Table of Contents
- What is a Spinal Fusion?
- Is Spinal Fusion a Disability?
- How to Qualify for Disability with Spinal Fusion
- Medical Evidence Needed
- Treatment Evidence Needed
- Getting Approval Using a Residual Function Capacity
- Spinal Fusion Disability Rating
- Permanent Restrictions
- Common Problems After Spinal Fusion
- Retraining as a Reason for Denying an SSDI Claim
- How to Apply for Benefits After a Spinal Fusion
- Get a Free Case Evaluation
- Additional Resources
- Related Content
What is a Spinal Fusion?
Spinal fusion is a surgical procedure that involves connecting two or more of the vertebrae in your spine to create a solid piece. Spinal fusion is a major surgery that takes several hours.
There are several different approaches for this surgical procedure. One approach involves taking bone from a bone bank or the pelvic bone to bridge the vertebrae and help new bone growth. Another approach is using metal implants to hold the vertebrae together until there is new bone growth. Spinal fusion is a procedure that has grown in popularity and several thousands of people undergo it each year.
Anterior Cervical Discectomy with Fusion (ACDF) surgery is a surgery that combines both spinal fusion and spinal decompression. As one might expect, it is a major surgery. And many people suffer from permanent restrictions after ACDF surgery.
Is Spinal Fusion a Disability?
Yes, as per the guidelines set forth by the United States Social Security Administration (SSA), spinal fusion is indeed considered a disability. However, it’s important to note that spinal fusion (as a condition by itself) does not have its own listing in the SSA’s Blue Book—the official manual used by the SSA to assess all disability claims. Instead, spinal fusion falls under the broader classification of Section 1.04 - “Disorders of the Spine” in the Blue Book. It is important to note that, to qualify for disability with spinal fusion, you must be unable to work for at least 1 year due to your spinal fusion.
The classification of spinal fusion under Blue Book Section 1.04 - “Disorders of the Spine” stems from the fact that the procedure is primarily utilized to correct spinal issues, and its effects can significantly impact an individual’s functional abilities. The implications of spinal fusion surgery can vary depending on the success of the procedure as well as the individual patient’s response. Post-surgery, individuals may experience a range of symptoms, which may include—but are certainly not limited to—infection, spinal nerve damage, instability of the spine, and degeneration of the spine.
One notable consequence of spinal fusion surgery is that many patients experience permanent restrictions in their daily activities and functionality. These restrictions can hinder one’s ability to work and lead to a diminished quality of life. As a result, if an individual is unlikely to be able to work for at least the next 12 months due to the effects of spinal fusion surgery, they may qualify for Social Security Disability Insurance (SSDI) benefits.
The SSA’s determination of spinal fusion as a disability is based on the understanding that this surgical procedure can result in significant and lasting impairments. In evaluating disability claims related to spinal fusion, the SSA considers the severity of the symptoms, the impact of the surgery on the applicant’s ability to perform work-related tasks, and the expected duration of the disability. The crucial factor is whether the limitations caused by spinal fusion surgery make it impossible for an individual to engage in substantial gainful activity (SGA), which refers to the work that provides a substantial income.
How to Qualify for Disability with Spinal Fusion
Before submitting an SSDI application, you need to be sure that you qualify. The main eligibility criterion for SSDI benefits is having a disability that will prevent you from working in any type of job for at least 12 months.
To qualify for SSDI benefit payments, you must have paid a sufficient amount into the SSDI program.
The SSA uses work credits to understand how much you’ve worked. In 2023, one work credit is accumulated for every $1,640 you earn via your paycheck. You can earn a maximum of four work credits each year. So, once you’ve made $6,560 in a calendar year, you will have earned the maximum of four work credits for that year and, thereby, won’t be able to earn more for that year.
Generally speaking, the SSA requires 40 work credits for SSDI—20 of which were earned in the last 10 years stopping with the year that you became disabled. However, the specific number of work credits you will need to qualify for SSDI varies based on your age. The older you are, the more work credits you will need to qualify for SSDI.
If you are 24 years old or younger and you’ve become disabled due to your spinal fusion, you should be eligible for SSDI if you have worked for 1.5 years out of the past 3. Similarly, if you’re between the ages of 24 and 30 and have become disabled, you will most likely be eligible for SSDI if you’ve worked for 3 out of the past six years.
Ultimately, the rule of thumb when it comes to work credits and SSDI is that the more work history you have, the more likely you are to have enough work credits to qualify for SSDI.
