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Degenerative joint disease and Filing for Disability
Degnerative Disc disease is one of the most common medical conditions listed on SSD and SSI disability applications. While this condition can cause significant limitations to a personís daily activities, it can be difficult to qualify for disability benefits. This condition falls under musculoskeletal impairments under the adult listing section 1.00- Musculoskeletal System - Adult.
It was my experience as a Social Security disability examiner that the disability rules and guidelines made it difficult to be approved on the basis of back conditions. This was especially true if the disability applicant was under the age of 50, because disability vocational guidelines favor older individuals.
Social Security uses the disability criteria established in impairment listing 1.04 Disorders of the Spine of the blue book (guidebook for Social Security disability determinations) to evaluate disability claims with an allegation of back pain or problems. For example, if you have osteoarthritis, herniated nucleus pulposus (ruptured disc), spinal stenosis, degenerative disc disease, facet arthritis, spinal arachnoiditis, or vertebral fracture, this listing will be used to make your medical determination for Social Security disability.
The listing that covers degenerative disc disease
Listing 1.04 Disorders of the Spine. In order to meet this listing a person must be able to prove through objective medical evidence that they have nerve root compression, or spinal arachnoiditis, or lumbar spinal stenosis.
According to impairment listing 1.04, Disorders of the Spine, you must have a disorder of the spine that results in a compromise of the nerve root or spinal cord, along with one of the following:
1. Nerve root compression evidenced by neuro-anatomic distribution of pain, range of motion limitation of the spine, motor loss with muscle weakness with sensory or reflex loss. If the lower back is involved positive straight leg rising (you have pain with raising of the leg) in the sitting position or lying down; Or
2. Spinal arachoiditis, verified by an operative note, or pathology report of tissue biopsy, or by medically acceptable imaging. Demonstrated by severe burning or painful dysesthesia, resulting in the need to change position or posture more than one time every two hours; Or
3. Lumbar spinal stenosis resulting in pseudoclaudication, evidenced by findings of medically acceptable imaging, manifested by chronic nonradicular pain and weakness, that results in an inability to ambulate effectively (i.e. use of prescribed cane, crutches, or even wheelchair).
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).
Additionally, it could help a personís disability claim if they have a statement from their most recent employer that addresses sick days, short or long term disability, and or medical leave taken due to their medical condition.
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
More on qualifying for disability with Degenerative disc disease
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and Social Security attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the Social Security hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
Facts about degenerative disc disease
1. Degenerative joint disease is also called osteoarthritis. It is the most common type of arthritis and occurs when cartilage in your joints wears down, typically in old age.
2. Degenerative joint disease most often affects the hands, hips, knees, neck and lower back. However, it can affect any joint in any part of the body.
3. Osteoarthritis gradually worsens over time, as the cartilage continues to wear down in the affect joint or joints. This is the reason for the name 'degenerative' joint disease.
4. Although all people with osteoarthritis are of an older age, not all older people develop the condition. Risk factors include being over age 40, being female, having bone deformities, injuries, obesity, occupations or activities that stress a particular joint continuously, and conditions such as gout, rheumatoid arthritis, bone disease and septic arthritis.
5. Some medical specialists believe the underlying cause of all degenerative joint disease comes from stress on joints from overuse, such as injuries, being overweight, low muscle tone and misaligned bones.
6. Symptoms of degenerative joint disease include pain, tenderness, stiffness, loss of flexibility, grating sound and sensation, and bone spurs in the location of the affected joint. Overtime these symptoms worsen and can limit daily activities and cause poor quality of life. At this point, joint replacement surgery is usually recommended.
7. Alternative techniques have proven effective for some with degenerative joint disease. Acupuncture, ginger, tai chi and yoga are some commonly known techniques that can be affective. Less commonly known are avocado-soybean unsaponifiables (ASUs) that are oral supplements containing a mixture of avocado and soybean oil. ASUs have been the most effective in alleviating pain in the hip and knee joints more than other areas.
8. More conventional treatments include pain medications, physical therapy, supportive devices like shoe inserts or braces, classes on managing chronic pain, and surgical procedures. Surgical procedures include joint replacement as well as bone realignment and bone fusion.
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These pages answer some of the most basic questions for individuals who are considering filing a claim.
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Permanent Social Security Disability
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Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
For the sake of clarity, SSDRC.com is not the Social Security Administration, nor is it associated or affiliated with SSA. This site is a personal, private website that is published, edited, and maintained by former caseworker and former disability claims examiner, Tim Moore, who was interviewed by the New York Times on the topic of Social Security Disability and SSI benefits in an article entitled "The Disability Mess" and also by the Los Angeles Times on the subject of political attempts to weaken the Social Security Disability system.
The goal of the site is to provide information about how Social Security Disability and SSI work, the idea being that qualified information may help claimants pursue their claims and appeals, potentially avoiding time-consuming mistakes. If you find the information on this site helpful and believe it would be helpful to others, feel free to share links to its homepage or other pages on website resource pages, blogs, or social media. Copying of this material, however, is prohibited.
To learn more about the author, please visit the SSDRC.com homepage and view the "about this site" link near the bottom of the page.