Social Security awards for long-term disability benefits are paid to back pain claimants more often than for any other reason. It is estimated that up to 25% of disability awards are for back problems. That's because having back pain can disable you from doing even a desk job, and x-rays or MRI scans of a bad back can “prove” to Social Security that your pain is “real.”
What Causes Back Pain (DDD)?
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 to help prove to Social Security that you have an objective basis for your back pain and disability.
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 you get Social Security 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. Social Security calls this “objective evidence” of an underlying medical condition.
2.) Objective Evidence More than “Mild”
The findings on your x-rays and MRI should be more than “minimal” or “mild” in order to convince Social Security that your back pain is disabling. In other words, Social Security wants to see 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, Social Security will usually be unwilling to award disability benefits, because they will probably doubt the intensity of your back pain.
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, and Social Security may think it has improved or gone away, or at the very least, that it is not persistent and decide that you are not entitled to benefits.
4.) Document Impaired Function
In the medical records, your doctor must document more than the fact that you have back pain, because Social Security needs to know how your back pain affects your ability to work and function. To do that, Social Security requites answers to specific questions. [See: paragraph 5, below.] From your answers to these questions, Social Security decides how much work you can do, if any. This is called your “Residual Functional Capacity,” or “RFC.” How your doctor answers these questions, may determine whether or not you get disability benefits.
5.) Questions That Prove Impaired Function
When Social Security decides how disabled you are, it does this by asking your doctor to answer how your back pain impairs your ability to sit, stand, walk, lift, and carry. The answers to these questions will be used by Social Security to determine whether you can do sedentary, light, moderate, or heavy work.
6.) Less Than Sedentary
Although the Social Security disability rules are very complicated, the bottom line is that the odds of getting a disability award from Social Security will be much better if your doctor can document your ability to work is “less than sedentary.”Social Security's definition of “less than sedentary” is that the most you can:
- Lift or carry, is less than 10 pounds.
- Walk or stand, is less than 2 hours.
- Sit, is less than 6 hours.
In other words, out of an 8-hour workday, this means that you must rest, by lying down, more than 2 hours every day. If your doctor documents these specific functional limitations, this means to Social Security that your back pain makes you unable to do even a desk job (“less than sedentary”), and your chances of getting a disability award will be greatly increased.
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 be only as good as 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.
Similarly, if your x-rays and MRI's are normal or show only “mild” or “minimal” abnormalities, Social Security may be unwilling to accept that your pain and disability are as bad as you claim and may deem your doctor's report that you are disabled as not “credible.”
9.) Don't Try to “Game” Social Security
You are not likely to be able to “game” the Social Security system. 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. Otherwise, Social Security may deny your disability benefits because they consider you to be not credible.
10.) Find a Good Doctor
In getting disability benefits, you must do your part. Find a good doctor who believes you are disabled and is willing to support your disability claim by providing medical records and filling out forms for Social Security. Tell your doctor that you are applying for Social Security disability, see that doctor regularly (we recommend monthly), and be cooperative and compliant with medicines and treatments that he prescribes, to show Social Security that you are trying to get better.
Talk to your doctor about your back pain each time you see him and keep describing how it impairs your daily activities. Try not to use words like “better” or “improved,” which may be misleading. Instead, describe your pain on a 1-10 scale (“1” little or no pain; “10” severe pain), which is more accurate.
For example, if today your back pain is ‘better,' describe it as a ‘7,' if it was a ‘9,' when you last saw the doctor. Words like “better” or “improved” stick-out in the medical record and may cause Social Security to wrongly think your underlying condition has improved, when it hasn't. Although, on some days, your back pain may be ‘better,' the condition of your back, or what we call its “anatomy” (bone spurs, bad discs, arthritis, spinal stenosis), is not likely to get better. If anything, with time, it's likely to get worse.
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.
Getting disability benefits for back pain can be complicated. Much of it depends on your age, educational level, prior work history, transferrable skills, and other factors. However, with everything else being equal, if your back pain prevents you from doing even a desk job (“less than sedentary”), and your doctor has documented significant abnormalities after taking x-rays or doing an MRI of your back, then your chances of getting a Social Security disability award will be much better.
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/
Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.