Are Social Security Disability Claims Based On Back Pain Usually Turned Down?
When I was a Social Security Disability examiner, I noticed that it was often difficult to approve individuals who alleged back pain. Although the Social Security Disability impairment listings do address back or spine conditions, it is difficult to meet or equal the criteria contained in those listings.
Additionally, some individuals have back pain that is caused by conditions that do not have a lot of objective tests available to prove their severity. For instance, many individuals suffer from osteoarthritis of the spine.
And while it can be detected by imaging techniques, the amount of pain and limitation it causes often depends upon the individual. Unfortunately, the more subjective
Like all disability determinations, loss of functional ability is a major factor in approving an individual based upon back pain or any other musculoskeletal condition.
The fourth impairment listing (1.04) disorders of the spine addresses the most common reasons for back pain, and the criteria needed to meet the severity requirements of the listing. If an individual' s back pain is due to a herniated nucleus pulposis (ruptured disc), arachnoiditis, spinal stenosis, degenerative disc disease, facet arthritis, osteoarthritis aka arthritis, or a vertebral fractures, this is the listing used to determine if they are able to meet or equal the criteria outlined in the impairment listing.
To meet the listing, an individual has to have one of the following:
Part A requires that an individual have a compromise of the nerve root or spinal cord along with nerve root compression that has causes limitation of motion of the spine, neuro-anatomich pain distribution, and motor loss with atrophy that involves muscle weakness or muscle weakness along with sensory and reflex loss.
If the lower spine is involved, the individual must also have positive straight-leg raising (in the sitting position or lying down). Positive in this situation means positive for pain.
Part B provides the criteria needed to meet or equal the severity of 1.04 if the individual has arachnoiditis.
Part C of the listing provides the requirements for lumbar spinal stenosis.For the purposes of our question, the criteria for part C needs to be explored further because so many disability claimants with back pain have lumbar spinal stenosis.
An individual's spinal stenosis must result in pseudoclaudication. This is pain caused by a narrowing of the lumbar spinal canal that generally causes pain or discomfort in the feet, legs, and buttocks upon prolonged standing or walking.
Individuals with pseudoclaudication might also experience numbness or weakness in their legs. Sitting or bending forward at the waist often relieves leg pain that is caused by pseudoclaudication because it decreases the pressure on the affected nerve or nerves.
Lumbar spinal stenosis must also be documented by medically acceptable imaging (i.e. CT scans, MRIs, or X-rays) and it must be evidenced by chronic non-radicualr pain and weakness that causes the individual to be unable to ambulate effectively. For the purposes of a disability determination, to ambulate effectively, a person has to be able to sustain a reasonable walking pace for a distance that would allow them to complete activities of daily living.
Examples of ineffective ambulation might include the inability to walk without a walker, a need for a crutch or two crutches for ambulation, or an inability to walk over rough or uneven surfaces. Additionally, individuals who are able to get around in the home without the use of assistive devices are not necessarily performing effective ambulation.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
Most popular topics on SSDRC.com
Social Security Disability in North Carolina
Common Mistakes to avoid after being denied for Disability
Tips to Prepare for Filing for Social Security Disability or SSI
Advice to Win SSD and SSI Benefit Claims
Social Security Disability SSI Questions
What is the difference between Social Security Disability and SSI?
How to get disability for depression
Getting disability for fibromyalgia
SSI disability for children with ADHD
What is the Application Process for Social Security Disability and SSI?
Social Security Disability SSI Exam tips
More Social Security Disability SSI Questions
What makes you eligible for Social Security Disability or SSI?
These pages answer some of the most basic questions for individuals who are considering filing a claim.
Can you get a quick disability approval in Missouri
How long does it take for a disability decision in missouri?
Will I qualify for disability Benefits in Missouri?