The Social Security Administration recently updated the way they evaluate most back and neck impairments. The most common listing, 1.04, is now 1.15 and has additional requirements. I have included the new listing below. You may want to read ahead to reference, but many will also find it to be cumbersome or even intimidating.
The previous elements are still there, requiring neurologic compromise resulting in pain, changes in sensation or muscle weakness, and imaging studies showing compromise of a nerve root. It adds, however, additional requirements of a medically documented need for a two-handed assistive device or inability to use both hands.
These additional requirements from the D subsection make an already difficult to meet listing even more stringent. It is similar to language in previous listings regarding “ambulating effectively”; however, instead of referencing use an assistive device for walking, it requires documentation of their need. Not just a single cane either but two canes, crutches, a walker, or a wheelchair.
The other categories of the D section criteria outline neurological impairment affecting the use of both hands for fingering and handling or the same limitation in one hand while simultaneously needing the other hand for a cane or other assistive device.
The result of this is claimants will need even further medical treatment and documentation to show their need for assistive devices. Claimants anticipating the prior listing may want to see a doctor for updated treatment in light of these new requirements. This may also affect how claims are argued, as the listing will be that much harder to meet. Perhaps more medical experts could be required to assist in parceling out the new listing elements and testify to an “equaling” of the severity of the listing as meeting each element will be difficult in most cases. But with a harder listing to meet, it follows that equaling will, in turn, be a higher threshold as well.
Of course, for now, this is only speculative as it remains to be seen how Social Security’s ALJs will apply these new rules, what regulations advising their use may come along and how medical experts may change how they testify to the new listing. However, it is necessary to become familiar with all the new listing elements and, if needed, find help understanding them and how they may apply to your claim. While this new listing should never deter someone from filing for disability, it requires a greater degree of understanding and expertise with Social Security rules and procedures. Please consider hiring an attorney to assist you with your claim.
1.15 Disorders of the skeletal spine resulting in compromise of a nerve root(s) (see 1.00F), documented by A, B, C, and D:
A. Neuro-anatomic (radicular) distribution of one or more of the following symptoms consistent with compromise of the affected nerve root(s):
1. Pain; or
2. Paresthesia; or
3. Muscle fatigue.
B. Radicular distribution of neurological signs present during physical examination (see 1.00C2) or on a diagnostic test (see 1.00C3) and evidenced by 1, 2, and either 3 or 4:
1. Muscle weakness; and
2. Sign(s) of nerve root irritation, tension, or compression, consistent with compromise of the affected nerve root (see 1.00F2)
3. Sensory changes evidenced by:
a. Decreased sensation; or
b. Sensory nerve deficit (abnormal sensory nerve latency) on electrodiagnostic testing; or
4. Decreased deep tendon reflexes.
C. Findings on imaging (see 1.00C3) consistent with compromise of a nerve root(s) in the cervical or lumbosacral spine.
D. Impairment-related physical limitation of musculoskeletal functioning that has lasted, or is expected to last, for a continuous period of at least 12 months, and medical documentation of at least one of the following:
1. A documented medical need (see 1.00C6) for a walker, bilateral canes, or bilateral crutches (see 1.00C6d) or a wheeled and seated mobility device involving the use of both hands (see 1.00C6e(i)); or
2. An inability to use one upper extremity to independently initiate, sustain, and complete work-related activities involving fine and gross movements (see 1.00E4), and a documented medical need (see 1.00C6a) for a one-handed, hand-held assistive device (see 1.00C6d) that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand (see 1.00C6e(ii)); or
3. An inability to use both upper extremities to the extent that neither can be used to independently initiate, sustain, and complete work-related activities involving fine and gross movements (see 1.00E4).