Facts about Spinal Injury 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) Spinal injury, otherwise known as SCI (spinal cord injury), is when the spinal cord receives damage that effects sensory and motor functioning.
2) It is estimated that nearly 11,000 Americans suffer from a spinal injury each year, while over 1.2 million Americans are currently living with a spinal cord injury.
3) SCI can be caused by a multitude of things,from trauma, tumor and developmental disorders, to neurodegenerative diseases, ischemia, vascular malformation, and transverse myelitis. In turn, these causes may be caused by a variety of things, from stroke and inflammation to automobile crashes and cancer.
4) There are five different categories a SCI can fall into. Class A is a complete SCI, classes B, C, and D are various forms of incomplete SCI, and class E is a normal SCI, indicating that motor functioning and sensory functioning are normal.
5) Many syndromes, such as Anterior cord syndrome, Cauda equina syndrome, Brown-Sequard syndrome, and Central cord syndrome, are associated with SCI.
6) Males are more likely to receive a spinal injury than females. Nearly 60 percent of all spinal cord injuries happen to men. The most common age for a spinal injury is around 48-50 years old, though it can happen to anyone at any age.
7) The most common cause of SCI is a work related accident (nearly 30 percent), followed closely by automobile accidents (around 25 percent). Recreational and sporting accidents are responsible for over 15 percent of spinal injuries, while falling leads to almost 10 percent of spinal injuries.
8) The location of the spinal injury (cervical, thoracic, lumbar and sacral) will determine the details and severity of the spinal injury, and these factors will determine the type of treatment that is needed.
9) Sometimes spinal injury may cause central cord syndrome, which is very similar to paraplegia, only it is referred to as inverse paraplegia because the upper extremities are affected (hands and arms), as opposed to the lower extremities (legs and feet).
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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