If you are unable to work because of degenerative disc disease, you may be eligible to receive Social Security disability benefits. Social Security Disability Insurance pays benefits to the disabled individual and certain dependents in his or her family if he or she has worked long enough to earn enough credit and has paid in the required amount taxes to Social Security.
In order to qualify for benefits, you must be permanently disabled. The first six months you are out of work are not eligible for payments. During the application process, the Social Security Administration collects a large amount of information, including medical records, in order to determine whether or not you do indeed meet the Social Security administration’s disability definition and are eligible to receive monthly benefits.
The Financial Costs of DDD
Just like any other disability, degenerative disc disease can be a very expensive medical problem. If you have health insurance, you will be billed copays for doctor’s visits and prescription copays as well as any deductibles and co-insurance costs. While insurance covers many treatments for the disease, there are some treatments that may be excluded.
If you do not have health insurance can expect to pay a lot out of pocket, such as $200 for hot or cold packs and non-steroidal anti-inflammatory medication prescriptions. Physical therapy can run from $50 to $350 per sessions running into thousands of dollars. Surgery can run anywhere from $20,000 to $150,000 with a microdiscectomy or discectomy being the least expensive and spinal fusion costing the most.
Additional medical appliances may be required. Canes range from $25 to $100 and walkers can be more than $200. Back braces or corsets are $200 or more. While initial treatment may start with your primary care provider, you will most likely be referred to a specialist, such as a neurosurgeon or orthopedic specialist. With insurance, you can still end up paying tens of thousands of dollars out of pocket in the long-term. Without insurance, you could end up paying hundreds of thousands of dollars for medical treatment.
These expenses do not include the money lost from missing work or the inability to work. The loss of income will make a significant impact on your financial situation, only making your financial matters worse than before.
The SSA Evaluation and Medical Qualifications
There are strict guidelines that the Social Security Administration follows to determine whether someone is disabled or not and if you qualify for disability benefits. There is step-by-step process revolving around five questions.
This process involves acquiring your medical records to determine your actual diagnosis and the prognosis of your medical issues. A list is kept of the major body systems, and for each system there is a list of medical conditions that are so severe they mean automatic approval for disability.
The Social Security definition of disability differs than the definition under other programs. Social Security will only pay for complete, total disability and not for short-term disability or partial disability. Disability, according to Social Security, is based “on your inability to work”.
The disability determination team will check to see that you cannot do the work you did before, check to see if your medical condition prevents you from adjusting to other kinds of work, and if your disability has already lasted a year or longer, or if it is expected to last more than a year and/or result in death.
According to the Blue Book, the SSA medical guide for determining what classifies as a full and permanent disability, there are specifications on how degenerative disc disorder (classified as a spine disorder listed under section 1.04) will most easily qualify. It states that degenerative disc disorder results in a compromised nerve root of the spinal cord or one of the following specifications:
- Evidence of root compressions that cause spinal pain, limited spinal movement, limited motor function and muscle weakness, and a loss of touch and reflexes. OR
- Spinal arachnoiditis (an inflammation of one of the membranes around the nervous system), which has been confirmed by an operative note, pathology report of tissue biopsy or some other laboratory testing and it results in the need to readjust your posture or positioning at least every two hours. OR
- Lumbar spinal stenosis resulting in pseudoclaudication (when the spaces between the vertebrae narrow), which is confirmed by medical testing, weakness and chronic pain that results in the inability to move properly.
Qualifying for Disability Without a Blue Book Listing Using RFC:
If your disability is not listed in the Blue Book listings of approved disabilities, you could still be eligible for disability benefits. The severity of your medical conditions is considered as are your age, your education, any of your skills that can be transferred to another job and any past work experience that you may have.
If you have more education and more transferable skills, Disability Determination Services is more likely to believe there is a job that you can still do even if it is not work you have previously done. This where the RFC can come in handy and actually help you win your claim.
The RFC, also known as the residual capacity functional assessment, is a form that doctors complete about a patient showing what they can or cannot do. One of these forms completed by your doctor can greatly increase your chances of receiving benefits. These forms are very detailed, indicating how long you can stand and sit, how much you can lift, how often you can bend and how often you can lift your hands over your head.
How to Apply Specific Medical Tests
Although Social Security will have access to your medical records, it is not uncommon for them to order an examination by a different doctor. The Social Security Administration will cover the cost of this exam. These consultative exams are not for medical treatment but to determine whether or not your claims regarding your limitations and conditions are accurate. These exams may include blood work or X-rays.
In this particular situation, the doctor will be checking to determine that your degenerative disc disease is far enough advanced that it does prevent you from working and doing the things that you used to do. You can still be determined disabled even if you make it to this advanced stage of the evaluation and determination process. With degenerative disc disorder, the odds are that you cannot stand, walk, lift or bend nearly as frequently as you did before the disease impacted your life.
Getting Help with Your Degenerative Disc Disease SSD Application
Since degenerative disc disease can qualify for SSD benefits in several ways, you must work cooperatively with your doctor to ensure your documentation satisfies one procedural review requirements for eligibility. Doing so will help decrease your wait for a determination on eligibility and could increase your chances of receiving SSD benefits as well.
Additionally, as receiving a quick and favorable decision on your eligibility is your goal, you’ll want to consider the benefits of working with a Social Security advocate or disability attorney to complete your initial application and collect the appropriate documentation for supporting your claim.