Patients with a spine disorder may be unable to work because of their disease and its complications such as severe back pain. Patients who find themselves unable to work because of their spine disorder may qualify for long term disability (LTD) and/or Social Security Disability benefits. There are a number of spine disorders that may qualify for disability benefits, but the insurance company and/or Social Security will have to review the medical evidence to see if your condition is severe enough to qualify. There may even be specific evidence that is required in order to receive disability benefits for certain spine disorders. For example, the Social Security Administration requires surgical notes and tissue biopsy reports for conditions such as arachnoiditis.
What are Spine Disorders?
Your spine is what allows you to stand or sit upright. The spine is comprised of a stack of little bones called vertebrae centered on your back, from your low-back to your neck. It supports your head, shoulders, and entire upper body. The vertebrae also make a tunnel for your spinal cord, which is the set of nerves that connect your brain to most of your body.
The anatomy of the spine is typically viewed by dividing up the spine into three major sections:
- The cervical spine at the top (the neck);
- The thoracic spine in the middle (the mid-back); and
- The lumbar spine at the bottom (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.
A number of diseases or injuries can change the structure of the spine or damage the vertebrae and surrounding tissue. Such problems include:
- Conditions, such as ankylosing spondylitis and scoliosis; and
- Changes in the bone structure that come with age, such as spinal 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 cord or nerves and can limit your ability to work. Disorders of the spine can also limit movement.
Diagnosis and Symptoms
Spine disorders are typically diagnosed with one or more of the following tests:
- Computed Tomography (CT, or “Cat Scan”);
- Electromyography (EMG);
- Magnetic Resonance Imaging (MRI); and
Treatments and Therapies
Treatment for spine disorders may include one or more of the following:
- Artificial Disc Replacement;
- Back Surgery;
- Epidural Injections for Spinal Pain;
- Lumbar (Open) Microscopic Discectomy;
- Vertebroplasty for Spine Fracture Pain;
- A Halo;
- Posture Exercises; and
- Spine Conditioning Program.
Specific Spinal Conditions
So what spine disorders qualify for disability? The following are some spinal conditions that may qualify you for long term disability insurance or Social Security Disability benefits:
- Herniated Disc – also called a bulging disc or a slipped disc. A herniated disc results when the annulus fibrosus (outer portion) of the vertebral disc is torn, which then causes the nucleus (inner portion of the disc) to “herniate” or extrude through the fibers.
- Nerve Root Compression – Herniated discs in the spine that compress nerve roots can cause severe neurologic damage. This is also called nerve root impingement and is typically evidenced by MRI findings. This condition causes severe motor and sensory loss and may result in the weakening or atrophy of muscles. Symptoms include a limitation in range of motion, radiating pain, and dulled senses and reflexes.
- Cervical Spondylosis – As we all age there is a gradual breakdown in the bones of the neck. This breakdown may result in a slipped disk, or the vertebrae may sprout extra bone (called spurs) in an effort to boost strength. The ligaments that connect the vertebrae then may become stiff and tight. The neck may hurt or be harder to move. Moreover, if the disks or vertebrae squeeze nerves and nerve roots, there could be permanent damage.
- Spinal Stenosis – This common condition causes compression (or narrowing) of the spinal canal, which “pinches” the nerve roots and spinal cord. A ruptured or bulging disc in the cervical or lumbar spine can cause this condition; however, it is more commonly the result of the aging process. Symptoms include pain in the buttocks, thighs, and lower back; lower extremity weakness; cramping, and numbness. Many patients have continuous non-radicular pain. This type of condition is typically diagnosed with a CT scan or MRI.
- 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. That may make the neck or back painful or stiff. Women are more prone than men to suffer osteoarthritis in their spines.
- 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 spondylarthropathies. It causes inflammation of the vertebrae (remember – these are the spinal joints) and can lead to severe, chronic back pain and discomfort.
- 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 lower back, through one’s bottom, and 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. Sample 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 most common type affects children during a growth spurt just before puberty. The spine may even bend sideways. For those with scoliosis, their shoulders might be uneven or one shoulder blade might stick out more than the other.
- Kyphosis – Kyphosis bends the spine forward. It usually occurs when the vertebrae crack or smash down. It can cause severe pain and other problems. In more severe cases, it may even bend the whole body out of shape.
- Spinal Cord Injury – A spinal cord injury most often comes as the result of trauma, such as an accident (like a fall to the ground, car crash, or sports mishap) or even from a gunshot. One result may be that the spinal cord gets 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 bones, including vertebrae. When that happens to one of the top seven vertebrae in the cervical spine – just below the skull – it’s called a broken neck; farther down in the lower back it is a broken back. Bone loss or weakening because of aging can also make the back weak. The weakening may cause a break to occur slowly over time. Broken vertebrae may also hurt the spinal cord.
- Spondylolisthesis – Vertebrae may slide sideways, such that they no longer line up with the ones above and below them. Spondylolisthesis is a leading cause of lower back pain. It happens as the body ages, but it may also affect younger individuals who participate in sports that stress the lower back – like football, gymnastics, and weightlifting.
- 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 symptoms 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 spinal cord.
Qualifying for Long Term Disability with a Spine Disorder
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. This does, of course, assume that you have coverage for LTD benefits through your employer. Your claim will be reviewed by the long-term disability insurance company that issued the benefit plan, or it may be reviewed by a “third party administrator”. Depending on the requirements of your LTD policy, specific medical criteria must be satisfied as part of your “proof of loss”. You will need to submit medical records from all of the doctors treating you for your spine disorder.
You can typically get your disability claim started by either (a) contacting the long term disability insurance company directly or (b) requesting an application from your human resources department. Regardless of the approach, medical records and hard evidence are the keys to a successful disability claim. Watch the video below to learn more about getting long term disability benefits for a back pain disorder.
Qualifying for Social Security Disability with a Spine Disorder
Section 1.04 of the Social Security Administration’s impairment listing manual, also known as the 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);
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;
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.
The Social Security Administration also requires that your condition last (or be expected to last) at least 12 months in order to qualify for benefits.
Residual Functional Capacity (RFC)
If an adult who has a spine disorder has been denied disability benefits based on the Social Security Blue Book listing but is still unable to work, you can apply for disability based on a medical-vocational allowance. During this process, the individual will have to submit to testing to determine the level of functioning in daily life and your ability to work. Your doctor usually completes this paperwork. They will ask questions 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?
Based on your answers, you will be assigned a rating of sedentary, light, or medium work. Mental limitations are taken into account i.e., a low IQ, level of education, and working experience. Your mental RFC will assign you a rating of unskilled, semi-skilled, or skilled worker. If you are given a rating of sedentary work and unskilled worker, this will increase your chances of being approved for Social Security Disability benefits.
Consult with a Disability Attorney
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your spine disorder. 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 disability benefits.
While the process can be daunting, your experienced disability attorney will be able to guide you through the process. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills.
The Ortiz Law Firm has successfully represented people in disability cases across the United States. If you would like to talk to a disability lawyer about your spine disorder and its impact on your ability to perform your job duties, call us at (888) 321-8131. We would be happy to evaluate your case and to discuss how to help you get approved for disability benefits.