Patients with spine disorders may be unable to work because of their condition and its related complications. Those unable to work as a result may qualify for long term disability (LTD) and Social Security Disability benefits.
What Spine Conditions Automatically Qualify for Disability?
However, a diagnosis alone is insufficient to get your disability claim automatically approved. The disability insurance company or Social Security Administration (SSA) must evaluate the medical evidence to see if your condition is severe enough to be approved.
There may be specific medical evidence that is required to be approved for disability benefits for particular disorders. For example, with arachnoiditis, the Social Security Administration requires surgical notes and tissue biopsy reports.
What Spine Injuries Qualify for Disability?
So, what spine disorders qualify for disability? Common disabling spinal conditions include cervical spinal stenosis, lumbar spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, spinal arachnoiditis, herniated discs, and vertebral fractures.
The spine is comprised of bones called vertebrae. The anatomy of the spine is typically viewed by dividing the spine into three major sections:
- The cervical spine (the neck);
- The thoracic spine (the mid-back), and
- The lumbar spine (the lower back).
There are seven cervical vertebrae (C1 to C7), 12 thoracic vertebrae (T1 to T12), and five 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:
- Conditions such as ankylosing spondylitis or scoliosis, and
- Changes in the bone structure that come with age, such as stenosis and herniated discs.
A significant cause of disability is the back pain that comes with spinal disorders. The pain typically occurs when bone changes pressure the spinal nerves and can limit your ability to work. Diseases of the spine can also alter 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”;
- Electromyography (EMG);
- MRI; and
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;
- A Halo;
- Posture Exercises, and
- Spine Conditioning Programs.
Specific Spinal Conditions
So, which disorders qualify for benefits? The following spinal conditions and resulting impairment may be eligible 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, it causes severe motor and sensory loss. It 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 neck bones gradually break down, which may result in a slipped disc or vertebrae sprouting extra bone to boost strength. The ligaments that connect the vertebrae may become stiff and tight. The neck may hurt or be more challenging to move. There could be permanent damage if the discs or vertebrae squeeze nerves and nerve roots.
- Stenosis – This condition causes spinal canal narrowing, 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. Stenosis can affect the upper cervical spine, middle thoracic spine, and lower lumbar spine. Symptoms include pain in the buttocks, thighs, and lower 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. In patients with osteoarthritis, the cartilage toughens or wears down, and the vertebrae rub against each other, causing pain and stiffness.
- Spinal Arachnoiditis – Arachnoiditis results from an inflammation of the arachnoid, a membrane surrounding and protecting the spinal cord, and may cause thickening and swelling of the nerve roots. 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. Sciatica symptoms include back pain from the lower back into the leg. A herniated disc, bone spur, or other spinal condition can pressure the sciatic nerve.
- Tumor – Cancer may spread from the spot where it started to form new growth in the spine. Cancers 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, a car crash, a sports mishap, or even a gunshot. The damage may bruise the spinal cord or cut off parts of its blood supply, which may keep the brain from controlling part of the body and 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, so they no longer line up with the others. It happens as the body ages but 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 pressure this group of nerves, called the cauda equina, causing extreme pain. Other complications include a loss of feeling, movement, or control of the bladder 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.
Does a Bad Back Qualify for Disability?
Long Term Disability Benefits
Suppose you have a spinal disorder that affects your ability to work. In that case, you might be eligible to receive disability benefits from a long term disability insurance company (assuming that you have coverage for LTD benefits). The insurance company that issued the benefit plan or maybe a “third-party administrator” will review your claim.
Specific medical criteria outlined in your policy must be satisfied as part of your “proof of loss.” You or your lawyer must submit medical records from all doctors treating you for your spinal problems. Regardless of the approach, objective medical evidence is the key to a successful disability claim.
If your long term disability benefits have been denied, you should contact an attorney immediately. There are strict time limits to file an appeal, but an attorney can assist you in obtaining medical evidence and will file your appeal on time.
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Social Security Disability Benefits
If your disorder meets one of the Social Security Administration’s Listing of Impairments, your claim will be medically approved for benefits. Spine disorders fall under Listing 1.00 Musculoskeletal Disorders. 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);
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.
You must also prove that your condition lasts (or is expected to last) at least 12 months 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 met one of the SSA listings, you could qualify for a closed period of benefits from the SSA. If your claim has been denied, you should contact an attorney immediately, as you only have 60 days to file an appeal.
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Residual Functional Capacity (RFC)
If the SSA denied your claim based on the SSA Blue Book listing, you can apply for disability based on a medical-vocational allowance. During this process, you must 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?
You will be assigned a physical RFC rating of sedentary, light, or medium work. Mental limitations are also considered and will give you a rating of unskilled, semi-skilled, or skilled worker. If your rating is that of a sedentary work and an unskilled worker, there is a better chance that the SSA will approve your claim. 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 can 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 can guide you through the daunting disability claim process. Your lawyer will only charge you once you win your case, allowing you to seek help without worrying about upfront costs or unexpected bills. Complete our contact form or call (888) 321-8131 today to get started.