Patients with a spine disorder may be unable to work because of their disease and its related complications. Those who are unable to work as a result may qualify for long-term disability (LTD) and/or Social Security Disability benefits. Common disabling spinal disorders include cervical spinal stenosis, lumbar spinal stenosis, osteoarthritis, degenerative disc disease, arachnoiditis, and herniated discs.
There are many different spine disorders that can qualify for disability benefits, but the disability insurance company and/or Social Security Administration (SSA) will have to evaluate the medical evidence to see if your condition is severe enough to be approved. There may be specific medical evidence that is required in order to be approved for disability benefits for certain disorders. For example, with arachnoiditis, the Social Security Administration requires surgical notes and tissue biopsy reports.
What are Spine Disorders?
The spine is comprised of bones called vertebrae. The anatomy of the spine is typically viewed by dividing up the spine into three major sections:
- The cervical spine (the neck);
- The thoracic spine (the mid-back); and
- The lumbar spine (the low-back).
There are 7 cervical vertebrae (C1 to C7), 12 thoracic vertebrae (T1 to T12), and 5 lumbar vertebrae (L1 to L5). Bones called the sacrum and coccyx are below the lumbar spine. The sacrum is part of the pelvis. The coccyx is the “tailbone” below the sacrum. Spinal disorders or injuries can change the structure of or damage the vertebrae and surrounding tissue. Such problems include:
- Infections;
- Injuries;
- Tumors;
- Conditions, such as ankylosing spondylitis and scoliosis; and
- Changes in the bone structure that come with age, such as stenosis and herniated discs.
A major cause of disability is the back pain that comes with spinal disorders. The pain typically occurs when bone changes put pressure on the spinal nerves and can limit your ability to work. Disorders of the spine can also limit your range of motion.
Diagnosis and Symptoms
Imaging is necessary to evaluate your impairment. A spinal disorder is typically diagnosed with one or more of the following tests:
- CT, or “Cat Scan”;
- Discography;
- Electromyography (EMG);
- MRI; and
- X-Ray.
Treatments and Therapies
Treatment for the physical symptoms related to spinal disorders may include one or more of the following:
- Artificial Disc Replacement;
- Back Surgery;
- Epidural Injections;
- Lumbar (Open) Microscopic Discectomy;
- Vertebroplasty;
- A Halo;
- Posture Exercises; and
- Spine Conditioning Programs.
Specific Spinal Conditions
So which disorders qualify for benefits? The following spinal disorders and resulting impairment may qualify you for long term disability insurance or Social Security Disability benefits:
- Herniated Disc – A herniated disc results when the outer portion of the vertebral disc is torn, which then causes the inner portion to “herniate” or extrude through the fibers.
- Nerve Root Compression – Herniated discs in the spine that compress nerve roots can cause severe neurologic damage. Also called nerve root impingement, this condition causes severe motor and sensory loss and may result in the weakening or atrophy of muscles, a limitation in range of motion, radiating pain, and dulled reflexes.
- Cervical Spondylosis – As we age the bones of the neck gradually break down. This may result in a slipped disc or vertebrae may sprout extra bone in an effort to boost strength. The ligaments that connect the vertebrae may become stiff and tight. The neck may hurt or be harder to move. If the discs or vertebrae squeeze nerves and nerve roots, there could be permanent damage.
- Stenosis – This condition causes narrowing of the spinal canal, which “pinches” the nerve roots and spinal cord. A ruptured or bulging disc can cause this condition; however, it is more commonly the result of the aging process. Symptoms include pain in the buttocks, thighs, and low back; lower extremity weakness; cramping, and numbness. Many patients have continuous non-radicular pain.
- Osteoarthritis – The vertebrae in our spines have slippery tissue on each end that helps the spine flex without friction. If that cartilage toughens or wears down, the vertebrae start to rub against each other, causing pain and stiffness.
- Spinal Arachnoiditis – Arachnoiditis results from an inflammation of the arachnoid, a membrane that surrounds and protects the spinal cord. This may cause thickening and swelling of the roots of the nerve. This condition is typically diagnosed with a pathology report of a biopsy, an imaging test result, or an operative note.
- Ankylosing Spondylitis – Ankylosing spondylitis is considered an autoimmune disorder, a form of inflammatory arthritis, a kind of rheumatic disease, or one of the various spondyloarthropathies. It causes inflammation of the vertebrae and can lead to severe, chronic back pain.
- Sciatica – As the name implies, sciatica refers to back pain caused by issues with the sciatic nerve. Symptoms of sciatica include: back pain shooting down from the low back into the leg. A herniated disc, bone spur, or some other spinal condition can put pressure on the sciatic nerve.
- Tumor – Cancer may spread from the spot where it started to form new growth in the spine. Cancers that may spread include lung, breast, prostate, and bone cancer. Symptoms include back pain, with the pain spreading through the body. The patient’s arms or legs might be numb or weak. Part of the body could even be paralyzed. Treatment options include surgery, radiation, or chemo.
