Herniated Disc and Filing for Disability
Is Herniated Disc considered a disability by Social Security?
It's actually fairly common to see a mention of a herniated disc on an application for Social Security Disability or an application for SSI. Allegations such as herniated disc, lower back pain, and degenerative disc disease tend to show up quite frequently, in fact.
Of course, this is not surprising for at least a couple of reasons. One is the fact that these are degenerative conditions that tend to develop over time as people age and sometimes after the occurrence of an injury. Second, back pain can be particularly debilitating. As someone who has had recurrent problems with cervical and lumbar back pain, I happen to know exactly how true this is.
Unfortunately, as a former disability examiner, I also know how true it is that back cases do not receive the proper consideration that they should by SSA. Why is this? Typically, there are a number of factors that influence the outcome of disability cases involving back pain.
A. Pain is difficult to evaluate and difficult to take into consideration when making a disability determination. We see this, really, on nearly every case that involves allegations of pain, no matter what the actual impairment is.
Why is pain so difficult to evaluate? To some extent, this is true because the majority of disability examiners are younger individuals who have never experienced significant back pain. This is supposition on my part, of course. However, I know that, prior to developing some musculoskeletal problems myself, even I did not appreciate how significant and immobilizing ongoing back pain could be----of course, until it happened to me.
B. Too often, doctors do not document in their medical records (Social Security Disability and SSI cases are decided wholly on medical evidence) the nature and extent of a patient's pain, nor the functional restrictions and limitations that come into play as a result of ongoing pain.
In the final analysis, it can truthfully be said that the social security administration can be hard on "back disability cases". However, as I've said before, that does not mean that a disability case involving back pain cannot be won. With the proper documentation and often with the assistance of a good representative (a disability attorney or non-attorney rep), a solid case for approval can be presented.
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.
What are herniated discs?
Herniated disc (also known as ruptured disc, prolapsed disc, or herniated nucleus pulposos) is a tear in the outer fibrous ring that allows the soft gel-like center of the intervertebral disc to bulge out.
Generally, individuals between the ages of thirty and fifty have more herniated disc problems due to repetitive motions such as bending, lifting, and twisting. After the age of fifty, the gel-like center of the disc begins to dry up and herniation is less likely. In fact, most individuals with low back pain over the age of fifty suffer from spinal stenosis or degenerative disc disease.
The region of the spine most affected by disc herniation is the lumbar spine and herniations in this region account for about ninety percent of all herniated discs. Most herniated discs are the result of a bulging disc that becomes progressively worse. Symptoms may include pain in the affected disc area, radiating pain to areas connected to the nerve root that has been inflamed by the herniation, with tingling, numbness, paralysis, weakness, incontinence, etc.
Studies have indicated that some herniated discs heal themselves within three months with conservative treatment methods that might include bed rest, physical therapy, chiropractic manipulations, massage, oral and intravenous steroids, and various pain and anti-inflammatory medications. If conservative methods fail, there are surgical procedures options including spinal fusion, laminectomy, and discectomy that may be useful in treating herniated discs.
Seven facts about herniated discs
1) A herniated disc, sometimes referred to as a ruptured disc, prolapsed disc, or spinal herniation, is caused by the jelly-like inner layer of the intervertebral disc pushing out through a tear in the hard outer layer, usually resulting in irritated spinal nerves that cause pain and discomfort.
2) Not everyone is aware that they have a herniated disc, because symptoms are not always present. When present, symptoms of a herniated disk can range from weakness and pain, to numbness in the lower back, one leg, chest, shoulder, arm or neck. Sometimes the pain feels worse when sitting, sneezing or coughing, or while engaged in any movement that can cause extra pressure on the disc.
3) The risk of a herniated disk can be increased by smoking, obesity, being tall (over 5 feet and 11 inches for men, and five feet seven inches for women), physically demanding jobs that require twisting, lifting, pushing and pulling, and being between the ages of 35 and 45 years old. It can also be genetic.
4) Herniated disc is more likely in those in their 30's and 40's because as a person ages the jelly-like inner substance of the disc becomes drier and less likely to leak out of a tear in the outer layer.
5) Sometimes people refer to a herniated disc as a slipped disc, but this is not actually correct. The disc cannot 'slip', thought it can tear, degenerate, and twist.
6) The most common form of herniated disc is lumbar disc herniation, which is also the most common form of back pain. The second most common form of herniated disc is cervical disc herniation, which occurs in the neck and can cause pain in the neck, hand, arm and shoulder.
7) It is estimated that nearly 75 percent of all herniated discs are self healing and do not require surgery. Most patients may treat their herniated disc with bed rest, NSAIDs, oral or injected steroids, and physical or massage therapy. If these treatments do not work, then surgery may be an option.
Qualifying for disability benefits with a herniated disc
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 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 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.
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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