Patients with lumbar spinal stenosis may be unable to work because of their condition and its related complications. Patients who find themselves unable to work because of their lumbar spinal stenosis may qualify for long term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.
What Is Lumbar Spinal Stenosis?
Lumbar spinal stenosis is a medical condition that affects the spine causing narrowing of the spinal canal and compression of the spinal cord and nerves.
The word stenosis stems from the Greek word for “choked,” which is an example of what happens to the spinal column in those who suffer from this condition. The nerves in the spinal cord are literally choked off causing leg pain, difficulty walking, tingling, weakness, or numbness that radiates from the back down into the legs.
Because lumbar spinal stenosis is typically a degenerative condition, most people who receive a diagnosis of spinal stenosis are over age 50. It is less common for younger people to experience lumbar spinal stenosis, but it can happen in cases where a person has a curvature of the spinal cord or a spinal injury.
What are the Symptoms of Lumbar Spinal Stenosis?
The severity and effects of lumbar spinal stenosis are different for each person; for some, the pain, weakness, and numbness tend to come and go. People affected with this condition may have relatively pain-free periods with flares of pain or discomfort based on a number of different factors including physical activity or strain. Generally, symptoms that accompany a diagnosis of spinal stenosis include:
- Weakness of the limbs (upper and lower);
- Reflex abnormalities;
- Radicular pain in the arms;
- Sensory deficits;
- Wasting of the muscles;
- Leg pain; and
- Trouble walking.
How is Spinal Stenosis Diagnosed?
When a patient presents with leg pain (with or without back pain) that is aggravated by walking, or episodes of weakness or numbness in the legs, a physician will generally order an MRI scan or CT scan to make a diagnosis. The type of spinal stenosis that is found may fall into one of the following categories:
- Lateral Stenosis– This is the most common type of stenosis that occurs when a nerve root is found to have left the spinal canal and is then compressed by a bulging disc, herniated disc, or bone protrusion.
- Central Stenosis– This condition occurs when the central canal in the back is compressed and “choked” off.
- Foraminal Stenosis– This occurs when nerve roots in the lower back are pressed on and trapped by a bone spur in the opening where the nerve root leaves the spinal canal.
Treatment options for spinal stenosis often include anti-inflammatory NSAID pain relievers, physical therapy, and chiropractic care. In severe situations, back surgery may be necessary.
How Lumbar Spinal Stenosis Can Impact a Person’s Ability to Work
Because lumbar spinal stenosis is a degenerative illness, a person’s condition will continue to deteriorate over time. The resulting pain, numbness, or weakness can impact a person’s ability to carry out meaningful employment.
Many patients with lumbar spinal stenosis experience comfort while sitting but become symptomatic when standing upright. That is because the space that’s available for the nerve roots blocks the flow of blood from around the nerve. This congested blood irritates the nerve and ultimately causes pain when standing.
For that reason, your long term disability (LTD) insurance provider will seek to determine if there are alternative jobs that you may be able to perform that do not aggravate your condition, such as sedentary desk work. If desk work is not an option, or if you cannot sit longer than six hours without pain, your insurance company will further evaluate how well you can sit, stand, or walk and if there are any other jobs that you may be able to perform. If it is determined that your condition is severe enough to prevent meaningful employment, you may be entitled to long term disability benefits.
Medical Evidence Proving Lumbar Spinal Stenosis
You must also meet specific medical criteria to qualify for long term disability benefits. Again, in the case of lumbar spinal stenosis, you must have significant pain, and your movement or ability to walk must be limited or painful.
To prove the extent of your disability, you will likely need doctor and hospital records, laboratory test results, and sometimes a questionnaire that should be completed by your doctor. In general, the records must include the following:
- A confirmed diagnosis of lumbar spinal stenosis;
- A doctor’s note detailing the frequency and severity of your symptoms, including how your spinal stenosis impacts your ability to sit or stand over the course of an 8-hour workday;
- MRI’s or CT scans documenting degeneration in the spine;
- A history of any treatments tried; and
- Any other test results such as imaging studies or those that measure the range of motion of the spine.
Evaluating Disability for Persons with Lumbar Spinal Stenosis
The insurance company’s adjudicator is the insurance adjuster assigned to your claim. The adjuster may have your file reviewed by a physician, psychologist, or another medical disability examiner (such as a nurse practitioner) to give an opinion as to your level of impairment. The adjuster may also send you for a compulsory medical examination or functional capacity evaluation. In evaluating disability for persons with lumbar spinal stenosis, the insurance adjuster should consider all of the available evidence including the clinical course from the onset of the illness and should consider the impact of the illness on each affected body system.
If the insurance adjuster believes there is not enough information to make a decision, he or she may call or write you to find out if you have the needed information. If you do not, they may ask you or, in some circumstances, an independent medical source to provide the information.
Although your physician may reach a diagnosis of lumbar spinal stenosis on the basis of your symptomatology (after ruling out other disorders), your disabling impairment should still be documented by medically-acceptable clinical and laboratory findings. Statements merely recounting your symptoms or providing only a diagnosis will not usually be sufficient to be approved for long term disability insurance benefits. The insurance company should have reports documenting your objective clinical and laboratory findings. Thus, it is essential that your doctor(s) submit all objective findings available concerning your condition even if they relate to another disorder or establish that you have a different condition.
How the Insurance Company Assesses Your Residual Functional Capacity
In light of your documented symptoms, the insurance company may develop a Residual Functional Capacity (RFC) profile for you that states, for example, that due to persistent leg pain or weakness, you may need to take frequent breaks throughout the day. Because most employers would not accommodate this limitation, it would be difficult for you to obtain and maintain most jobs.
If you suffer from documented leg pain, numbness, or weakness from your spinal stenosis, your RFC may include limitations on certain work-related physical activities as well such as walking distances or lifting anything over 10 pounds that could further strain the back. This limitation would prevent you from doing jobs that required physical exertion such as factory work, warehouse work, and most janitorial positions.
Living with chronic pain from lumbar spinal stenosis can also cause mental health problems such as depression or anxiety. If you are receiving mental health treatment, you should ask your treating physician (your psychiatrist or psychologist) to fill out a mental RFC form that details his or her opinions of your work-related limitations.
Work With an Experienced Long-Term Disability Insurance Attorney to Ensure You Get the Benefits You Deserve
Your best chance of having a long-term disability case approved because of lumbar spinal stenosis comes by working with an experienced long term disability lawyer. Even if you have been denied benefits, that does not mean your fight is over. Many people are denied benefits the first time they apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.
Your long term disability attorney will be familiar with how your insurance provider handles spinal stenosis claims and will help you prepare your application and collect essential evidence. It’s important to note that your long term disability attorney does not get paid until you do, so you can proceed with your case without fear of upfront legal bills or costs.
If your LTD claim has been wrongfully denied or terminated and you’d like to speak to an experienced long term disability insurance attorney about your degenerative spinal condition and how it may be impacting your ability to work, contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine if you will be able to access long term disability benefits and how to move forward with the process.