Back Injuries and qualifying for Social Security Disability
If I’m having back problems and it’s affecting my ability to work can I receive disability benefits?
Author Attorney Lloyd Bemis:
According to the American Chiropractic Association, approximately 31 million Americans experience back pain at one time or another. Back pain is the leading cause of disability worldwide and among the most common reasons for people missing work.
Back pain can be the result of aging, an accident, or a medical condition. While most back pain is short-term, lasting days or weeks, chronic back pain persists 12 weeks or longer, even after an injury or condition is treated.
Some examples of back problems include:
- Traumatic injury, such as a car accident or a sports injury.
- Disc degeneration, an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column breaks down
- Herniated or ruptured disc, a condition that occurs when the rubbery cushions (discs) between the vertebrae of the spine become compressed and rupture.
- Radiculopathy, commonly called a pinched nerve, caused by compression of a nerve root in the spinal column.
- Spondylolisthesis, a condition where a vertebra of the spine slips out of place and pinches the nerves
- Sciatica, a type of radiculopathy, caused by compression of the sciatic nerve
- Spinal stenosis, a condition that results in the narrowing of the spinal column, putting pressure on the spinal cord and nerves
- Skeletal irregularities, such as scoliosis (a curvature of the spine).
The cost of treating a back problem adds up if one considers the expense of insurance premiums and co-pays, doctors, chiropractors and specialists, pain medications, physical therapy and tests such as x-rays, MRIs and CT scans.
The average person with insurance pays $1,500 to $3,500 per year for treatment; back surgery can cost between $20,000 and $150,000.
Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from back problems. If you have been denied disability don’t give up!
While back pain can severely impact a person’s ability to work, the Social Security Administration does not make it easy for an individual to qualify for Social Security Disability benefits.
Social Security receives more applications for back problems than any other condition. To be eligible, you must have a “medically determinable” condition such as spinal stenosis, nerve root compression, herniated disc, or arachnoiditis that has lasted one year and you must provide medical evidence in the form of x-rays, MRIs and CT scans.
Back problems covered in Social Security’s Blue Book are listed under Section 1.04 Disorders of the Spine:
1.04 Disorders of the spine
(e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord.
- 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);
- 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;
- Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.
Social Security defines loss of function 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.”
If your back condition does not match one of the impairments listed in Social Security’s Blue Book, you may still qualify for a Medical-Vocational Allowance. Social Security will perform a Residual Functioning Capacity (RFC) evaluation, taking into consideration your condition, symptoms and limitations along with your age, education, work experience and transferable skills.
Your doctor will need to complete a form detailing:
- how often you change positions,
- if you are unable to stand for more than one or two hours,
- how far you can walk, and
- if you need assistive devices to walk such as canes, crutches or a walker.
You will also need to provide information regarding any medication you are taking and how it affects you (i.e. drowsiness, dizziness).
As debilitating as back pain can be, it may still be very difficult to convince Social Security that you qualify for disability benefits.
Hiring a qualified disability attorney can increase your odds for approval substantially.
Cigna LTD Claims:
Continuing neck and back problems plagued one Grand Prairie, Texas client, followed by multiple surgeries. After one of the surgeries, one of her treating physicians, a neurosurgeon, stated on Cigna’s attending physician statement that she was unable to work secondary to pain and weakness and that she would never be able to return to work. The client underwent a two-day FCE protocol after which a Board Certified Orthopedic Surgeon wrote that her results were “about the clearest-cut case of someone applying for long-term disability that deserves it that [that physician had] seen in 27 years of clinical practice as a spinal surgeon.” The doctor further indicated that client was not fit for employment and that this would be a lifetime condition. She was awarded SSDI, but Cigna denied her LTD claim anyway. We challenged the denial and Cigna settled.
A Frisco, Texas client suffered from severe, intractable low-back pain. Imaging studies revealed multi-level degenerative disc disease of his lumbar spine.
Because of the extent of the degeneration, his orthopedic surgeon restricted him from bending, lifting anything exceeding ten pounds, and twisting. Even with these restrictions, his doctor stated that the client was unable to return to work due to continuous low back pain, that walking more than 100 feet was virtually impossible for him, and that he was unable to sleep for more than two hours at a time due to pain. Physical therapy only aggravated his condition. The doctor felt that he was unable to return to any type of meaningful occupation for the foreseeable future and that he should be considered persistently disabled until further notice. After CIGNA denied him anyway, he hired Bemis, Roach & Reed. We were able to get him a settlement.
Another client of ours from The Woodlands suffered from back pain, depression and carpal tunnel syndrome.
He had undergone an attempted lumbar decompression and fusion between his fourth and fifth lumbar vertebrae. This failed and was followed by a second surgery that attempted to fuse the third through fifth lumbar vertebrae. The second surgery failed, too, and the client’s condition continued to degenerate. He was on constantly increasing pain medications. The Social Security Administration awarded him full disability benefits. Prudential denied his LTD benefits, even though multiple physicians declared him completely disabled. We appealed and got him a settlement.
Claim for lumbar radiculopathy long-term disability:
Physicians had previously certified that our client from Streetman, Texas had a class 5 physical impairment and was totally disabled. Aetna’s own file reviewer indicated that the client was unable to be employed as a Registered Nurse. The denial letter suggested that she could engage in other types of nursing. This analysis did not, however, take into account her current restrictions and limitations. She had a history of a lumbar fusion surgery as well as chronic and persistent lumbar radiculopathy with chronic pain syndrome. This resulted in a very poor sitting tolerance of approximately ten minutes. She was also noted to have a short walking tolerance and was unable to lift more than five or ten pounds. For these reasons, our client was incapable of working full time. She was awarded disability benefits from the Social Security Administration. Though Aetna denied her claim, we were able to get her benefits reinstated.
In order to qualify for Social Security Disability, you will need to satisfy a few specific requirements in two categories as determined by the Social Security Administration.
The first category is the Work Requirements which has two tests.
- The Duration of Work test. Whether you have worked long enough to be covered under SSDI.
- The Current Work Test. Whether you worked recently enough for the work to actually count toward coverage.
The second category is the Medical Eligibility Requirement.
- Are you working? Your disability must be “total”.
- Is your medical condition severe? Your disability must be “severe” enough to interfere with your ability to perform basic work-related activities, such as walking, sitting, and remembering.
- Is your medical condition on the List of Impairments? The SSA has a “List of Impairments” that automatically qualify as “severe” disabilities. If your disease is not listed this does not mean you cannot get disability, it means you must prove you cannot maintain employment due to your limitations.
- Can you do the work you did before? SSDI rules look at whether your medical condition prevents you from doing the work you did prior to developing the condition.
- Can you do any other type of work? If you cannot do your prior work, an evaluation is made as to whether you can perform any other kind of work.
More details can be found on our Qualifying for Disability page.
Disability benefits are an important source of income for those who are unable to work. If you not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Lloyd Bemis has been practicing law for over 35 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Bemis obtained dual board certifications from the Texas Board of Legal Specialization. Lloyd is admitted to practice in the United States District Court - all Texas Districts and has argued before the U.S. Court of Appeals, Fifth Circuit. Mr. Bemis is a member of the Travis County Bar Association. He has been active in the American Association for Justice and is a past Director of the Capital Area Trial Lawyers Association. Mr. Bemis and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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