- Scoliosis – Scoliosis is when the spine is twisted out of shape. The spine may even bend sideways.
- Kyphosis – Kyphosis bends the spine forward. It usually occurs when the vertebrae crack or smash down. It can cause severe pain and other problems. It may even bend the whole body out of shape.
- Spinal Cord Injury – A spinal cord injury is often the result of trauma, like a fall to the ground, car crash, a sports mishap, or even a gunshot. The spinal cord may be bruised, or part of its blood supply is cut off. This may keep the brain from controlling part of the body, so it can be very serious.
- Broken Neck or Back – Accidents and injuries can also break vertebrae. When that happens to one of the top seven vertebrae in the cervical spine it’s called a broken neck; farther down in the thoracic and lumbar spine, it is a broken back. Age-related bone loss or weakening may cause a break to occur slowly over time.
- Spondylolisthesis – Spondylolisthesis is a leading cause of lower back pain. Vertebrae may slide sideways, such that they no longer line up with the others. It happens as the body ages, but it may also affect younger individuals who participate in sports that stress the lower back.
- Cauda Equina Syndrome – The nerve roots that branch out from the spine in the lower back help one’s brain control the legs and the organs in the pelvis. A herniated disc, fracture, or other spinal condition could put pressure on this group of nerves, called the cauda equina, causing extreme pain. Other complications include a loss of feeling, movement, or control of the bladder and/or bowels.
- Syringomyelia – Although rare, a little fluid-filled sac called a cyst can form in the spinal cord. It could happen when brain tissue pushes down from the skull into the spinal cord, or due to an injury or tumor. If the cyst keeps growing, syringomyelia can injure the nerves in your spine.
Qualifying for Long Term Disability
If you have a spinal disorder that affects your ability to work, you might be eligible to receive disability benefits from a long-term disability insurance company (assuming that you have coverage for LTD benefits). Your disability claim will be reviewed by the insurance company that issued the benefit plan, or it may be reviewed by a “third party administrator”. Specific medical criteria requirements outlined in your policy must be satisfied as part of your “proof of loss”. You or your lawyer will need to submit medical records from all of the doctors treating you for your spinal problems. Regardless of the approach, objective medical evidence is the key to a successful disability claim.
If you have been denied long-term disability benefits you should contact an attorney right away. There are strict time limits to file an appeal, but an attorney can assist you in obtaining medical evidence and will ensure that the appeal is filed in a timely manner.
Qualifying for Social Security Disability Benefits
What Diseases Automatically Qualify You for Disability?
If your disorder meets one of the Social Security Administration listings your claim will be medically approved for benefits. Section 1.04 of the SSA impairment listing manual, also known as the SSA Blue Book, describes the requirements to receive Social Security Disability benefits under the listing for disorders of the spine:
1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With:
A. Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine);
OR
B. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours;
OR
C. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.
If you meet the SSA Blue Book listing it is also required that your condition lasts (or be expected to last) at least 12 months in order to qualify for benefits. Even if you later regain the ability to perform work activity, if you were out of work for at least 12 months and meet one of the SSA listings, then you could qualify for a closed period of benefits from the SSA. If your claim has been denied you should contact an attorney right away, as you only have 60 days to file an appeal.
Residual Functional Capacity (RFC)
If your claim was denied based on the SSA Blue Book listing you can apply for disability based on a medical-vocational allowance. During this process, you will have to submit to a disability evaluation to determine your level of functioning and your ability to work. Your doctor usually completes this paperwork and will ask questions about your physical abilities like:
- How much can you lift, and how often?
- How long are you able to sit or stand?
- How well can you reach out or overhead?
- How well can you bend down, crouch, or stoop?
- How well can you grasp objects or use your hands?
- Do you require the use of an assistive device?
Based on your answers, you will be assigned a physical RFC rating of sedentary, light, or medium work. Mental limitations are also taken into account and will assign you a rating of unskilled, semi-skilled, or skilled worker. If you are given a rating of sedentary work and unskilled worker there is a better chance of your claim being approved for Social Security Disability. A lawyer can provide you with an RFC form customized to your conditions so that it will better explain your limitations.
Consult with a Disability Attorney
Working with a disability attorney will give you the best chance of getting the benefits you deserve. Denial or termination of your benefits does not mean your fight is over. You have the right to file an appeal with more information to support your case. Getting expert help from a lawyer is often the difference between being denied and being approved for disability benefits. If your claim has been denied or terminated you should talk to a disability lawyer right away.
An experienced disability attorney will be able to guide you through the daunting disability claim process. Your lawyer will not get paid until you win your case, so you can seek help without worrying about upfront costs or unexpected bills. Contact our law firm today to schedule a free disability case evaluation. Call Ortiz Law Firm at (888) 321-8131 or contact us online.