Disability for Back Pain: What Qualifies for SSDI Benefits?
By Wally Mountz / October 24, 2016 / Applying for Social Security Disability & SSI Benefits / 4 Comments
Back pain and spinal problems are the most frequent Social Security Disability claim. We explain how you can successfully collect SSDI benefits if you qualify.
If you have chronic back pain, the last thing you need to worry about is money. Add in doctor’s appointments, physical therapy, laboratory tests, and never-ending travels to specialists and your life quickly becomes very complicated. You could use some direction in your life . . . including not fighting with the Social Security Administration over benefits you should already be receiving.
Chronic back pain is the most common disability application the Social Security Administration (SSA) deals with each day. In fact, statistics reveal that back pain is a leading cause for someone to miss work, and bone degeneration is the primary disability for people under forty-five years old. Back pain can vary from a dull, nagging pain to severe pain preventing you from even getting out of bed.
The Essentials When Applying to Disability for Back Pain
Documentation is Key
For a successful SSA disability application for benefits related to this aliment, it must be well documented. It must also fall into Social Security’s “severe” classification. Misuse or overuse of back muscles is a frequent complaint as people age, but such back pain resulting from normal aging will not be approved for a disability claim.
Social Security has a blue book listing conditions that qualify for automatic approval for disability benefits, but chronic pain is not included. Nonetheless, a number of diseases and medical problems associated with chronic pain could pave the road to disability benefits: chronic renal disease, inflammatory arthritis, back injury, inflammatory bowel disease, somatoform disorders, and diseases of the neurological system.
The SSA understands that most back pain will resolve itself within a few weeks or a few months, and back pain is a very common complaint as people age. Accordingly, they essentially expect you to deal with it as you eventually reach retirement age.
To receive disability from the SSA, your back pain should be diagnosed as a specific medical problem, such as a herniated disk, nerve root compression, or sciatica. Even if you have a herniated disk, medical personnel should determine that the condition is not subject to rectifying treatment, and that it also meets their “chronic” definition.
What is Chronic Back Pain?
Chronic pain is considered to be pain that is not resolved within the usual recovery time frame for an injury—perhaps three to six months. As unlikely as it may seem, back conditions are sometimes difficult to diagnose. Much of the time, diagnosis may be based on your personal report of pain, which is very one-sided at best and does not always lend itself to rigorous scientific examination with concrete numbers. The SSA must then evaluate all the evidence to make a fair determination.
They will look at a doctor’s reports and any test results, of course, but they must go further and act more like a court jury deciding a case, meaning that they will also examine your work history, your previous and current statements concerning your condition, any witness statements, and photographs or video tape if available.
They will also want to see a detailed record of your attempts for treatment and any results. Such treatment might include physical therapy, yoga, exercises, medications, supplements, surgery, chiropractic or acupuncture treatments, bioelectric therapy, or ultrasound treatments. For instance, the hearing official might be interested in knowing if you have received any cortisone shots, how effective they were, how long relief lasted, and if any side effects occurred.
Specifically, what the SSA is ideally looking for is a “medically determinable” condition. They are trying to separate a chronic case, which must last for more than one year, with back pain normally associated with aging or an injury. Examples include heavy lifting, improper lifting, an accident, a fall, or back strain caused by a sports activity. Such cases would usually heal within a matter of weeks, which would be less than the required one-year time frame and would therefore not be allowed. This problem should also be expected to last for at least a year even with treatment.
Documentation You Need to Apply to Disability for Back Pain
Doctors and Tests
Medical proof is best—verifiable proof from a doctor and test results from MRIs and X-rays showing that your pain results from something abnormal in the spinal column or spinal canal. For instance, if an X-ray shows that a vertebra was fractured, an MRI indicates degeneration of bone in the spine, or a CT scan identifies a herniated disc, this could be the proof they want.
Your doctor’s records are very important in the claim process, and such notes must be very detailed. They should show your level of pain, rate of recurrence, triggering events, relief strategies, and a well-formed time line of the entire process. It is vital that you show continuing attempts to relieve this chronic pain. The physician should also list how this disability is affecting your normal daily activities. Because of these requirements, you should make certain that you have a doctor who is experienced in dealing with patients suffering from back pain.
