A spinal cord injury is when the bones, tissue, or nerves around the spine become damaged, which can lead to loss of function. Most spinal cord injuries are the result of some sort of accident, and not disease.
To receive disability benefits for a spinal cord injury, there are certain types of medical evidence you can show to the Social Security Administration (SSA) to help your claim.
Keep in mind that most spinal cord injury claims are based on pain, which is difficult to be measured by medical tests. Therefore, the pain or limitations you experience can be worse than the evidence you provide is able to prove. Because of this, the SSA will often make their decisions based on your own claims and statements instead of your medical history, and they will attempt to determine whether your disability caused by pain is truthful or exaggerated.
There is certain medical evidence that you should provide to the SSA. Helpful tests to include with your claim are any x-rays or MRIs of your spine that were taken around the time of your injury.
When determining if you are eligible for disability benefits, the SSA will also look at any functional limitations to your ability to work. Functional limitations are any activities you aren’t able to do because of your spinal cord injury. This is arguably the most important evidence you can provide to the SSA for a spinal cord injury claim, and these activities will be included in your Residual Functional Capacity assessment, or RFC.
Your RFC shows how much work you can reasonably expected to perform with your spinal cord injury. While the SSA will prepare an RFC for you based on your own medical history and records, it is especially helpful if the doctor responsible for treating your spinal cord injury also fills out an RFC for you. The opinion of a spinal specialist will be more valuable to the SSA when they determine your eligibility.
There are certain functional limitations that may make you eligible for disability benefits with your spinal cord injury. It is important that these disabilities are well documented in your medical history. These limitations can include:
- If you are unable to walk for more than one block without needing to take a break
- If you can’t bend over or stoop down
- If you can’t lift objects over ten pounds
- If you can’t sit up or stand for at least two hours per day
- If you need to keep one leg elevated throughout the day
- If you must be able to move around or change positions frequently
- If you need to lay down for most of the day
- If you can’t sit down for at least six hours during a workday
A final step for the SSA in determining your eligibility for disability benefits is your credibility. For this, they will look at your medical history as well as statements by your doctors and previous employers, your daily activities, your medical treatment and medication history, and more. It is important that your statements and those of your doctors remain consistent to potentially qualify you as disabled.
Understanding the Process of Filing for Disability Benefits
If you have been told that you have a spinal cord injury and your recovery time is likely to take a long time you may be eligible for disability benefits to cover the financial loss while you are unable to work. It is never easy filing an application for disability benefits and you may find it is the most stressful thing you have ever done in your life.
However, if you understand how disability benefits are allocated and how the process of filing for the benefits takes place this makes the whole process easier to understand. Some of the reasons for delays in receiving disability benefits is due to mistakes that have been made in the application in the first place.
The Requirements Set by the SSA to Qualify for Disability Benefits
One of the ways to save wasting time when preparing an application for disability benefits is that you must be certain that your disability must have lasted or expected to last at least 12 months. If you are unable to match this requirement you won’t qualify for benefits. If you do qualify then the next step is to find spinal injuries in the Blue Book listing. This will help you determine if your spinal injury is likely to qualify for disability benefits. Spinal cord injuries can be found in the blue book under section 1.04—titled Disorders of the Spine.
In order to qualify for disability benefits using this listing, you need to provide medical evidence which shows you have damage to your spinal cord. You will be asked to provide proof that your spinal injury has caused nerve root compression. The symptoms of this are pain, weakness, and the lack of ability to move around with ease. This has to be demonstrated by providing medical images, your doctor’s statements about your injury, and your medical record showing surgery that has been completed and any other key treatments that you have received.
If you find you are unable to qualify through this listing, but you are paralyzed it is possible you could qualify under 11.00 in the Blue Book listing which is titled “Neurological Disorders.” If again you are unable to meet the requirements in this blue book listing there is still another option available to you and that is the medical vocational allowance. The SSA will assess your claim based on factors such as your age, skills, and current functional capacity which helps to determine if you are capable of undertaking any work.
Completing Your Initial Application For Disability Benefits for a Spinal Injury
You can file your initial application for disability benefits online, using the phone, or going in person to your local Social Security Administration (SSA) office. However, before you do this you should have all the necessary evidence to include with your application which you should get from the doctor treating you. This should include the following:
- the progression of the spinal injury;
- the spinal injury symptoms and how they affect you
- the location of the spinal injury;
- what treatment you have been getting and the results;
- prediction for future outcomes;
- imaging scans indicating the location of the spinal injury;
- records showing your hospital admissions;
- surgical and lab reports, if applicable;
- facts describing how the symptoms affect your ability to undergo everyday activities.
The most important thing about filing an application for disability benefits is taking your time so that you can gather all the information you need to support your application. If you rush you may make some errors or there may be some ambiguities in your application that could hold the decision up until they have been solved. If you are waiting for some test reports, be patient and don’t submit your application without them. The more details you provide the better it will be for you in the long run.
If you leave out any vital medical evidence because it is taking too long to get it this could hold up your application so you should take your time. You may be told you need an RFC assessment. If your physician agrees s/he can complete this form for you as they have the best knowledge about your disability and what you can and can’t do. The SSA takes what is filled in on the RFC seriously so it has to be completed accurately as the result of your claim may depend on the SSA evaluation of your RFC.
Don’t Expect a Quick Decision from the SSA
The SSA takes its time when considering disability claims so don’t expect to hear as soon as you have filed your application. In most cases it will take several months before you will be told about the decision. If the SSA decides to approve your claim, your disability benefits should begin within a few months. If you have already waited more than five months you will be awarded back pay on top of your monthly disability benefits.
Speak to a Qualified Attorney
An experienced and qualified disability attorney can use his/her accumulated knowledge about the SSA’s decision making process and can complete what’s required about your spinal injury on the application on your behalf. You can be rest assured that the attorney will make this time-consuming task far easier and will ensure all the evidence needed to support your spinal injury claim including the RFC is both accurate and complete. You may be surprised how well an attorney can simplify the process.
If your initial application is denied and you want to go through to the reconsideration stage your attorney can work with you to improve your chances of winning. Even if that fails there are still other processes allowed by the SSA including ALJ Hearing, the Appeals Council, and finally the Federal Court.
An attorney can be there to help you until you finally get what you deserve, financial security to help you bear the obstacles caused by your spinal injury. You don’t need to pay any upfront fees and you only pay once your SSDI has been won. There is a cap of $6,000 on legal fees, or 25 percent of your back pay.