hours, loses concentration due to pain-related cognitive interference, and would miss three or more workdays per month” – that changes outcomes.
Do chronic pain cases take longer than other disability claims?
Not necessarily longer in calendar time – the SSA process runs three to six months for initial review, plus 12 to 18 months for an ALJ hearing in Los Angeles regardless of diagnosis. But chronic pain cases often need more development time on the front end: establishing the MDI, building a treatment history, documenting the relationship between pain and functional limits. Starting that process early – ideally before the hearing is scheduled – prevents delays from incomplete records.
What should I bring to my first consultation?
Bring whatever you have. The most useful items are: names and addresses of all treating providers over the past two years, a current medication list, any imaging results, records from specialist visits, and any prior SSA correspondence. If you’ve already been denied, bring that notice – the appeal deadlines are strict and I need to know exactly where your case stands.
Talk to a Los Angeles Chronic Pain Disability Attorney
Winning a chronic pain disability claim in Los Angeles is hard enough. Navigating the Social Security disability system on top of that – with its regulations, deadlines, and evidentiary requirements – shouldn’t fall entirely on you. At Devermont & Devermont, we represent chronic pain claimants throughout Los Angeles County, from initial applications through ALJ hearings and federal court appeals.
Our representation is contingency-based – if your chronic pain case doesn’t result in benefits, you owe us nothing. Call (310) 730-7309 for a free consultation. Let’s look at your case and tell you honestly what we think.
