Back Injuries and qualifying for Social Security Disability
Can I get disability benefits if I am suffering from the effects of Back Pain?
Author: Attorney Lloyd Bemis
Back pain is one of the world’s biggest health issues and one of the most common reasons people see a doctor or miss work. It is estimated that 80% of people in the United States will experience back pain at some point in their lives. Back pain can be a sharp or shooting pain, or a constant ache. If you are suffering from the effects of back pain you may qualify for disability benefits.
Can I Qualify for SSDI With Chronic Back Pain?
There are two types of back pain: acute (or short term) and chronic.
Acute back pain usually resolves on its own in a few days to a few weeks and there is no loss of function while chronic back pain continues for 12 weeks or longer, even after an injury or underlying cause has been treated. The following are some examples of common back problems:
- Disc degeneration, an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column breaks down.
- Traumatic injury, such as a car accident or a sports injury.
- Compression of a nerve root in the spinal column.
- Herniated or ruptured disc, a condition that occurs when the rubbery cushions between the vertebrae of the spine become compressed and rupture.
- 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).
- Sciatica, caused by compression of the sciatic nerve.
- Spondylolisthesis, a condition where a vertebra slips out of place and pinches the nerves.
In addition to a patient’s description of pain, one or more tests may help determine the cause of back pain.
These tests include:
- x-rays to show arthritis or broken bones;
- MRIs and CT scans to show herniated disks or problems with nerves, tissue, muscles, and blood vessels;
- blood tests to determine if an infection is present; and
- nerve studies that can confirm pressure on nerves.
If you are suffering from back pain and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? Just give us a call, we love to help folks just like you!
Though most cases of back pain get better within a month, others may last much longer.
Among the treatments recommended are pain relievers, muscle relaxants, topical pain relievers, anti-depressants, physical therapy and, in severe cases, surgery.
How Can I Qualify for Social Security Disability Income?
The Social Security Administration provides a manual called the Blue Book that contains a listing of impairments that can automatically qualify for disability benefits.
Although there is no specific listing for chronic back pain, the Blue Book does list conditions such as spinal stenosis, nerve root compression, spinal fusion issues, arachnoiditis and spondylitis, which can lead to chronic back pain. Approval for chronic back pain is not based on symptoms alone, but depends on the extent and duration of your back pain and how it impacts your daily life and ability to earn a living. Most important, you will need proof of a medically determinable impairment (MDI). A medically determinable impairment is documentation that shows your back pain is caused by a physical abnormality of the spine or spinal canal.
You will need to submit the following medical evidence to Social Security:
- Diagnosis of a specific condition leading to chronic pain.
- Complete medical records including MRIs, x-rays, CT scans, blood tests and nerve studies.
- Doctors’ notes showing your level of pain, triggering events, and rate of recurrence.
- Medications used, efficacy and side effects.
- Treatments used to relieve pain and your response.
- Doctors’ notes should include how chronic back pain impacts your daily life.
You may be asked to fill out an ADL form (Activities of Daily Living) to describe how chronic back pain impacts your normal day.
Consider your daily tasks fairly and don’t exaggerate as that may damager your credibility. Among the questions you should ask yourself:
- What tasks are you no longer able to do?
- What tasks take longer than normal?
- Is your social schedule the same or has chronic back pain kept you from going out?
- How has pain affected you psychologically?
- Are you depressed or moody and has that alienated you from others?
- Does pain keep you from thinking clearly or remembering?
- Unable to sit 6 hours.
- Unable to stand 2 hours.
- Unable to walk 1 block without stopping.
- Unable to carry 10 lbs. during a work day
- Needing to lie down during the day.
- Must keep one or both legs elevated.
- Unable to bend over and lift.
- Unable to reach overhead.
Any of the above could interfere with maintaining full-time employment.
Social Security may also contact your friends and family to ask about your normal activities and if your pain is noticeable to them.
Your treatment history and doctors’ opinions are very important in getting approved for disability benefits.
Social Security will use your medical records and doctor’s opinion to conduct a residual functional capacity (RFC) assessment to determine if you can perform your last job or any job taking into account whether or not you are able to drive, your age, and your level of education. You should ask your doctor for a statement detailing your limitations and restrictions.
For example, you might have the following restrictions caused by back pain:
Age or another medical condition may help you get approval.
Social Security may find that your old job is too strenuous and depending on your age and job experience, Social Security might not expect you to learn a new job.
Social Security follows a set of medical-vocational grid rules to determine when the agency expects an applicant to learn a new job. Disability applicants who are older than 50 or 55 will often fall under a grid rule, which means they don’t have to learn a new job; for example, a 55-year-old man who has worked in construction all his life and has little experience with computers. If you can’t go back to your old job and you don’t have to learn a new one, Social Security will likely grant you disability benefits.
Additionally, you may be eligible for Social Security Disability benefits if you have another impairment, such as high blood pressure or asthma.
By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.
What are the basic financial requirements for SSDI?
You won’t be approved for SSDI if you don’t meet Social Security’s basic financial requirements.
You must: 1) have a disability that has lasted, or is expected to last 12 months; 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which in 2023 is $1,470 per month for nonblind applicants and $2,460 per month for blind applicants.
What if I don’t qualify for SSDI?
If you earn too much income or don’t have enough work credits, you may be eligible for disability benefits through another Social Security program, like Supplemental Security Income (SSI) or from long-term disability insurance through your employer or a privately purchased policy.
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. It is based on income, not work credits, and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
Long-term disability insurance (LTD) is coverage to protect your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company.
Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. If you have an LTD policy, your coverage is good only as long as you are employed, so do not quit your job before you file a claim. Be sure to check the policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Note that long-term disability insurance companies can require a claimant to also apply for SSDI.
How do I file for Social Security Disability benefits?
You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.
Do not be discouraged if your application is denied – most initial applications are. You will have the opportunity to appeal. There are four steps to the appeal process:
- File a Request for Reconsideration with the Social Security Administration to completely review the case.
- If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI and SSI cases and either uphold or overturn decisions to deny SSDI or SSI benefits. If you are not represented by an attorney, you should obtain legal counsel at this critical point to raise your chance for success.
- If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
Do I need a disability attorney for SSDI or SSI?
If you have chronic back pain, and it has prevented you from working for at least 12 months, you may be eligible for Social Security Disability benefits.
However, few claims for chronic back pain are approved, and applying for Social Security Disability benefits is a long process that can take months to years. If your claim is denied, your chances of approval are increased significantly if you have legal representation. At the request for reconsideration and hearing levels, an attorney can collect and submit relevant medical evidence, obtain doctors’ opinions, draft a brief to the ALJ, and prepare you for questioning by the judge. An attorney can also elicit helpful testimony from you and cross-examine vocational and medical experts, demonstrating your inability to work. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.
Do I need a disability attorney for LTD?
Whether you have a long-term insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process. The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.
The attorneys at Bemis, Roach & Reed have wide experience in representing clients at all levels of the Social Security Disability process and in long-term disability insurance cases.
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.
At The Texas Disability law firm Bemis Roach & Reed, our attorneys are committed to helping injured or disabled clients receive the benefits they deserve. Mr. Roach is AV Preeminent and SuperLawyers rated and has become a recognized leader in the field of Long Term Disability law. Mr Bemis focuses his practice on Social Security disability while Mr Reed handles both LTD and SSDI claims. Both are AV Preeminent and SuperLawyers rated and all our attorneys have been successfully helping people fight for their rights against big insurance companies and the government since 1993. If you have applied for benefits and been denied call 512-454-4000 for a free consultation and get help NOW.
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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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