Social Security Disability Benefits for Back Pain or DDD
Have you been denied SSI or SSDI for Degenerative Disc Disease?
There are many different causes of back pain, but the main three things are: (1) bad discs, (2) arthritis, and (3) pinched nerves.
By “bad discs” we mean degenerated, bulging, or ruptured (prolapsed) discs that cause pain and inflammation in the back.
“Arthritis” in the back refers to bone spurs and “wear and tear” of the facet joints. (The facet joints allow the back to twist and bend.)
“Pinched nerves” are when discs and bone spurs press on nerves (“neuro-foraminal impingement”) or the spinal cord (“spinal stenosis”), causing pain, numbness, or tingling down one or both legs (“radicular symptoms”).
Having one or more of these conditions can cause chronic and disabling back pain, and they can be documented by x-rays and MRI's of your back.
Ten Tips to Help You Get Disability Benefits
If you suffer from chronic back pain and are unable to work, the following ten “tips” or guidelines will help towards disability benefits.
1.) Get a Diagnosis
Your doctor must diagnose, and document in your medical records, the cause of your back pain by getting x-rays and an MRI that show you have some combination of “bad discs,” degenerative arthritis, and “pinched nerves” in your back.
2.) Objective Evidence More than “Mild”
The findings on your x-rays and MRI should be more than “minimal” or “mild” in order to show pain is disabling. In other words, if the objective findings on your x-rays and imaging studies “match” the amount of pain that you are complaining of. If your x-rays and MRI's are normal or show only “mild” or “minimal” abnormalities, it may not correlate with significant pain from an objective standpoint.
3.) Document Your Back Pain
In the medical records, your doctor must continually document that you are suffering from disabling back pain and how it impairs your ability to sit, stand, walk, lift and carry. [See: paragraph 6, below.] Your doctor will do that only if, every time you see him, you tell him that you are having back pain and describe to him how it affects your ability to function. Otherwise, he may fail to document your back pain.
4.) Document Impaired Function
In the medical records, your doctor must document more than the fact that you have back pain. Documenting your limitations: How does your condition affect you? Be specific to articulate to your physician details of your physical limitations and how they impact you on a daily basis with regard to your daily living activities, your ability to stand/walk, lift/carry, and even sit for extended periods of time and need for breaks or rest from pain or fatigue. These are important factors and details regarding your functional capacity and important in evaluating whether you can perform your work or any work.
5.) Questions That Prove Impaired Function
Documenting your limitations: How does your condition affect your daily living activities, your ability to stand/walk, lift/carry, and even sit for extended periods of time and need for breaks or rest from pain or fatigue. These are important factors and details regarding your functional capacity and important in evaluating whether you can perform your work or any work.
6.) Less Than Sedentary (unable to do sedentary work)
Lift or carry, is less than 10 pounds.
- Walk or stand, is less than 4 hours.
- Sit, is less than 6 hours.
- unable to perform desk job in competitive work environment
7.) Tell Your Doctor
You must tell your doctor at each office visit how much back pain you have, how many hours you must lie down during the day to rest your back, and how your back pain impairs your ability to sit, stand, walk, lift, or carry. Your doctor can't read your mind, and he doesn't have a crystal ball. How else is he going to know how much pain you have and how it affects your ability to sit, stand, walk, carry, or lift, unless you tell him?
8.) Your Doctor's Opinion Needs Support
Remember that your doctor's opinion as to how much back pain you have and how it prevents you from being able to sit, stand, walk, lift or carry, will likely be evaluated by SSA by the objective abnormalities on your x-rays and MRI's, and the findings on your physical examination in the doctor's office.
For example, if in the doctor's office, you have little or no difficulty in sitting, standing, walking, lifting or carrying, and you have little or no difficulty in climbing up on the doctor's examination table, those observations may be entered into your medical records by the doctor or the office staff, and they may suggest to the doctor or to Social Security that your back pain isn't that bad, and your functional abilities are not significantly impaired.
9.) Don't Try to “Game” the system
You are not likely to be able to “game” insurance providers. To get disability benefits, your back pain must be “real,” and it must be supported by significant (“moderate” or “severe”) objective abnormal findings on x-rays and MRI's of your back. Always be honest, detailed and consistent. Credibility is important therefore
10.) Find a Good Doctor
In getting disability benefits, you must do your part. Talk to your doctor about your back pain each time you see him and keep describing how it impairs your daily activities. Try to be specific regarding how your back pain may change in terms of where a baseline pain level for you is on a 1-10 scale (“1” little or no pain; “10” severe pain), which is more accurate.
If you are interested in reading more about back problems, you can visit the following sites. They give accurate and authoritative information.
Mayo Clinic at https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906
National Institutes of Health (NIH) at https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
Arthritis Foundation at https://www.arthritis.org/about-arthritis/types/degenerative-disc-disease/