Social Security Disability Benefits for Spinal Stenosis
Posted on behalf of Goldberg Finnegan, LLC on Dec 16, 2016 in Social Security Disability
I recently pulled a muscle in my lower back while lifting weights. It was localized, with no radiating pain or pain shooting to other parts of my body. Luckily, it was just a pulled muscle, and it healed fully after a difficult week.
Many disability claimants are not so lucky. They can have debilitating degenerative spinal disorders – often in the lumbar or cervical regions – with no end in sight. Worse, these disorders, including spinal stenosis, herniated discs, and arachnoiditis, often lead to nerve pain in other parts of the body. For example, a herniated nucleus pulposus (“slipped disk”) can push on a nerve root, leading to pain in the region innervated (this is what causes sciatica). Spinal pain can be radiating, burning, or feel like weakness, among other symptoms. And nerve pain is equally frustrating to deal with.
The Social Security Act accounts for such spinal impairments in listing 1.00, which covers the musculoskeletal system. (You get a sense of how pervasive back injuries are in workers because they are covered in the first listing).
To win a disability case based on 1.04, disorders of the spine, you must show that your spinal condition, such as herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, or vertebral fracture, have resulted in compromise of either a nerve root or the spinal cord. After this, you must show specific evidence for the particular spinal disorder you have which meets a listing.
For example, if you have lumbar spinal stenosis (Listing 1.0(C)), you must show “findings on appropriate medically acceptable imaging, manifested by nonradicular pain and weakness, and resulting in inability to ambulate effectively.” The language is straightforward, but the implications for proving the case are more subtle.
Clearly, it is critical to get medical imaging done to confirm the stenosis. This means ensuring you get an MRI or CT scan. Moreover, it means that when you go to the doctor for your back problem, you must be vocal about the pain you experience and describe it as accurately as possible. Discuss how the pain interferes with your daily activities, what you try to do to control the pain, and how you have altered your life around the pain. Administrative Law Judges must follow the medical record in evaluating disability claims, and the medical record is the best place to show your pain goes back to when you stopped working. A huge disconnect can occur when someone’s longstanding experience with pain does not make it into the medical record because they assume the doctor will understand what they are going through. Your job is to be as clear and open as possible with the doctor about your pain. Moreover, with electronic medical records, you must combat rote and repeated “default” language in medical records that paints a healthier, less symptomatic-sounding picture than your actual experience. Do not be afraid to tell your doctor exactly what is going on and how it affects you. You must essentially “bring the medical imaging to life” by describing how the objective results in the imaging feel to you in daily experience.
It is also critical to have the doctor test your movement and gait to objectively evaluate how the disease has impacted these critical aspects of daily living. As stated in the listing, the spinal stenosis must have made you unable to “ambulate effectively,” which means “an extreme limitation of the ability to walk; i.e., an impairment(s) that interferes very seriously with the individual's ability to independently initiate, sustain, or complete activities . . . To ambulate effectively, individuals must be capable of sustaining a reasonable walking pace over a sufficient distance to be able to carry out activities of daily living.” 1.00(b)(1)-(2). The best way to prove this is by having a doctor record the difficulties you have with walking. To get to this, of course, you must be vocal with your doctor about how your walking has been impacted.
Spinal stenosis is just one spinal listing you might meet in your disability case. But the common themes of getting imaging, being vocal about your pain to your doctor, and making sure what you say is shown in the medical record are critical in meeting any listing. Moreover, if you cannot exactly meet a listing but nonetheless have restricted functioning, the same ideas will give you a stronger case to show that you have cannot perform past work or other work in the economy (the next step in the analysis if you cannot meet a listing). If you have a spinal disorder and wish to apply for disability, please contact our firm immediately.