Activities of Daily Living
You may also be required to fill out an Activities of Daily Living (ADL) form. You would be asked to describe your limitations throughout your normal day. Remember not to exaggerate your problems because you do not want to damage your credibility with the SSA. Answer carefully and truthfully.
You need to fairly assess your daily chores and determine if you can no longer perform some of these or if they take longer to complete than normal. Is your social schedule the same, or has the pain kept you housebound and away from friends and relatives? Has your pain changed your psychological state? Do you now have troubling moods or depression that has alienated friends, neighbors, and relatives? Does the pain stop you from thinking clearly or remembering details? All this information may have a direct effect on any full-time job you might consider.
The SSA may also contact your friends and relatives and ask them specific questions about your normal activities and if your pain is noticeable to them.
The examiner may turn to one of their medical consultants for another opinion of the case. Unfortunately, these consultants will only examine available records to reach their initial conclusions. Many facts may escape them because you would not be interviewed.
The Social Security examiner will compare your condition with their list of functional limitations. These changes in daily activities can be expected with a severe and chronic case of back pain. This list would include your statements of the pain you are experiencing. Your credibility becomes very important in the final assessment.
Residual Functional Capacity
A Residual Functional Capacity (RFC) form will also be completed by Social Security doctors. This form is used to determine your ability to work full-time and will also assess your current physical abilities, such as the following:
- Amount of weight you could carry and lift
- Your ability to walk and how far
- How long you could sit
- Your ability to push and pull
- How long you could maintain a standing position
- Your ability to bend over and lift
- Your ability to reach over your head
To bolster your case, have your own doctor, who should be a specialist in back pain and injury, also complete an RFC. The more functional limitations noted on the form, the better your case for winning a disability claim.
Examples of Functional Limitations
- Unable to remain seated for 6 hours in a normal workday
- Unable to stand for 2 hours a day
- Unable to walk one block without stopping
- Need to lie down during the day
- Unable to carry 10 pounds intermittently during a workday
- Having to keep one or both legs elevated during the day
Maintain Your Credibility
The hearing officer or the administrative law judge may also consider your personal statements to determine if they are believable or if you seem to be exaggerating your claims. A psychiatric consultation could also be ordered for a better picture of your mental health and if your claims are inconsistent with what is expected with your particular condition.
To gauge your credibility, a hearing officer or judge may consider the following:
- Your statements
- The intensity of your pain, the location, and how long the pain and effects last
- Triggering incidents
- Effectiveness of medications, dosage, and any side effects
- Self-treatment strategies and their effectiveness, such as sleeping on a board or icing or applying a heat pack to the painful area
- Employer statements
- Employment history and how the pain affected it
- Witness statements
- Medical records, including your doctor’s records and prognosis
- The history and results of any therapy
- Any indications of untruthfulness, such as stating in the records that you cannot sit more than a few minutes, but you remain seated during a long interview with an examiner
- How compatible all your statements are with existing records
- An examination of the history of your condition and how it has changed over time
These findings could well be critical for approving or denying your claim. In fact, if you have a long history of emergency room visits, examinations by different doctors, and any therapy procedures, such as physical therapy, different medications, dosages, or acupuncture, your creditability is boosted, which can only help your case.
Even after all this effort, however, you are still fighting an uphill battle because disability benefits do not come easily. In fact, only the most severe cases will be approved.
Spinal Problems Recognized for Benefits by the SSA
The SSA has three categories of spinal problems that could lead to being approved for disability benefits:
- Nerve Root Compression
The SSA provides examples of spinal cord compression or nerve root compression that could cause moderate or chronic pain all the way up to paralysis:
- Herniated, slipped, prolapsed disc (herniated nucleus pulposis [HNP])
- Facet arthritis
- Vertebra fracture
- Degenerative disc disease (DDD)
Beginning the Process
It is important to call the Social Security Administration to begin your claim application process, which can be complicated, especially if you have to make any appeals. In that case, the process is more likely to last months rather than weeks.
Since back disability claims are often not approved, it would also be a good idea to arm yourself with a qualified attorney who handles Social Security disability claims. This attorney should have experience with the Social Security Administration disability application and appeals process and especially chronic back pain claims.
Your lawyer will review your application, prepare you for the hearing, and perhaps also cross-examine experts used by the SSA to show why their conclusions are incorrect or too stringent. Such testimony could be particularly helpful for approving your benefits.
Make your choices carefully throughout this process. It is your future that you are dealing with.