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I have a back condition. Can I get disability benefits?

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Q:

I have a back condition. Can I get disability benefits?

A:

Severe back conditions—including a herniated disc, degenerative disc disease, spondylolisthesis, spinal stenosis and osteoarthritis—are often so painful and debilitating that sufferers will find that they are unable to perform substantial work. In fact, claimants with severe back conditions often suffer from a variety of symptoms ranging from the minor to severe, including:

  • Shooting pain, which radiates down one or both legs
  • Stabbing pain, which radiates down one or both arms
  • Limited range of motion
  • Inability to walk with a natural gait
  • Inability to stand for extended periods of time
  • Severe muscle aches
  • Weakness and numbing in the legs, hands or fingers
  • Bowel or bladder incontinence

SSDI and common back conditions

Social Security Disability Insurance (SSDI) benefits are offered to claimants who have a severe health condition that does not allow them to perform substantial gainful activity (SGA) for at least 12 continuous months.

Claimants must also meet other non-medical requirements to qualify for SSDI benefits. For example, they must not be working and earning too much money at the time they apply for benefits, and they must have sufficient work credits to be considered insured for SSDI benefits.

Severe back conditions are one of the most common conditions approved for disability benefits, but not all claimants with a severe back condition will be approved for SSDI. Having the right medical evidence to prove you cannot work will be critical to winning your case.

Making a disability determination for back conditions

The Social Security Administration (SSA) has two methods that they use to make a disability determination. First, they will review your back condition and determine if it “meets or equals” a listing in their SSA Listing of Impairments (a list of conditions and symptoms that the SSA has determined are automatically disabling). If your condition meets or equals a listing, assuming you meet the non-medical requirements for SSDI benefits, you will be awarded SSDI.

Reviewing your medical evidence

Listings for back conditions or disorders of the spine are evaluated by the SSA under 1.00 Musculoskeletal System, Section 1.04 Disorders of the spine. The SSA specifically lists the following severe back disorders: herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis and vertebral fracture, resulting in compromise of a nerve root (including the cauda equina) or the spinal cord.

Regardless of whether or not you have one of the listed conditions, to meet or equal a listing you will have to show that your condition is as severe as a listed condition.

After your SSDI application is sent to the Disability Determinations Office (the group of examiners who review your medical records and make a disability determination), the examiner will review your medical records they have requested from your treating sources and determine if your records contain a valid diagnosis from a treating doctor and objective evidence of the severity of your disorder.

The listing in the SSA Listing of Impairments has specific symptoms that the SSA will consider disabling. Some of the symptoms they will analyze include whether you have nerve root compression that is causing pain, limitation of motion of the spine and motor loss. Other conditions, such as stenosis, could cause narrowing of the spinal column and could be considered disabling if the pain is so severe that the claimant cannot effectively ambulate.

Medical evidence provided to the SSA should not only contain your diagnosis and supporting medical documentation, but it should also provide medical information about your ability to perform a wide range of movements, which can translate into work activities.

For example, the doctor should include information about the range of motion of your spine, your gait, a straight leg test, and your ability to perform a variety of exercises: squats, bends, stoops, walking on your heels, etc. Also important is the amount of time you can sit and stand or the time in which you must vary your posture (i.e. get up and walk around).

Why are my physical functional limitations important?

Above we discussed the first method that the SSA will use to make a disability determination: by reviewing whether your condition meets or exceeds a listing on the SSA Listing of Impairments. Claimants who do not meet a listing, however, may receive benefits through the SSA’s second evaluation process called the "medical vocational allowance". Through the medical vocational allowance process, the SSA will determine whether you have the functional residual capability to work your current job or retrain for less strenuous new work.

The range of motion tests performed by the doctor, and documented in your medical records, is critical to determining your work limitations. For example, if you have been performing “light work”, which includes sitting no more than two hours in an eight-hour work day and standing for up to six hours in a work day, assuming the doctor has limited your ability to sit to two hours, you could argue that you could no longer perform light work. The question, then, is whether you could perform sedentary work, which includes “walking for no more than about two hours of an eight-hour workday, and sitting approximately six hours of an eight-hour workday”.

Bottom Line:

Whether your back condition will be considered disabling will depend on whether you have medical evidence to either meet or exceed the listing in the SSA Listing of Impairments or whether you can prove, through a medical vocational allowance, that you do not have the residual functional capacity to retrain for new work.

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