Can I Get Social Security Disability for a Spine Disorder?

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Back problems are some of the most common complaints amongst Americans and is a common reason why people apply for Social Security Disability.  However, applying for and receiving Social Security Disability benefits can be a complicated and difficult process.  However, this does not mean that you cannot receive benefits from the Social Security Administration for back pain or a spine disorder.

How Do I Apply for Social Security Disability or SSI Benefits?

The Social Security Administration (SSA) offers three ways for a person to apply for Social Security Disability benefits:

  • By Telephone
  • In person at a local Social Security Office.
  • Through the internet

If you want to complete an application for SSI or Social Security disability by telephone or in person, then you will first have to call the SSA at 1-800-772-1213. If you choose to go a Social Security office to complete the application, the person at the 800 number will schedule an appointment for you, give you directions to the Social Security office, and tell you what papers you need to bring along. This can be beneficial because it can prevent you from having to make multiple trips because you did not have a piece of evidence that you needed for your claim. If you want to apply by phone, you will be given a date and an approximate time to expect a phone call from someone at the Social Security office who will take your application over the phone. The application will then be mailed to you for your signature.

If you want to use the Internet to apply, go to www.socialsecurity.gov/applyfordisability/adult.htm. If you want to apply for SSA’s other disability program — Supplemental Security Income (SSI) –you cannot complete an SSI application online but you can complete one of the necessary supporting documents, the Adult Disability and Work History Report, on the Internet.

Do Disorder of the Spine Count?

The Social Security Administration has collected and established a comprehensive listing of disabling impairments, which is known as the Disability Evaluation under Social Security, however it is often referred to as the Social Security Blue Book.  Under the Blue Book Section 1.04 Disorders of the spine, a person may be entitled to Social Security Disability payments for a disorder of the spine such as herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), which results in compromise of a nerve root (including the cauda equina) or the spinal cord.  In addition, a person who is claiming that they are disabled because of a spine disorder will need to show

Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine); OR

Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours;

or

Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in an inability to ambulate effectively, as defined in 1.00B2b.

While the Blue Book may lay out the requirements for a person to receive Social Security Disability benefits under this section, this can be a difficult process because back pain is often very difficult to prove in the absence of some medical evidence such as a broken bone in the spine. Often a person will claim that their pain is so severe that they have suffered a loss of function.

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What is Loss of Function?

For a person to be considered to be disabled under the Social Security Administration’s standards they need to experience some loss of function.  Fortunately, the Blue Book also provides some insight into what it means for a person to have loss of function.

Under the Blue Book Section 1.00

Regardless of the cause(s) of a musculoskeletal impairment, functional loss for purposes of these listings is defined as the inability to ambulate effectively on a sustained basis for any reason, including pain associated with the underlying musculoskeletal impairment, or the inability to perform fine and gross movements effectively on a sustained basis for any reason, including pain associated with the underlying musculoskeletal impairment. The inability to ambulate effectively or the inability to perform fine and gross movements effectively must have lasted, or be expected to last, for at least 12 months. For the purposes of these criteria, consideration of the ability to perform these activities must be from a physical standpoint alone. When there is an inability to perform these activities due to a mental impairment, the criteria in 12.00ff are to be used. We will determine whether an individual can ambulate effectively or can perform fine and gross movements effectively based on the medical and other evidence in the case record, generally without developing additional evidence about the individual’s ability to perform the specific activities listed as examples in 1.00B2b(2) and 1.00B2c.

There are many reasons that a person may experience a loss of function of their back, however, the important feature is that you are unable to do such basic things such as walking, sitting, and reaching for things.

What Medical Evidence Do I Need?

One of the most important parts of any Social Security Disability claim, if not the most important part is the medical evidence that you have collected that supports your claim. In the case of a spine disorder or back problem, you will generally need to gather sufficient medical evidence. The Social Security Administration requires that in order for a person to receive social security disability payments that they need to present documentation of the existence of their impairment from medical professionals defined by SSA regulations as “acceptable medical sources.” Once a person has established that they have an impairment, all the medical and non-medical evidence will be considered in assessing impairment severity. Some of the acceptable medical sources are:

  • Licensed physicians (medical or osteopathic doctors);
  • Licensed or certified psychologists. Included are school psychologists, or other licensed or certified individuals with other titles who perform the same function as a school psychologist in a school setting, for purposes of establishing intellectual disability, learning disabilities, and borderline intellectual functioning only;
  • Licensed optometrists, for purposes of establishing visual disorders only (except, in the U.S. Virgin Islands, licensed optometrists, for the measurement of visual acuity and visual fields only). (See paragraph (f) of this section for the evidence needed for statutory blindness);
  • Licensed podiatrists, for purposes of establishing impairments of the foot, or foot and ankle only, depending on whether the State in which the podiatrist practices permits the practice of podiatry on the foot only, or the foot and ankle; and
  • Qualified speech-language pathologists, for purposes of establishing speech or language impairments only. For this source, “qualified” means that the speech-language pathologist must be licensed by the State professional licensing agency, or be fully certified by the State education agency in the State in which he or she practices, or hold a Certificate of Clinical Competence from the American-Speech-Language-Hearing Association.

It is very important that you take the time to carefully gather this information, and compile it for the Social Security Administration. If you do not have enough evidence that supports your claim then you may be denied Social Security Disability Benefits.

What Happens if My Claim is Denied?

When someone who is experiencing back pain or any other ailment and they see  how complicated and intricate the process to apply for Social Security Disability benefits is, they immediately are concerned about being denied benefits. However, while there are many reasons why a person may be denied benefits just because you receive a denial does not mean that you will be precluded from receiving benefits.

Generally, there are four levels of appeal that a person is entitled to under the law. These are:

  • Reconsideration
  • Hearing
  • Appeals Council review
  • Federal Court Appeal

Many people assume that Social Security is trying to make sure that people do not receive benefits, however to the contrary, Social Security carefully examines each decision to determine whether a person does or does not qualify for and what benefits they are entitled to receive. That being said, if a person is denied they are entitled to go through the different levels of review.  In order to file an appeal however, a person need to make sure that you understand the time frame. If you have been denied Social Security Disability payments, then you will have 60 days from the date you receive the letter informing you about the SSA’s decision.  This date is important because if you do not appeal within the 60-day time limit, you may lose your right to appeal and the last decision that was made at whatever stage in the process will generally become final.  If a person is denied then they need to file a request for appeal in writing. However, the Social Security Administration will also allow a person to appeal the decision online.  It is also important to note that, you have a right to representation at your appeal.

A lawyer may represent you and once they are authorized to represent you will be presented all information in the same way that it is presented to you.  A representative will be able to guide you through the four levels of review and may in fact be beneficial or required if you seek to appeal the decision all the way to the Federal Court.

Rely on Our Social Security Attorneys in Northwest Arkansas

Ken Kieklak, Attorney at Law is dedicated to fighting for hard-working people who have had to stop work due to a serious illness or injury. To schedule a free and confidential SSDI consultation with a Fayetteville Social Security disability attorney, call at (479) 251-7767 or go online today.

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