Obtaining disability benefits for Spondylosis
Can I get disability benefits if I am suffering from the effects of Spondylosis?
Author: Attorney Lloyd Bemis
Spondylosis is a form of spinal arthritis that can lead to neck pain, back pain or loss of normal spinal function. Often called spinal osteoarthritis, the term is often used interchangeably with degenerative disc disease, but should not be confused with spondylitis, an inflammatory form of arthritis.
If you are suffering from the effects of Spondylosis you may qualify for disability benefits.
It is estimated that 85% of adults over the age of 60 experience some degree of spondylosis, but is a relatively common condition that may even begin between the ages of 20 and 50.
While some cases are not serious, others can result in pinched nerves and serious symptoms that prevent a person from holding any type of job.
Spinal discs act as cushions between vertebra in the neck and back, but as people age, these discs become dry, stiff and thin, placing stress on muscles, joints, and ligaments resulting in pain and decreased range of motion.
There are three types of spondylosis: cervical spondylosis that occurs in the neck, thoracic spondylosis that occurs in the upper or mid-back, and lumbar spondylosis in the lower back. Over time, spondylosis can lead to compression of spinal nerve roots, bone spurs, and herniated disks.
Some people with spondylosis have no symptoms, while others have symptoms that come and go or become worse with time and certain activities, such as sitting for a long period of time.
The most common symptoms include:
- Back pain
- Neck pain
- Muscle spasms
- Inability to turn the head or bend the neck
- Loss of balance
- Difficulty walking
- Lack of coordination
- Grinding noise or popping when turning the neck
- Numbness or tingling in upper and lower extremities
- Shooting pain down the leg
If you are suffering from the effects of Spondylosis 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!
Any of the above symptoms can interfere with your work life.
If spondylosis leads to nerve root compression, it can impact your ability to walk. Numbness and weakness in your fingers can prevent data entry, styling hair, or other jobs that require manual dexterity.
While aging is the main cause of spondylosis, other risk factors may contribute to its development:
- Genetic factors
- Sedentary lifestyle
- Injuries to the spine
- Jobs that put repetitive stress on joints or require lifting
Unfortunately, spondylosis is irreversible because it is a degenerative process.
Treatment focuses on relieving back and neck pain using medications such as anti-inflammatories, analgesics, and muscle relaxants. Other therapies include exercise, physical therapy, chiropractic, and acupuncture. In cases where spondylosis causes nerve compression or affects an individual’s mobility, surgery may be considered.
How can I qualify for SSDI if I have Spondylosis?
If your spondylosis symptoms are advanced and you are unable to work because of pain, you may be eligible for disability benefits.
Social Security has created a manual called the Blue Book which lists impairments Social Security considers disabling and may automatically qualify for benefits. Spondylosis is not mentioned specifically, but you may be able to qualify if you can prove your disability is equivalent in severity and duration to a listed disorder. For example, if spondylosis has led to nerve root compression, you may be able to satisfy the requirements of Section 1.15 Disorders of the skeletal spine resulting in compromise of a nerve root(s).
To qualify under this listing, you must show ALL of the following:
- Evidence that your nerves are affected and you experience 1) muscle weakness, 2) nerve root irritation, tension, or compression, and 3) either sensory changes such as decreased sensation or sensory nerve deficit, or decreased deep tendon reflexes;
- Radiating pain, paresthesia (prickling or “pins and needles” type sensation), or muscle fatigue consistent with compromise of the affected nerve root;
- Imaging from MRI or CT scan showing compromise of a nerve root in the neck or lower back; AND
- One of the following physical limitations:
- Needing an assistive device that requires 1) the use of both hands such as a walker, bilateral canes or crutches, or a wheelchair, or 2) the use of one hand, but you’re unable to use the other hand for work-related activities, or
- The inability to use both hands for work-related activities.
You will be expected to provide complete medical records to Social Security, including:
- A physician’s diagnosis of degenerative disc disease
- x-rays, CT scans, MRIs and other imaging providing evidence of nerve root compression and disc deterioration
- Detailed descriptions of pain levels and motor function limitations
- Treatment notes from your doctor(s) detailing treatments and prognosis
- A list of every medication you’ve taken in the past year and your response
- Laboratory tests and results of blood work
- Records of hospitalizations and surgery
- Records from physical therapy appointments
- Records for massage, acupuncture, and chiropractic treatments
You also need to show that you are receiving regular medical treatment and following your doctor’s instructions.
A written statement from your doctor regarding your diagnosis and outlook for your recovery is extremely helpful. Be sure to see your doctor at least once every two months and discuss any difficulties you are having, such as trouble bending down to pick something up or sitting for long periods of time. Medical records that document how spondylosis has impacted your daily life very specifically over a period of months will have a greater influence on the SSA’s determination than a general statement that you have. Inform your family and friends about your condition. Social Security may call an applicant’s family members and friends to get further information about the applicant’s impairment.
If your spondylosis symptoms don’t match a Blue Book listing, you may be able to qualify for Social Security Disability benefits if you can demonstrate your medical condition prevents you from working at your old job or any other job.
Social Security is primarily interested in your functional limitations and how they impact your daily life. You may be experiencing pain, headaches, loss of coordination, difficulty walking and numbness in your fingers that affect your ability to do physical work or sedentary work. Keep a diary of your symptoms for at least 30 days to show how your daily life is impacted. Can you do laundry, shop for groceries, or pick up objects that you’ve dropped? Social Security will conduct a Residual Functional Capacity (RFC) assessment to evaluate your physical and mental capabilities to determine if there is any job you can do, taking into consideration your age, education and whether or not you can drive. Even better, ask your doctor to fill out an RFC form. If Social Security decides you cannot do your old job or don’t have the skills to perform a new job, you may be approved for a Medical-Vocational Allowance.
If you are 55 or older or have another medical condition you may get approval.
Social Security follows a group of rules to determine when the agency expects an applicant to learn a new job.
Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.
You may also be eligible for Social Security Disability benefits if you have another medical condition.
Some disorders such as scoliosis and osteoporosis may result in painful spondylosis symptoms. One disorder alone may not meet the criteria 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.
Social Security also has basic financial requirements.
You must satisfy some basic financial requirements to be considered eligible for Social Security disability benefits.
You must: 1) have a disability that has lasted or is expected to last 12 months; and 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 is $1,470 per month in 2023 for nonblind applicants and $2,460 per month for blind applicants.
What if I don’t qualify for SSDI?
If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan 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. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
Yes, you should file a claim as soon as you become disabled.
Long-term disability insurance (LTD) is coverage that protects 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. But, do not quit your job before you file a claim because LTD coverage is good only as long as you are employed and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware 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.
Don’t be discouraged if your initial application is denied – most are – and you will have the opportunity to appeal. There are four steps to the Social Security 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 at this point, now is the time to obtain legal counsel. This is a critical point in the process and will 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 spondylosis and cannot work, you may be eligible for Social Security Disability benefits, but qualifying is difficult and your chances for approval are increased significantly if you have legal representation.
At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. 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 a long-term disability insurance claim?
Whether you have a long-term disability 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.
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.
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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