If you suffer from back pain and it makes unable to work, you may be eligible for Social Security Disability benefits. The Social Security Administration (SSA) offers the Social Security Disability Insurance (SSDI) program. The SSDI program enables individuals who have worked to earn sufficient credits and who have paid in enough taxes to the SSA to be considered eligible for benefits if specified criteria are met. In many cases, dependent children of the disabled individual are also eligible for benefits as well.
There are several conditions of the spine that can cause back pain and problems. Some of these conditions occur naturally with age, but others may happen prematurely or be the result of an accident or another condition. Some examples of back problems that may qualify include degenerative disc disorder, arachnoiditis, spondylitis, osteoarthritis, rheumatoid arthritis, herniated discs, nerve root compression, scoliosis, spinal stenosis, and spondylolisthesis.
While back pain can be very debilitating and cause agony to the individual who suffers from it, the SSA makes it a challenge to get benefits for those who suffer from back pain. In order to qualify for SSDI benefits, you have to be diagnosed with a medical condition that lasts for at least a year. Your examinations, including x-rays, MRIs, or your physician’s notes regarding an examination, indicate you suffer from an abnormality of the spine or spinal canal and that is what causes your pain and discomfort.
The Cost of Treating Back Pain
According to the Journal of the American Osteopathic Association, the cost of treating back pain has a major worldwide economic impact. Patients suffering from musculoskeletal conditions incur medical costs of about $240 billion per year in the United States.
Patients suffering from back pain can expect to pay co-pays and coinsurance for doctor visits, chiropractors, and physical therapy. There are also costs for prescriptions such as painkillers, steroids, and muscle relaxers. Some patients also have to get steroid injections. There are also tests such as x-rays, MRI scans, and CAT scans and visits to specialists.
The average individual with back pain who has health insurance pays out anywhere from $1,500 to $3,500 per year for treatment. Back surgery is expensive, and can vary in cost from $20,000 to $150,000 depending upon the kind of surgery and the hospital where it is performed.
The SSA Evaluation and Medical Qualifications
The SSA uses their own medical guide to evaluate disability benefits applications that they receive. This guide, known as the Blue Book, helps to determine whether or not an individual meets the criteria to be considered disabled and eligible for SSDI. There is no listing for back pain, but there are listings that apply to specific conditions that do cause back pain. There are several conditions that may cause debilitating back pain.
As an example, degenerative disc disease does not have a specific listing, you have to have severe symptoms such as requiring assistance to walk, needing to adjust your position more than every two hours and suffer from nerve-specific problems. It may result in additional problems that may be found under a listing in the Blue Book.
Rheumatoid arthritis, however, does have a listing in the Blue Book that refers to ankylosing spondylitis, which involves a fixation of the spine of at least 45 degrees or if you ankylosing spondylitis or another form of spondyloarthropathy with a fixation of the spine of at least 30 degrees as well as moderate involvement of two or more bodily systems.
Regardless of the cause of your back pain, you have to provide evidence of how it impacts your ability to work and causes you daily limitations. Your documents need to include notes from your physician about limitations you have when walking or standing, and if you have to have a cane, walker, or crutches in order to be mobile. These are all considered with great weight when making a disability determination decision.
Many back pain problems can be classified under Section 1.04, which deals with spine disorders. If you can prove that your particular back pain meets the equivalent for spinal disorders, you would meet the requirements set forth in the medical guide.
This particular listing includes:
Lumbar spinal stenosis – which must cause pain in the thighs, lower extremities, and buttocks resulting in difficulty walking or standing for extended time frames.
Spinal arachnoiditis – which must result in burning, pain, and the need to shift more than one time every other hour.
Nerve compression – which must cause a significant loss of reflexes and range of motion.
Using the Medical-Vocational Allowance and RFC
If your condition does not meet a listing in the Blue Book, you can still be approved for disability benefits using the medical-vocational allowance. Using this approach, your condition, symptoms, and limitations are taken into consideration with your age, education level, transferable skills, and work experience.
When using this approach, a residual functioning capacity (RFC) form will need to be completed regarding your condition. On this form, your doctor will indicate how often you will have to change positions, if you are unable to stand for longer than an hour or two hours, how far you can walk, and if you require assistive devices in order to walk, such as canes or crutches.
If your condition requires that you take pain medication regularly, the form should clearly indicate that and include how that medication impacts you as well, such as drowsiness or dizziness that it may cause. All of your symptoms and side effects from the conditions and medications should be listed. You should also include any other medical conditions that you have and how they also affect your daily living and your ability to perform your regular work duties.
When considering the medical-vocational allowance, the SSA will determine if you have skills that can transfer to another kind of work position so you can continue gainful employment in another field. If Disability Determination Services decides that you are unable to work at any job for at least a year, you will be considered disabled.
Applying Specific Medical Tests to Your Case for Disability
Several medical tests, including x-rays, MRI and CAT scans, and other tests and examinations can be used as ways to confirm that you are suffering from a disorder that is causing severe back pain and difficulty with your mobility. The SSA may order an additional medical evaluation at their expense to confirm your condition and the severity of your symptoms. The SSDI application process can be lengthy and may involve denials and appeals. In order to prove your case, you should submit as much documentation as possible to prove your case.