If you have been diagnosed with scoliosis and it impacts you enough that you are unable to work, you may be eligible for Social Security Disability benefits. The Social Security Administration (SSA) has a Social Security Disability Insurance (SSDI) plan that will pay monthly benefits to those who are disabled if they have worked enough to earn sufficient credits and paid in enough taxes to the SSA. The individual must either meet the requirements set forth in the SSA medical guide or be able to demonstrate they are disabled through the medical vocational allowance.
Scoliosis is not a disease, but a curvature of the spine that could vary from mild to severe. Usually, a diagnosis means the spine has an abnormal curvature that extends more than 10 degrees laterally from a frontal view. There are four main kinds of scoliosis that can be diagnosed:
- Idiopathic – this is the most common form, and it is believed to be hereditary.
- Cognenital – a curvature that is present at birth.
- Degenerative – this can result after a bone collapse following osteoporosis or a traumatic injury. It can also develop after major back surgeries.
- Neuromuscular – This stems from muscle or nerve abnormalities, and can accompany spina bifida and other conditions that impact the neuromuscular junction.
Severe cases of scoliosis can cause the spine to form an “S” shape and cause physical limitations, reducing breathing functions and lung capacity. The curvature of the spine can also cause additional pressure on the nerves, causing functioning that is slower. Sometimes the condition does not progress beyond the initial curving.
Most often, scoliosis occurs and is diagnosed as a child is in his or her growth spurt before he or she hits puberty. During the screening process, doctors look for uneven hips and differences in arm or leg lengths. Scoliosis may not have a negative impact on many people, but there are some people who are severely impacted by the spine curvature.
The Costs of Treating Scoliosis
According to Cost Helper, patients who have health insurance usually just pay for co-pays for doctor visits, co-pays for medical equipment, and the coinsurance or co-pays for surgery. Those who don’t have health insurance typically pay about $1,000 per year for treatment expenses which includes doctor visits and x-rays on occasion.
The initial bracing costs from $2,000 to $6,000 then about $1,000 each year for follow-ups with physicians and for x-rays. Surgery can cost anywhere from $100,000 to $150,000. An x-ray scoliosis study can vary from hospital to hospital and state to state, but generally from $180 to $380. The average cost for the patient who underwent surgery was $113,000.
Medically Qualifying for Disability with Scoliosis
If scoliosis has rendered you disabled, you may be eligible for SSDI benefit based on the Blue Book listing 1.04, which is Disorders of the Spine. In order to qualify under this listing, you have to demonstrate the following symptoms in order to qualify for disability benefits:
- Proof of compression of the nerve roots, which is characterized by neuro-anatomic distribution of pain, limited spine motion, sensory reflex loss that accompanies motor loss,
- Lumbar spinal stenosis that causes inflammation of the spinal cord nerves, which gets manifested by radiating weakness and pain that causes an inability to effectively ambulate.
- Pain caused by swelling of the spinal membrane, which manifests by painful discomfort or severe burning that requires a change in positioning more than one time every two hours.
If these qualifications are not met, the SSA understands that scoliosis can affect more than a spine. The Blue Book also has a listing for musculoskeletal disorders, which can include inflammatory arthritis caused by scoliosis that may make it hard to walk or move. In the event your scoliosis makes it hard to breathe, or you have heart failure or mental illness, you could qualify under a listing that applies to your particular symptoms.
Qualifying for Disability without Meeting a Listing in the Blue Book
If you don’t meet the requirement of a Blue Book listing, you may still meet the requirements using a vocational medical allowance, which considers your symptoms, medical conditions, age, work experience, transferable skills, and your ability to transfer your skills and experience into another profession.
Your physician can help your case with a residual functioning capacity (RFC) form, which explains how scoliosis and other conditions combined have impacted your ability to work and function normally. It gives precise details, such as how often you must reposition, how much you can lift, how much you can carry, your ability to bend and lift, your ability to reach and grasp, and so forth.
The more documentation you can include with your medical records, the better your evidence in your disability case. You want to be able to provide the details that they need to show that you are unable to work and how your life has been impeded by your conditions. This additional evidence from your physician will be given serious consideration as part of your disability claim.
You will only be approved for SSDI for scoliosis if it impacts your ability to work. However, it can cause debilitating conditions if it has severe symptoms and works in conjunction with other medical conditions or disorders that you have. Getting approved for disability is usually not easy with any condition, but it requires documentation and persistence.
Applying Specific Medical Tests to Your Case
Scoliosis is diagnosed with a comprehensive physical examination. There may be x-rays, CAT scans, and MRI scans may be required to determine the severity of the curvature and determine the need for surgery or a brace. The SSA may send you for a medical evaluation with a doctor of their choice at their expense, but this is just for an evaluation and information to confirm your condition.
Sometimes the SSA orders a mental evaluation as well because they understand anxiety and depression caused by a disorder can also impact your ability to work. Again this is not for treatment but for information in helping Disability Determination Services make a decision regarding your claim. Your claim can be denied twice, and you can file an appeal each time. The final stop is an administrative hearing before an administrative law judge who will rule on your disability case.