Medical Criteria to Qualify with Lumbar Spinal Stenosis

Many individuals suffer from back pain of varying degrees of severity. Lumbar Spinal Stenosis (LSS) is a condition in which the spinal canal narrows, causing compression of the spinal cord and nerves.

While some people with LSS have intermittent pain or numbness when walking, others are so severely impacted that they are unable to work.

The Social Security Disability Insurance (SSDI) program was created to assist those who have become disabled due to a condition such as lumbar spinal stenosis.

While the Social Security Administration (SSA) recognizes lumbar spinal stenosis as a disabling condition, not everyone who applies will be awarded benefits for their condition.

Your ability to win your disability claim will rest on your ability to provide sufficient medical evidence to the SSA.

Is Spinal Stenosis a Disability?

Yes, the SSA identifies spinal stenosis as a disability. As long as you have the evidence to prove you have the medical condition you will meet the SSA’s listing 1.16 for lumbar spinal stenosis in the blue book. This means providing your medical history from the time you were first diagnosed with Lumbar Spinal Stenosis.

The medical evidence you should include is the following:

  • Your symptoms,
  • The history of your medical condition;
  • How the disease has progressed since the diagnosis.

Some of the key symptoms of spinal stenosis include chronic pain in your legs as a result of nerve root compression which is worse while walking or standing in one place. This will restrict your mobility and is often accompanied by numbness and weakness. You will need to show proof if you need an assistive device to enable better mobility such as the use of a wheelchair, walker or cane.

Your doctor will need to provide written results of a straight leg test while you are sitting and lying down.  He or she will have to provide an operative note and/or a pathology report if you have had surgery. Also test results from x-rays, MRIs or CT scans are required to prove you have spinal stenosis.

Many victims of LSS typically receive treatment from medical specialists like an orthopedist, surgeon and neurologist. You will need to ask these professionals for your medical reports to support your claim for disability benefits. This may offer a greater chance of winning disability benefits for your medical condition.

The Importance of the “Blue Book”

Arguably, the easiest way to qualify for disability for LSS is to meet the requirements for the listing in the SSA’s Blue Book. The Blue Book is the list of conditions that qualify for disability. 

Lumbar spinal stenosis is listed in section 1.04 of the Blue Book, under Disorders of the Spine. The Blue Book publication, which is now entirely available online, includes a long list of impairments and their criteria that you must meet in order to be approved. In fact, being able to meet the criteria of a Blue Book listing can be one of, if not, the most important signs your disability claim will be approved.

Evidence Needed Related to Your Lumbar Stenosis Diagnosis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your Lumbar Spinal Stenosis.

As there is no specific test for lumbar stenosis, medical records from your physician are of vital importance. They should include your presenting symptoms, the history and progression of your disease, as well as the results of a full physical examination. Be certain that your doctor addresses the following in his notes:

  • Any pain that you experience in your legs that is caused by compression of your nerve roots, referred to as pseudo claudication. Typically, this pain is made worse by standing or walking and is often relieved by sitting or lying down.
  • Any difficulty that you have with mobility due to pain, numbness or weakness
  • Any required use of an assistive device, such as a walker, cane, or wheelchair
  • Any assistance that you require navigating stairs or getting in and out of a car due to pain, numbness or weakness
  • Your physician should perform and document the results of a straight leg raise test, both sitting and lying down.
  • If you have required surgery as a result of your lumbar spinal stenosis, your operative note and/or a pathology report should be included in your records.
  • Imaging results such as x-rays, MRIs or CT scans are of vital importance to provide related to your case

Most people who have LSS will be working with a neurologist, orthopedist, or surgeon. As the SSA gives more weight to professional medical specialists, you will want to ensure that you obtain records from these experts.

Medical Criteria Needed to Qualify with Lumbar Spinal Stenosis

Evidence Needed Related to Your Lumbar Stenosis Treatments

The treatment for lumbar spinal stenosis varies from person to person.

The SSA will need to know exactly what treatments you have received, your response to those treatments, and most importantly if your condition has worsened despite those treatments.

Be certain that your doctor has documented the following:

  • Any and all medications that you are receiving as a result of your spinal stenosis, as well as your response to the medications
  • Any injections that you require, such as steroids, as a result of your spinal stenosis
  • Any surgical procedures that have been performed including operative notes from the surgeon
  • Any physical therapy or other related therapies that you are getting to treat your lumbar stenosis

Evidence About Your Quality of Life and Ability to Care for Yourself

If your spinal stenosis does not meet the criteria listed in the Blue Book, you may still qualify for benefits through a medical vocational allowance. Your doctor should provide physician notes documenting his or her opinion regarding your limitations and inability to function in life.

For example, if you experience weakness in your hand that frequently causes you to drop things, be sure that you have discussed this with your doctor.

You should address any physical limitations with your physician, both those that impact your work and those that impact your personal life.

If you have trouble showering, brushing your hair, or walking around your home, be sure that you communicate this.

The SSA may want to perform a residual functional capacity (RFC) assessment to determine the extent of your limitations. You can be proactive and ask your physician to complete one for you.


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Steps You Can Take to Win Your Disability Claim

There are many concrete steps that you can take to help enhance your application for SSDI benefits for lumbar spinal stenosis. The most important thing you can do is ensure that all of your medical evidence is in order. This may require phone calls to the medical records department at your hospital or doctor’s office.

While you don’t need to provide this documentation to the SSA yourself, having the records on hand helps you to determine what information you have on hand and what you still need to collect.

A strong working relationship with your doctor is key. You will want to communicate your need for disability benefits to your healthcare providers.

The entire Blue Book is available online, and the section on spinal disorders is quite detailed, so you may want to review section 1.04 with your physician.

There are several ways that your neurologist, orthopedic doctor, or primary care physician can help including:

  • Ensuring that your full medical history related to your spine is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects

Obtaining help from an experienced Social Security disability attorney or advocate can mean the difference between you receiving the financial assistance you need or not.

You can seek a free evaluation with a lawyer or advocate in your local area. Disability advocates are only paid if you win your claim. Take our SSDI calculator to see how much you could get with disability benefits.

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