Further Reading: Social Security Disability Benefits Age Chart (for Work Credits)
Medical Evidence Needed Related to Your Spinal Fusion
The first type of medical evidence that the Blue Book directly requests is a complete medical history of your spine disorder. Medical records from your physician are of vital importance.
She or he should include your presenting symptoms, the history, and progression of your spinal disease, as well as the results of a full physical examination. Be certain that your doctor addresses the following:
- Any leg pain that you experience that is caused by nerve root compression, referred to as “neurogenic claudication” or “pseudoclaudication.”
- Loss of feeling or reflexes caused by nerve root compression
- Difficulties with mobility due to numbness, pain or weakness
- Use of a walker, cane, wheelchair, or other assistive device
- Any assistance that you require due to pain, numbness or weakness
- Results of a straight leg raise test, both lying down and sitting
You can use the following diagnostic tests to support your documented symptoms:
- Imaging results such as X-rays, MRIs, or CT scans
- A complete operative record from your surgeon needs to be included in your application
- Any complications, such as failed back surgery syndrome (FBSS), that have occurred as a result of your surgery should also be carefully documented
If you are working with an orthopedist, neurologist, or surgeon, be sure to obtain your medical records from these specialists. The SSA places more weight on the opinion of medical experts.
Essentially, the most important thing here is that you convey to the SSA (1) the medical history and background that came before your ACDF surgery or spinal fusion surgery, (2) why you and your doctor decided ACDF surgery or spinal fusion surgery was needed (i.e., was the necessary and natural next step), and (3) how exactly you have suffered permanent restrictions after ACDF surgery or spinal fusion surgery that have inhibited you from being able to work and earn an income.
Treatment Evidence Needed Related Your Spinal Fusion
The SSA will need to know how you responded to your spinal fusion surgery, and most importantly, if your condition has worsened despite surgery.
As noted, many individuals who undergo a spinal fusion end up exhibiting continued pain and disability.
Be certain that your doctor has the following medical documentation available:
- Any and all medications that you are receiving as a result of your back pain or spinal fusion, as well as your response to the medications
- Complete operative reports, as well as a description of any perceived failure of the surgery
- Any injections that you require, such as steroids
- Any physical therapy or other related therapies that you are receiving
- Any mental health problems, such as depression, that have occurred as a result of your failed surgery.
Only the most severe spinal fusion surgery cases will meet a particular listing in the Blue Book. Therefore, you will need to provide as much information as you can on medications, the side effects of those medications, and any unintended consequences that have occurred as a result of the failed surgery.
If you can prove that your disability limits your ability to work for at least one year, you may still be awarded SSDI benefits.
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 form for back pain. It will also indicate if you are unable to bend and lift, carry more than 10 pounds repeatedly, walk long distances, or sit for 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.
Further Reading: Signs That You Will Be Approved For Disability
Spinal Fusion Disability Rating
If you have a spinal fusion disability rating from the VA, it does not guarantee you will qualify for SSDI. VA disability benefits and SSDI are two different benefits, but you may be able to qualify for both. When applying for SSDI, you may be able to use your VA disability rating for your spinal fusion as medical evidence in your SSDI claim.
VA disability ratings for spinal fusion determine the degree of spine movement possible without intolerable pain. This rating is a figure between 10% and 100%—with a 100% rating being the worst possible determination which means that the individual has almost no capability to move any part of their spinal column. Even though a 10% rating might mean that the individual has a restricted capacity for being able to bend the different regions of their spine, a 10% rating is better than one that is 100%. For example, the 10% rating may mean the individual has the potential for arc movement of the neck (cervical) part of the spine that is more than 30%, but not more than 45%.
VA ratings for spinal fusion—while they are part of the evidence that veterans can use to support their claim for disability payments—are not a guarantee in and of themselves. However, if your VA disability rating has been designated as 100% P & T (permanent and total)—i.e., it has been determined that there is no chance that further surgery will correct your spinal fusion damage—then your application for disability benefits may be expedited. This doesn’t mean that your claim would be guaranteed to be approved. However, it means that your disability benefits application would be reviewed more quickly than normal.
Permanent Restrictions After ACDF Surgery or Spinal Fusion
Many people who have ACDF surgery can find themselves in a position in which they are suffering from permanent restrictions after ACDF surgery—possibly as a result of the operation.
Following spinal fusion surgery, there are several work restrictions and weightlifting restrictions. Some individuals, however, recover faster and appear to have never had fusion surgery. Most people who recover return to work within six months.
