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Spinal Fusion and Social Security Disability

Social Security Disability Benefits for Spinal Fusion

If you have suffered from a spinal disorder that has resulted in you undergoing spinal fusion, but you are still unable to work, you may be eligible to qualify for Social Security disability benefits. To qualify for Social Security disability for spinal fusion, your condition must meet one of the several listings for spinal disorders in the SSA's Blue Book.

Spinal fusion is a surgical procedure that involves connecting two or more of the vertebrae in your spine to create a solid piece. A major surgery that takes several hours, there are several different approaches for this surgical procedure.

Bone can be taken from a bone bank or the pelvic bone to bridge the vertebrae and help new bone growth. Metal implants will hold the vertebrae together until there is new bone growth. The procedure has grown in popularity and several thousands of people undergo it each year.

Back surgeries have risks, including infection, damage to the spinal nerve, instability of the spine, and degeneration. In order to be eligible to receive disability benefits for spinal fusion, your back condition needs to meet one of the disability listings in the Social Security Administration (SSA) medical guide. This guide, which is called the Blue Book, consists of the qualifying conditions for disability benefits.

Disability benefits are provided monthly to those who are approved to help with the costs of living while you are unable to work. In order to get benefits, you must have a condition that has lasted a year, will last a year, or that will result in death.

The Cost of Spinal Fusion

As one can expect, spinal fusion is an expensive procedure. Spine Health estimates the cost of spinal fusion to be about $115,000. It is a major surgery that takes hours to complete. It does require a hospital stay. You are not required to have bedrest when you go home from the hospital, but you do have to perform light duty work for a while. Complications can result in longer downtime and cause even more expenses.

Even those with insurance will have copays and coinsurance costs ranging from 5% to 50%. Those who won’t have the procedure covered by health insurance will have a substantial out-of-pocket cost for the treatment option.

Your Spinal Fusion may qualify you for Social Security disability benefits.

Medically Approving for Disability Benefits

The Social Security Administration (SSA) uses the Blue Book, which is a medical guide, to determine if an individual is disabled. Your condition has to meet the criteria of one of the disability listings for back problems in order to get medically approved for benefits. There are several listings for spinal disorders in the Blue Book. If your condition from spinal fusion meets a listing, or if your impairments weren’t corrected by the surgery, you may be able to meet the Blue Book listing.

In the Blue Book, Listing 1.04 covers Disorders of the Spine. If you are seeking benefits using this listing, you have to show that you have one of the following problems:

  • Compression of the nerves of the spine resulting in muscle weakness, pain, and movement of the legs OR
  • The membrane surrounding your spine is inflamed, causing pain or severe burning that makes you have to reposition at least one time every two hours OR
  • A narrowing spinal canal that causes weakness, difficulty walking or pain.

If you can prove that you have impairments that have similar severity and duration of another listing, you may be able to get approval for benefits using that approach as well.

Listing 1.03: Reconstructive Surgery or Surgical Fusion of Weight-Bearing Joints applies to surgery or fusion on a weight-bearing joint, such as the wrist or hand, ankle or foot, shoulder, hip, elbow, or knee. In order to meet this listing’s requirements, you have to show that you cannot walk effectively and that you didn’t return to walking normal after the surgery and it isn’t expected to return for normal for at least a year after the onset. While the spine isn’t specifically included in this listing, limitations on walking that can result from or not be corrected from back surgeries are similar to those that occur from injuries or surgeries involving the weight-bearing joints.

There are several listings that you may be able to use for your disability caused by spinal fusion or pre-existing spinal problems that were not corrected during the major surgical procedure. By looking through the Blue Book, you can find several listings that relate to spinal issues or the symptoms that you may be experience, such as difficulty with mobility, the inability to stand for long periods, and other problems.

Getting Disability Approval by Using a Residual Functioning Capacity

If you can’t meet the requirements of a medical listing to gain approval for disability benefits, you can still get approved with the help of a residual functional capacity (RFC). The RFC is a detailed form that your treating physician can complete to explain your condition, your treatments, your side effects and symptoms, and even your limitations and restrictions.

As an example, if your back pain and burning are so severe that you have to reposition every hour, your physician should note that on your RFC. It will also indicate if you are unable to bend and lift, carry more than 10 pounds repeatedly, walk long distances, or sit more than two hours without repositioning. With the RFC, your physician can clearly demonstrate to Disability Determination Services how you are limited and why you are unable to work.

As part of the medical-vocational allowance, your age, work experience, transferrable skills, and education level will be considered. When it is determined that you are unable to work, you will be approved for disability benefits. The monthly disability benefits can be used to help with your general living expenses.

How to Apply for Benefits

To start the Social Security disability application, you can go online at www.SSA.gov or call 1-800-772-1213. You can also apply in person at your nearest SSA office. You can enlist the help of an attorney. The claims process is complicated. It takes an average of five months for a disability claim to be processed. You may face two denials, but appeals can be filed. The final step is a hearing before an administrative law judge to rule on your case. Your odds of approval are much greater with the help of a disability attorney.