Social Security Disability SSI and Degenerative Disc Disease
An individual filing for Social Security Disability or applying for SSI on the basis of Degenerative Disc Disease can be evaluated according to the criteria of impairment listing 1.04, Disorders of the Spine.
While this listing addresses degenerative disc disease, it also address other conditions such as herniated discs, spinal stenosis, osteoarthritis, vertebral fractures, facet arthritis, and spinal arachnoiditis.
Section A of this listing, 1.04 A, specifically addresses degenerative disc disease, herniated discs, facet arthritis, vertebral fracture, and osteoarthritis, while sections B and C address the severity level criteria for spinal arachnoiditis and spinal stenosis, respectively.
How to qualify for disability under this listing
Impairment listing 1.04 A states an individual's degenerative disc disease must result in compromise of a nerve root, including the cauda equina or spinal cord. There must be evidence of nerve root compression evidenced by limited motion of the spine, neuro-anatomic pain distribution, or motor function loss (atrophy with muscle weakness or muscle weakness) along with sensory or reflex loss.
If a person has degenerative disc disease that involves the lower back, there should be a positive straight leg test (both sitting and lying down). A positive straight leg test simply means that when a straight leg is lifted up 30 ' 70 degrees while they are sitting or in a lying position there is pain.
If the disability examiner is able to determine that an individual's DDD is so severe that it meets, or is equivalent to, the requirements of the listing, they may be approved for disability benefits.
What if you don't meet the listing for DDD?
Unfortunately, most individuals with degenerative disc disease do not meet or even equal the severity criteria of listing 1.04A. However, failing to qualify for disability benefits on the basis of the listing does not mean that a person cannot be approved for SSD or SSI benefits. In other words, Social Security realizes that just because you don't satisfy the requirements of the listing does not mean you will necessarily have the residual functional capacity, i.e. remaining function, that would allow them to return to work. "Residual functional capacity" refers to a person's remaining capacity after consideration of their condition or conditions.
If an individual does not meet or equal an impairment listing, then they must be given a residual functional capacity rating (claimants are rated as being capable of performing medium, light, sedentary, or less-than-sedentary work activity). If the rating is so restrictive as to prevent work activity in their past jobs, and is so restrictive that the individual is considered incapable of doing some type of other work, they may win their disability benefits through a medical vocational allowance (approval).
Here is an excerpt from the medical vocational allowance page linked to in the preceding paragraph:
Being approved on the basis of a Medical Vocational Allowance
A medical vocational allowance is granted when Social Security has reviewed both the claimant's medical records and their work history (for the 15 year period prior to becoming disabled) and come to the following conclusions:
1) The individual is not capable of returning to their past work. This includes their last job and potentially any other jobs they may have held in the last 15 years that were worked long enough for them to learn the requirements of the job.
2) The individual is not capable of doing some type of other work based on their job skills, their age, their education level, and their current level of functional capacity (residual functional capacityresidual functional capacity).
More on filing for disability with degenerative disc disease
Millions of Americans suffer from some form of degenerative disc disease. DDD causes the discs between vertebrae to deteriorate; as the discs deteriorate they cause a significant amount of pain and loss of mobility. Sometimes an individual suffers from so much pain and loss of function they become unable to perform any kind of substantial work activity.
Individuals who have been unable to perform substantial gainful activity (SGA) for twelve months or who expect to be unable to perform SGA-level work activity (a monthly earnings amount deemed by Social Security to be self supporting (See the current amount here: SGA) for twelve months due to degenerative disc disease may be able to receive monthly Social Security Disability (SSD) and/or Supplemental Security Income disability (SSI).
Social Security considers any medically determinable mental condition or physical impairment that has prevented the performance of SGA to be a disabling condition. Social Security is less concerned with specific physical or mental conditions and is more concerned with how an individual's disabling condition limits their ability to function or their ability to perform daily activities that might be associated with work activity. Because of this, Social Security is interested in objective medical evidence that addresses the severity of an individual's condition, functional limitations, and response to treatment.
Since musculoskeletal impairments have a habit of improving with time or responding to treatment, Social Security Disability examiners like to have at least a twelve month clinical record to assess the severity of an individual's DDD. Acceptable medical evidence might include imaging techniques (MRI, CT, or x-ray), blood work, or clinical notes that are obtained from licensed physicians, orthopedists, neurologists, etc. Social security does not consider medical evidence from chiropractors to be acceptable though they will use objective medical testing information included in their medical records, such as xrays.
If a person has no ongoing medical treatment, Social Security must still have current objective medical evidence to make their disability decision. In the absence of recent treatment and the records that go along with this, Social Security will get the needed information through a consultative examination with a medical professional who has been contracted to perform services for Social Security. These independent medical exams often prove to be short non-thorough examinations aimed at giving the disability examiner just enough medical information to make their disability decision.
Generally, decisions based upon a consultative examination are not an approval for disability benefits. This is why it is so important, if at all possible, to have medical treatment notes that contain objective medical information from an acceptable medical source (your medical doctor and any hospitals and clinics you have been treated at).
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.
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