Back Injuries and qualifying for Social Security Disability

Can I get disability benefits if I am suffering from the effects of 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.

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.

Demonstrating that you are following your doctor’s treatment plan is an important part of qualifying for disability benefits.

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.

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.

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.

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.