If you suffer from one or more herniated discs that cause severe pain or limit your activity severely, including the inability to work, you may be eligible to receive Social Security Disability benefits. Social Security Disability Insurance (SSDI) is a program administered by the Social Security Administration (SSA).
In order to be eligible for SSDI benefits, you have had to work long enough to earn enough credits and paid sufficient taxes to the SSA. The spine’s vertebrae are separated by soft cushions that seem to be elastic. These cushions are referred to as spinal discs. As someone ages, the discs lose elasticity.
A herniated disc, also called a ruptured disc, is the result of the cushioning material being pushed from its position between the two vertebrae and then allowing irritation of the nerves near the disc to become pinched, compressed or irritated. This can be the result of something sudden, such as an accident, or it can occur gradually from repeated stress on the spine.
Herniated discs can cause severe back pain, weakness in the legs or leg pain. It frequently occurs in conjunction with spinal stenosis, which is the result of the spinal canal and the vertebral openings where the nerves pass through have narrowed. Herniated discs can narrow the opening more, causing the irritation of the nerves to continuously worsen.
The SSDI application process can be very complicated and lengthy. It involves providing extensive documentation that gives evidence of your condition and how it impacts your functioning. Herniated disc can result in the inability to perform daily activities, including the complete inability to work.
The Cost of Treating Herniated Disc
Herniated discs involve doctor visits and physical therapy, all of which result in copays and coinsurance costs for those who have health insurance. Of course those without insurance can expect to pay those costs out of pocket, which may run a few thousand dollars each year.
According to Cost Helper, there are numerous treatment options available for a herniated disc, but more extreme cases may require a surgical procedure. While health insurance may cover some of the cost of surgery for herniated discs, the average cost ranges from $20,000 to $50,000 for the procedure.
For patients who undergo surgery, there is a lengthy recovery process involving therapy. It usually takes about 6 weeks to recover following the surgery. In addition, medical equipment such as a walker which can cost from $50 to $200 may be required. A back brace also costs around $200.
Both before and after surgery, the doctor may prescribe some pain medications. Medications typically have copays or coinsurance expenses that you will pay as well. Depending on the prescription and your insurance coverage, the costs for medicine can range from $10 to $50.
It is very rare, but about 4% of the patients who undergo surgery for herniated disc treatment require a second surgery. The second surgery, of course, will cost about the same as the first surgery.
The SSA Evaluation and Medical Qualifications
The Blue Book is the medical guide that is used by the SSA to determine whether an individual is considered disabled per the SSA guidelines. Herniated discs are considered a disorder of the spine under section 1.04 of the Blue Book.
In order to qualify for benefits for this condition, you must be able to prove your condition is severe enough to limit your occupational and physical limitations for at least twelve months. You must have medical evidence that you have a herniated disc and meet one of these conditions:
- 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.
You must show proof of what kinds of treatment you have undergone, the impact of the treatment on your condition, and if you responded to the treatment. Your medical records need to show the severity of your herniated disc pain is disabling you are rendered unable to work.
Meeting Disability Criteria with an RFC
If you do not meet the Blue Book listing for disability with your herniated disc, you may still qualify with a medical vocational allowance using a residual functioning capacity (RFC) form. This form, completed by your physician, clearly states any limitations caused by the condition.
It will specify any symptoms, treatment and the prognosis. With this detailed form, Disability Determination Services will be able to decide if you can return to work or not. No partial disability or short-term disability can be awarded.
The SSDI program only recognizes those who are fully and permanently disabled for a minimum of a year. The RFC will specify how the pain and weakness impacts the ability to stand and how you must reposition frequently. It will indicate if pain medications are needed and if they cause drowsiness which can impact your ability to work.
Any limitations the doctor has put on lifting or carrying items needs to be specified, such as lift no more than 10 pounds three times a day or carry no more than 5 pounds for 20 feet. Used together, all of these descriptions paint a clear picture of how your disability has limited your ability to perform your work duties.
This documentation will be considered along with your work history, work skills, educational level and age to determine whether you can find gainful employment in another field or a different position. After the SSA has determined you are unable to adjust to another kind of work and be gainfully employed, you may be approved for benefits.
Applying Specific Medical Tests to Your Case for Disability
There are several medical tests that are used to determine whether an individual has herniated discs. These tests include MRIs, CAT scans and x-rays. Detailed medical records include tests documents and physician notes should be included when you apply for SSDI benefits.
The SSA may order a medical evaluation, at their expense, to confirm information supplied in your medical charts. This exam is used for informational purposes only during the decision making process and may involve simple tests such as x-rays.
Sometimes a mental evaluation may be ordered to see if depression or anxiety are hindering your ability to work as well. The SSDI application process is long and drawn out. It can take months before you get a decision and after denials and appeals, the process may take a couple of years to resolve.
Your Herniated Disc Disability Case
If you are considering claiming Social Security disability based on herniated discs, or have already made a disability claim and been denied, consider consulting with a Social Security disability lawyer. Most Social Security lawyers offer an initial consultation at no cost to you and they will only charge you if your claim is approved and you are awarded Social Security disability benefits.
Studies show that the chances of receiving an approval improve significantly at all stages of the claims and approval process when a claimant is represented by an attorney who regularly deals with Social Security disability claims.