Facts about Sciatica 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. Sciatica refers to back pain associated with the sciatic nerve, which runs from the spinal cord, through the hips and down the backs of the thighs. The sciatic nerve is the body's longest, and this nerve is responsible for controlling leg muscles and sensation in the legs and feet.
2. Pain along the sciatic nerve is a symptom of a variety of conditions that affect the nerve. Often this is a herniated disk compressing part of the nerve.
3. It can also be caused by spinal stenosis in the lower back, a condition that causes narrowing of the canal around the spinal cord and creates pressure on the nerves. Spondylolisthesis, where one vertebra slips over another, can pinch the nerve as well. Tumors and injuries to either the spinal cord or the sciatic nerve specifically may also cause sciatic pain.
4. Sciatica pain typically radiates from the lower back down through one of the legs, and can be mild or severe, sudden or prolonged. It can also cause numbness, weakness and uncomfortable sensations such as tingling in the feet and toes.
5. Occasionally, both sides may be affected, but differently, such as with pain in one leg and numbness in the other.
6. One rare symptom, suddenly losing control of the bladder or bowels, is a medical emergency, as it is a sign of a serious condition.
7. Most of the time, sciatica is mild and acute, going away on its own in about a month. At home self-care measures can help treat and alleviate symptoms, including applying heat or cold, doing stretches and exercises, and taking over-the-counter pain relievers.
8. If the pain lasts for longer than a month or continues to get worse despite at home care, a doctor will be able to help with more aggressive treatment. This may include therapy, prescription pain relievers, steroid injections or, in the most serious circumstances, surgery.
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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