Back problems are one of the most common reasons people apply for Social Security disability benefits. However, getting approved for disability due to back pain is difficult because most back pain claims are based largely on pain. Pain is a subjective (personal) experience that is hard for doctors to scientifically measure. Even when objective medical evidence indicates a problem, the pain or other limitations a person experiences may be much worse than the medical evidence suggests.
Because of these reasons, the Social Security Administration (SSA) often has to rely largely on the claimant’s statements to make its disability decision rather than on objective medical evidence like x-rays or MRIs. This means that the SSA’s decision often simply depends on whether it believes the claimant is telling the truth and not exaggerating.
How a Back Claim Is Evaluated
When the SSA evaluates a back claim, the agency will look at:
- the objective signs and symptoms of your back problem (objective refers to things that can be demonstrated scientifically; for example, x-rays or MRIs)
- any functional limitations your back problem causes (for example, if your back problems prevent you from bending over or if require you to change positions every few minutes), and
- your credibility.
Objective Signs and Symptoms
You must be able to prove to the SSA that the symptoms of your back problem are caused by a “medically determinable impairment.” This means that you have to provide the SSA with evidence that shows you have some sort of back abnormality. For example:
- an x-ray that demonstrate a fractured vertebra
- discography or myelogram that highlights the damaged area in your back
- a CT scan which indicates you have spinal stenosis
- an MRI that shows you have bone degeneration, or
- an EMG (nerve conduction test) that establishes the presence of muscle weakness in your body.
A functional limitation is something you can’t do because of your back problem. The extent of your functional limitations and how they impact your ability to work are the most important aspect of your claim. The more functional limitations you have, the less likely you can work full time.
Your functional limitations are used to determine your residual functional capacity (RFC). Your RFC is the most you can do on a regular and sustained basis (full-time). For example, an RFC might say you can walk up to six hours per day, lift up to 20 pounds occasionally, and carry up to 10 pounds frequently.
To make your RFC assessment, the SSA will use the medical evidence in your file to prepare an RFC form. Here are some examples of functional limitations that are assessed on an RFC form:
- how long you can sit or stand
- how much you can lift or carry on a frequent and occasional basis
- how well you can reach shoulder-high and overhead, and
- how far you can walk without taking a break.
Even though the SSA doctors will prepare an RFC assessment for you, it is vital to your claim that your treating doctor fill out an RFC form for you as well. Make sure that the doctor who prepares your RFC form is a back specialist.
Severe Limitations Leading to Disability Benefits
Certain functional limitations are more likely to result in an approval for disability benefits than others. Remember, however, that these limitations must be documented in your medical records. Here are some examples of limitations related to back problems that may help you get approved for benefits:
- the inability to walk more than a block without taking a break
- being unable to bend or stoop to pick something up
- not being able to lift or carry more than ten pounds occasionally
- the inability to sit or stand for at least two hours in a day
- the need to keep at least one of your legs elevated throughout the workday
- the requirement that you be allowed to get up and move around or to change positions whenever you need to
- the need to lay down throughout the day, and
- the inability to sit for at least six hours in a workday.
Your credibility can make or break your case, especially if your medical records alone can’t demonstrate that your problem is disabling. To assess your credibility, the SSA may assess and compare the following factors:
- the objective medical evidence in your file
- statements by your treating physicians about your prognosis, and
- statements made by you or other people that know you (particularly past employers and your doctors) that describe how your symptoms have impacted your ability to work, the attempts you have made at working, and any treatments you have undergone and how well you did, or did not, respond to them.
In addition to these, the SSA will also consider:
- your activities of daily living (called ADLs)
- where your pain and other symptoms are located, how long they last, the intensity of the pain, and how often the pain or symptoms happen
- what factors cause the pain or other symptoms and what makes them worse
- the medications you take for your pain or symptoms (how well they work, the type and dosage, and any side effects)
- anything else (other than medication) that you must do to relieve your pain or other symptoms (such as sleeping on a back board or changing positions every few minutes)
- how often you have visited your doctor for your back pain, and
- any other factors about your functional limitations or restrictions caused by your pain or other symptoms.
An important factor in determining whether your statements are credible is the consistency of your statements throughout your record and to the SSA. For example, if a person tells the SSA that he cannot walk more than a block without resting, yet the record indicates the claimant routinely does yard work, the claimant’s credibility will be damaged. Another example is if the claimant tells the SSA that she cannot sit for more than a few minutes at a time without pain, yet the SSA interviewer observes no discomfort in the claimant during an hour-long interview process.
Your Medical Treatment History
The efforts you have taken to alleviate your symptoms are an important factor in determining your credibility. This means that SSA will be more inclined to believe a person’s statement about his or her pain if the records indicate a long-term effort at finding successful treatment. For example, did the claimant try multiple medications and dosages? Did the claimant seek alternative treatments such as acupuncture? Did the claimant go through long-term physical therapy?
Back Conditions That Are More Likely to Get Approved
Some back conditions are more likely to get approved than others. This is often because they can be documented more easily on “medically acceptable imaging” or with some other objective means like sensory or reflex tests. The following are back conditions that are fairly easy to prove and that will satisfy the SSA's official disability listing for back problems, meaning they'll automatically qualify for benefits.
Arachnoiditis. This is an extremely painful condition caused by inflammation of the membrane that surrounds and protects the spinal cord. Symptoms often differ among sufferers but include pain, weakness, painful electrical sensations in the legs, and the loss of bowel and bladder function.
Spinal stenosis. This is caused by the narrowing of the spinal column that then puts pressure on the spinal cord and can cause pain, numbness, and weakness. Severe spinal stenosis in the cervical spine (upper) can even lead to bowel and bladder incontinence.
Nerve root compression. This can be caused when a bulging or herniated disc, spinal fracture, or arthritis puts direct pressure on a nerve. Severe nerve root compression can lead to pain, weakness, numbness, and eventually muscle wasting.
Whether you have one of the above conditions or plain old degenerative disc disease, the more evidence you can provide about your limitations, the better your chances for getting approved. If you've had spinal surgery, see Nolo's article on disability benfits after spinal fusion.