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Back Pain Medical Conditions Eligible For Social Security Disability

Back aches are a very common complaint, but if your back pain disrupts your ability to work and earn or even to move freely, you may need some financial assistance. The Social Security Administration (SSA) provides benefits to disabled individuals, either in the form of Social Security Disability benefits (SSD/SSDI) or Supplemental Security Insurance (SSI).

To receive these benefits, you must show that you have a medical condition that’s listed in the SSA’s “blue book” and that this condition disables you. Some of the medical conditions in the SSA’s list involve back pain. Click on each of these conditions to see its specific eligibility requirements.

Degenerative Disc Disease (DDD)

As you grow older, the soft disks that cushion the bones of your spine – called the vertebral discs – can gradually wear out. If this causes you debilitating pain, it may be considered a degenerative disease. Degenerative disk disease is actually one of the most common impairments of disability claimants, primarily because the vertebral discs naturally shrink with age.

Herniated Disc

You may also know this as “slipped disc” or “ruptured disc”. This condition is centered on any of your intervertebral discs, which are small donut-like tissues between the bones of your spine. If a disk tears, the soft matter inside it pushes out or “herniates”.

Nerve Root Compression
Also called “pinched nerve”, this condition occurs when a nerve is compressed between ligaments, tendons, and/or bones. It can often happen to a nerve root on your spine, causing pain to the neck area or lower back. If you have sciatica or lumbar radiculopathy – which both manifest as leg pain originating from the lower back – it may indicate that a nerve root along your spine is compressed.

Scoliosis
This refers to the abnormal sideways curve of the spine. It typically starts just before puberty and often does not cause health problems. But if unmanaged, the spinal curve may worsen over time and affect the functions of surrounding organs such as the lungs and heart.

Spinal Arachnoiditis
The key symptoms of arachnoiditis are severe stinging and burning pain. These result from the inflammation of a membrane called the arachnoid, which protects the nerves in your spinal cord.

Spinal Stenosis
This condition occurs when the space within your spine (the spinal canal) narrows, putting pressure on the nerves that pass through that space. It can cause not only back pain but also numbness and motion problems on the leg or feet.

Because back ache complaints are common and not all of them are disabling, the SSA is careful in evaluating applications of disability based on back pain-related conditions. It has a five-step process to confirm that you are disabled:

Step 1. Are you working?

At the first step, the SSA considers your work activity.  If you are engaged in Substantial Gainful Activity (SGA) you will not be found disabled.  The amount you must earn to be working at SGA changes each year.  For 2018 it is $1,180 per month if you are not blind and $1,970 per month if you are blind.  If you are working, and your earnings average more than the SGA limit, then you will not be found disabled.  If you are not working, or your earnings are less than SGA, the process proceeds to Step 2 where your back pain and any other physical or mental conditions are considered.

Step 2. Is your medical condition “severe”?

For the SSA to determine that you are disabled, your medical condition must significantly limit your ability to do basic work activities such as sitting; standing; walking; lifting; carrying; understanding, remembering, and carrying out simple instructions; making simple work-related decisions; responding appropriately to supervision, co-workers, and work stress; and dealing with changes in a routine work setting.

To be found disabled, you must have a medically determinable physical or mental impairment (or a combination of impairments) that is severe and has lasted or is expected last one (1) year or end in death. If your medical condition is not that severe, you will not be found to meet the requirements for Social Security disability benefits.  If your condition is that severe, the SSA goes to Step 3.

Step 3. Does your medical condition meet or equal the severity of a Listing?

The Social Security Administration maintains a listing of medical criteria that are considered to be so severe that you will be found disabled if your medically determinable physical or mental impairment(s) matches them.  The Adult Listing for back pain can be found here.

If you do not have an impairment that meets or equals one of the listings or the duration requirement is not met, the SSA determines what you’re capable of doing despite your impairments (your Residual Functional Capacity or RFC) and will proceed to Step 4.

RFC is a function-by-function assessment of your maximum ability to do sustained work-related physical and mental activities on a regular and continuing basis (8 hours a day, for 5 days a week) despite the limitations and restrictions resulting from your medically determinable impairments.  In short, it is an evaluation of your capacity for full-time work.

Step 4. Can you do any of the jobs you have performed in the past fifteen (15) years?

At this step, the SSA decides if your medical condition prevents you from being able to work full-time at jobs you have done in the past fifteen (15) years. If the SSA decides you can perform any of your past relevant work (PRW), you will be found not disabled. To be PRW, the work must have been substantial gainful activity (SGA); performed in the fifteen (15) year relevant period; and performed long enough to learn the job.  If the SSA decides you cannot perform your past relevant work, or you have not worked in the past fifteen (15) years, the SSA goes on to Step 5.

You have the burden of proof at Step 4. Two of the strongest types of evidence at this stage are medical records and the opinions of the doctors who are treating you for the conditions that are affecting your ability to work. The strongest medical evidence is what is known as objective medical evidence, or evidence that does not rely upon what you tell your doctors. The strongest opinions are opinions that are offered by doctors who specialize in the condition that is keeping you from working and which are supported by objective medical evidence.

Some types of objective medical evidence that can support a claim for disability based upon back pain include:

  • General clinical records
  • Documentation of medically prescribed treatment and response
  • Imaging results (MRI, CT scan, or x-ray)
  • Clinical notes of specialists, such as those describing decreased range of motion and reduced muscular strength

Doctors who specialize in treating back pain include:

  • Orthopedists/Orthopedic surgeons – These are medical doctors who specialize on the bones, nerves, joints, tendons, ligaments, muscles, and other components of the musculoskeletal system.
  • Neurologists/Neurosurgeons – These highly trained doctors focus on surgical and nonsurgical treatments for the nervous system, particularly the nerves.
  • Rheumatologists – These doctors specialize on conditions affecting the joints.
  • Physiatrists (Physical Medicine and Rehabilitation physicians) – Though they are non-doctors, they help manage medical conditions of the musculoskeletal system.

If you are only treating with your family doctor or primary care doctor for your back pain, the SSA may interpret this as meaning that your condition is not that serious (otherwise you would be treating with a specialist). An experienced Social Security disability lawyer can help you locate sources of treatment (even if you don’t have health insurance).

Step 5. Can you do any other type of work?

At Step 5, the “burden of proof” shifts to the SSA. If you cannot do your past relevant work, the SSA looks to see if you would be able to do other work. It evaluates your medical condition, your age, education, past work experience, and any skills you may have that could be used to do other work. If you can do other work, the SSA will determine you are not disabled. If you cannot do other work, SSA will find you disabled.

After age 50, there are special rules that may apply to your claim that can result in a finding of disability even if there is some other work you could perform on a full-time basis. An experienced Social Security disability lawyer will be familiar with these rules and can ensure that they are considered in the evaluation of your case.

The evaluation process for disability can be strict, and many applications get rejected. But whether this is your first time to apply or you are appealing a claim that has been denied, you may still have a good chance of receiving benefits for spinal pain disability.

Talk to us at the Gillette Law Group to see how we can make your claim much more likely to be approved by the SSA. We have years of experience in helping individuals like you succeed in their disability benefits applications, and we can do this for you, too.

Contact us for your free consultation. Call (855) 873-2604 today.

 

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