Lumbar Spinal Stenosis Disability Claims

Patients with lumbar spinal stenosis may be unable to work because of their condition and its related complications. Patients who are unable to work because of their lumbar spinal stenosis could qualify for long term disability (LTD) and Social Security Disability benefits. The insurance company and Social Security Administration will review their respective claims to see if the claimant’s spinal stenosis qualifies for disability benefits under their rules.

What Is Lumbar Spinal Stenosis?

Spinal stenosis is a medical condition that affects the spine by causing narrowing of the spinal canal and compression of the spinal cord and nerves.

Because lumbar spinal stenosis is a degenerative condition, most people who are diagnosed are over age 50. It is not common for younger individuals to have lumbar spinal stenosis, but it can happen if a person has curvature of the spinal cord or has suffered a spinal injury.

Other health conditions that impact the spinal cord and nerves are bulging discs, herniated discs, bone spurs, arthritis, scoliosis, or scar tissue. It is possible to suffer from both spinal stenosis and other spine disorders.

Symptoms Spinal Stenosis in the Lumbar Spine

The severity and symptoms associated with lumbar spinal stenosis varies for each person. In some cases, the pain, weakness, and numbness will come and go. They may experience mostly pain-free periods with flares of pain or discomfort. These flares are based on a number of different factors, including physical activity or exertion.  Generally, the symptoms that come with a diagnosis of lumbar 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.

Diagnosing Spinal Stenosis

Patients may present with leg pain (with or without back pain) that is aggravated by walking, or episodes of weakness or numbness in the legs. Generally, a physician will order an MRI scan or CT scan to make a diagnosis. Having this type of objective evidence in your file will increase your chances of getting approved for disability insurance benefits.

Your spinal stenosis will 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 spinal 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.

The typical treatment options for spinal stenosis include anti-inflammatory NSAID pain relievers, physical therapy, and chiropractic care. In severe situations, and when other options such as physical therapy have been exhausted, surgery may be required.

How Does Lumbar Spinal Stenosis Affect 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, and weakness in the lower back and lower extremities can impact a person’s ability to carry out meaningful employment and perform daily activities. If so, it may be necessary to file an application for disability benefits.

Many patients with lumbar spinal stenosis are comfortable while sitting, but experience symptoms when standing upright. That is due to the space that’s available for the nerve roots blocking the flow of blood from around the nerve. This congestion irritates the nerve in the lumbar region which causes pain when standing.

Your insurance carrier and the Social Security Administration will try to find alternative jobs you may be able to perform that will not aggravate your condition, such as sedentary office job. If your education and training are not suited for an office job, or if you cannot sit longer than six hours without lower back or leg pain, they will further evaluate your claim. They will look at how long you can sit, stand, or walk and if there are any other jobs that you may be able to perform with your limitation. If they find that your stenosis is severe enough to prevent you from working, you may be entitled to disability benefits in the form of long term disability insurance or Social Security Disability payments.

Evidence to Support Your Disability Claim For Lumbar Spinal Stenosis

You have to prove that you meet specific requirements to receive disability benefits. To prove the severity of your disability, you will need medical evidence such as doctor and hospital visit notes, laboratory test results, and an attending physician statement completed by your doctor. In general, the records must include the following:

• Your confirmed diagnosis of lumbar spinal stenosis;
• A statement form your doctor’s explaining the frequency and severity of your symptoms, specifically how your spinal stenosis impacts your ability to sit or stand in an 8-hour workday;
• MRI’s or CT scans documenting degeneration in the spine;
• Your treatment history; and
• Any other test results or imaging studies.

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, pain in your lower back, 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 preclude your ability to work doing jobs that required physical exertion such as factory work, warehouse work, and most janitorial positions. You can download a physical RFC form from our website so that your doctor can easily identify your limitations.

Living with chronic pain from lumbar spinal stenosis can also cause mental health problems such as depression or anxiety. Side effects of your pain medication may impact your cognitive abilities. 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 Disability Attorney to Get the Benefits You Deserve

Your best chance of having a disability benefits claim 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 prove your spinal stenosis disability claim. Getting expert help is often the difference between being denied and being approved for benefits.

Your disability lawyer will be familiar with how your insurance provider and Social Security handle spinal stenosis disability claims and will help you prepare your claim and collect essential evidence. It’s important to note that your 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 spinal stenosis and how it may be impacting your ability to work, call 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.