The following blog was posted by Andrew Kinney, Esq., at mylowerbackpain.com:
As an attorney at Hoglund Law Offices personally handling about 500 Social Security hearings per year across the country, I can safely say that a majority of my clients with severe physical problems have some form of low back pain. At administrative hearings with Social Security judges, there are particular ways I review and argue low back pain claims. A few common questions from these clients may help many of you who cannot work due to low back pain. I will handle these in turn. Keep in mind to get an attorney for advice that applies to you.
Q. What are Social Security disability benefits?
A. Social Security disability benefits (and Supplemental Security Income benefits) are monthly disability benefits payable to you if you are unable to work (or are expected to be unable to work) full-time for 1 year or more for medical reasons.
Q. How do I get Social Security benefits?
A. You must apply for them by: (1) calling Social Security’s toll-free number at 1-800-772-1213, (2) going to a local Social Security office, or (as of relatively recently) (3) applying on-line through the government website: SSA.gov.
Q. Can I apply if I can only work part-time?
A. Yes, but you cannot be going to work and regularly earning above certain monthly amounts. For 2010, this “substantial gainful activity” amount is $1,000 gross per month.
Q. What does Social Security review in low back pain claims?
A. Generally, Social Security reviews: (1) your diagnosis, (2) your imaging studies to support the diagnosis, and (3) your examination findings.
Q. When does Social Security find disability in low back pain cases?
A. The general rule of thumb is that the more your low back pain limits your ability to get around and function, the greater chance you will be found disabled. If you have trouble standing and sitting, it is usually harder for Social Security to deny you by finding full-time jobs that you can (in theory) do.
Q. What factors does Social Security use in evaluating low back pain cases?
A. Social Security focuses on objective neurological findings that your doctor records from your appointments. Examples of findings that support disability are called “listings.” These are found in Social Security’s regulations. The primary listing for disabling low back pain is musculoskeletal listing 1.04:
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.
Q. Do I need to have surgery to improve my chance for benefits?
A. Being an attorney (not a doctor), I always tell my clients to make medical decisions with their physician based on what is best for them. So, you may get a second opinion, but ultimately consider that, in my legal experience, Social Security judges generally find the need for surgery relevant. You can also tell your attorney before your hearing that you want a chance to explain to the judge why you forewent or delayed surgery. In short, make decisions about surgery to get better, not to get (a chance for) benefits.
Q. Does age matter?
A. Yes. If you are 50 or older when Social Security reviews your claim, the legal standards (called “medical-vocational guidelines”) favor you over those younger than 50.
Q. How can I make sure Social Security knows how bad my low back pain is?
A. Social Security’s decisions are primarily driven by your medical treatment records. You should get the appropriate treatment with doctors and associated professionals that you trust. Also, do not ignore your psychological needs. Depression, for example, is common for those with chronic pain. If you feel you are not getting relief from your low back pain, mention your concerns to your doctor. Also, even if you have may have no immediate options for improvement, you should maintain at least some regular visits to your doctors so they can understand (and document) the progress of your problems over time.