Facts about Low Back Pain and Filing for Disability
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.
Facts about the condition
1) Low back pain is a very common musculoskeletal disorder. It causes more disability than any other health circumstance.
2) The cause of low back pain can be quite varied. It can be due to trauma or injury of some kind, or lifting something heavy causing a spasm, strain or sprain. It can be due to stress, structural issues, being overweight, or poor posture. Low back pain can be due to loss of elasticity due to aging, irritated nerves, a spinal disc herniation, rheumatoid arthritis, or osteoarthritis. There are too numerous reasons for low back pain to even list.
3) It is thought that nearly 80 percent of all people will experience low back pain at some point in their life, and it is thought that nearly 4 out of every 5 American adults will experience low back pain during their life.
4) Being anxious, depressed, and stressed can increase your risk of low back pain, as can aging, being overweight, being female and smoking. You are also at a higher risk for low back pain if you work a sedentary job, or a job that is too physically demanding.
5) The cause of low back pain can most often be diagnosed with a physical exam, but at times a physician may need to use X-rays, electromyography, EMG, a bone scan, computerized tomography, or magnetic resonance imaging to determine the source of low back pain.
6) Low back pain is usually classified ' acute, sub acute, and chronic - by how long it has been present.
7) Low back pain can be treated a variety of ways, from medications such as NSAIDs, muscle relaxants, or acetaminophen, to spinal manipulation therapy and various exercises. Severe cases may need surgery to fuse vertebrae, or replace a disk or remove a disk or vertebra, but most cases of low back pain resolve within a few weeks, no matter the treatment.
Qualifying for disability benefits with this condition
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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