A spinal fusion can cause permanent restrictions that take away someone's ability to move the segment. Some of the most common permanent restrictions after spinal fusion include:
- inability to lift heavy objects,
- inability to twist
- inability to bend.
Those who get spinal fusion surgery do see permanent restrictions due to the fact that the surgery fuses the targeted vertebrae of the spine. Because of that, it is common for people who undergo spinal fusion to have permanent restrictions or problems that often make it difficult to work full-time, especially if they work a job that requires a lot of heavy lifting. So, if you got spinal fusion and you find it difficult to continue working full time, you may want to apply for Social Security disability benefits.
Common Problems After Spinal Fusion
After your spinal fusion, there could be some common problems that could still linger after the surgery. Common problems after spinal fusion include failure of bone healing and pseudarthrosis. Pseudarthrosis occurs when a spinal fusion surgery fails.
Common symptoms of those with pseudarthrosis are pain in the neck, back, arms, and legs.
Other symptoms after spinal fusion could include neurological symptoms, such as numbness, leg pain, and pain from your neck that goes down through your arm.
6 months after spinal fusion, you should expect to do things that you could normally do before the surgery, however, if the pain persists and you feel like you can no longer work, you may want to apply for Social Security disability benefits.
If you find that you’re experiencing any of the common problems after spinal fusion discussed here, and you can’t work as a result, you may want to apply for disability benefits to get some assistance covering your living and medical expenses.
Retraining as a Reason for Denying an SSDI Claim
One thing the SSA does before making a final decision on your eligibility for SSDI benefits is to determine whether you could be retrained in another skill, which you could do with the symptoms of your spinal fusion surgery. If there is any doubt that your symptoms are really serious and you could possibly be retrained you can request a "Residual Functional Capacity" test or RFC.
When conducted, it determines what you are able to do with your disability. Sometimes the SSA may request you undertake an RFC before a decision is made about your SSDI application.
The older you are the less likely you will qualify for retraining so you will then be eligible for SSDI benefits. If for some reason you are denied disability, you may qualify for the needs-based Supplemental Security Income (SSI) benefits. Specific conditions apply to these benefits. Be sure to look out for the signs that you will be denied for disability.
Further Reading: Signs That You Will Be Denied For Disability
How to Apply for Benefits After a Spinal Fusion
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 Social Security office. You can enlist the help of an attorney or disability advocate. A disability lawyer or advocate will be able to tell you how much disability you can get. 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.
Use our Disability Calculator to see how much money you can get each month with disability benefits for spinal fusion from the SSA.
Get a Free Case Evaluation
If you speak with a disability lawyer who has worked with people who are suffering from spinal fusion to get their SSA SSDI entitlements, this will help to ensure you have provided all the documentation needed to support your claim. Often, there are delays due to insufficient documentation or gaps in the information provided. Take our Free Disability Evaluation right now to see if you qualify for disability.
Your attorney should know exactly what you will need to provide to win either an SSDI or SSI claim. You cannot expect a quick decision for your application from the SSA as processing claims for any type of disability payments often takes months—and sometimes even years—before a decision is reached. However, you can expect quicker processing if you ask an attorney to work on your behalf as they will check your application before it’s submitted.
One benefit of hiring a disability lawyer is that they don’t ask for any upfront payment of legal fees until your claim has reached a settlement. If your claim is denied, as many are first time round, you may not be asked to pay any legal fees. This is because lawyers work on what is called a contingency fee basis.
If you need clarification of how and when the legal fees are paid check with your chosen attorney before going through the hiring process. This will take the worry of receiving an unexpected bill through the mail.
As many claims are denied the first time round this shouldn’t discourage you as your chosen attorney can work through the appeals process with the hope of winning a favorable settlement for you sooner rather than later. Complete the Free Case Evaluation form on this page right now to get connected with an independent disability lawyer who can help you today—all at zero cost to you!
- Disability Lawyers Near Me
- What Medical Conditions Qualify for Social Security Disability
- What Conditions Automatically Qualify You For Disability
- Signs That You Will Be Approved For Disability
- Tips on Qualifying For Disability Benefits With a Spinal Condition
- Permanent Restrictions After A Spinal Fusion
- How to Get Approved for Disability the First Time
- Is Spinal Fusion A Disability
- Medical Evidence Needed to Qualify with Spinal Fusion
- Disability for Back Pain
- Is Spinal Stenosis A Permanent Disability