Getting Social Security Disability Benefits for Back Problems

Back problems are some of the most common medical conditions listed on applications for Social Security disability benefits (SSDI or SSI). If you're wondering how to qualify for disability based on a "bad back," whether on its own or in combination with other impairments, it's helpful to understand how Social Security reviews claims for back issues in order to increase your chances of getting a disability allowance.

What Spine Disorders Qualify for Disability?

The Social Security Administration (SSA) maintains a list of conditions that the agency considers especially severe. If you have one of the conditions mentioned in the listing of impairments (or "Blue Book"), you can qualify for disability automatically provided your records contain specific medical evidence.

Back issues are generally categorized under Blue Book section 1.00 for musculoskeletal disorders. Depending on the type of back problem you have, you may qualify for disability under one of the following listings:

• Listing 1.15, Disorders of the skeletal spine resulting in compromise of a nerve root. Examples of spine disorders evaluated under this listing include herniated nucleus pulposus, spinal osteoarthritis (spondylosis), vertebral slippage (spondylolisthesis), degenerative disc disease, facet arthritis, and vertebral fracture or dislocation.
• Listing 1.16, Lumbar spinal stenosis resulting in compromise of the cauda equina. The "cauda equina" (Latin for "horse's tail") is a bundle of nerve roots at the end of the spinal cord. If you have severe low back pain that affects your ability to stand or walk, you may meet this listing if you have medical imaging that shows pressure on the cauda equina.
• Listing 1.19, Pathologic fractures due to any cause. Osteoporosis, endocrine system malfunctioning, or medication side effects can cause bones to become more brittle and increase the likelihood that they will break. If you have more than three vertebral fractures within a twelve month period, you may qualify for disability under this listing.

Another part of the Blue Book, section 11.00 for neurological impairments, contains other listings that can qualify people with severe back problems for disability. Listing 11.08 for spinal cord disorders and listing 11.14 for peripheral neuropathy require you to show either marked, extreme, or complete limitations in key areas of mobility or mental functioning.

Keep in mind that not many people with back problems will be able to meet the strict criteria of the listings. But you can still qualify for disability benefits if you can show that your back pain limits your functioning to the extent that you can no longer perform any full-time jobs.

Does Failed Back Syndrome Qualify for Disability?

Failed back syndrome is a complex pain disorder that may arise after you've already had surgery on your lower back. According to the National Institutes of Health, failed back syndrome can affect anywhere between 10-40% of patients who've had lower back surgery, depending on the type of procedure that was performed. The more complicated the surgery is, the more likely patients are to experience failed back syndrome, so somebody who has undergone a lumbar fusion is at a higher risk than somebody who had a relatively noninvasive microdiscectomy.

Failed back syndrome doesn't automatically qualify you for disability benefits by itself. But people who've had back surgery generally have stronger cases for disability than people who have only used more conservative treatment methods. And a diagnosis of failed back syndrome usually means that you have symptoms such as pain and muscle weakness that can significantly limit (or rule out entirely) the types of jobs you're able to do.

Can You Get a Disability Allowance for Chronic Back Pain?

The SSA needs to see evidence that you have a medically determinable impairment before the agency can award you disability benefits (20 CFR 404.1521). "Medically determinable" means that your doctor can point to an objective record, such as an MRI or physical examination, to identify the source of your pain. Simply stating that you have symptoms of back pain isn't sufficient for the SSA to approve your disability claim.

Once the cause of your pain has been identified, however, the degree to which your back pain limits your daily activities plays an important role in determining whether you're disabled. Provided that your limitations aren't out of proportion to the objective medical evidence, the SSA will consider whether any chores that you struggle to complete at home are indicative of tasks that you should avoid at work. For example, if you can't stand long enough to wash dishes or you have trouble carrying a full laundry basket, the agency is likely to find that you can't perform any jobs requiring lifting more than 20 pounds or being on your feet for longer than two hours total in a workday.

How to Get Disability for Back Problems

Your medical record is the foundation of your disability claim. When determining whether you're disabled, Social Security will first review your Form SSA-3368-BK, Disability Report, for information about the types of treatment you've received and the kinds of doctors you've seen. The agency will then request the medical records from the providers you've identified and review the records for objective signs and symptoms of your back pain, as well as any functional limitations your back problem causes. Additional factors, such as your consistency of treatment and doctors' opinions, can also tip the scales in your favor toward an award.

Objective Signs and Symptoms

You must be able to provide the SSA with objective evidence showing that you have some sort of back abnormality. Here are some examples that the agency will be on the lookout for:

• an X-ray or X-rays revealing a fractured vertebra in your lumbar spine
• a bone density scan showing widespread osteoarthritis
• a CT scan indicating that you have spinal stenosis
• an MRI that shows you have degenerative disc disease, or
• an EMG (nerve conduction test) that establishes "nerve latency," indicating muscle weakness.

The SSA will also look for findings on physical examination suggesting that you have medical "signs" indicative of back issues, such as a positive straight leg test or reduced range of motion in the lumbar spine. You should visit your doctor frequently enough to make sure that these tests and examinations are included in your medical records. If you don't have a regular doctor, you'll face an uphill battle in getting a disability allowance, so it's a good idea to try to establish a relationship with one before you apply for benefits.

Functional Limitations

Functional limitations include any activities that you can't do because of your back problem. Evaluating the extent of your functional limitations and how they impact your ability to work is at the heart of almost every disability determination. In Social Security lingo, this is called "assessing your residual functional capacity (RFC)." Your RFC is a set of restrictions that reflect the most you can do at work, physically and mentally, on a regular and sustained basis.

Applicants with back problems will almost certainly have physical restrictions on how much they can sit, stand, lift, and carry on the job (the "exertional limitations"). Depending on your symptoms, you may also have "non-exertional" limitations, such as a prohibition against working at heights or avoiding even occasional bending. Certain limitations in your RFC are likely to result in an approval for disability benefits, such as:

• an inability to stand or walk for more than two hours total in an 8-hour workday
• an inability to lift or carry more than 10 pounds occasionally
• needing to elevate your legs or recline in order to relieve lower back pain
• being mentally "off-task" greater than 10-15% of the workday due to medication side effects
• a limitation to occasional (one-third of the day or less) use of your arms and hands, and
• needing to miss work more than once per month.

Applicants under the age of 50 with the above limitations in their RFC are likely to qualify for disability, since these restrictions rule out even the easiest sit-down jobs. But applicants 50 years of age and older may qualify for benefits even if they're still physically able to perform sedentary jobs if they've never done that type of work before and don't have any transferable skills to help them learn.

Consistency of Medical Records

The SSA considers both the quality and quantity of your medical records when deciding whether you're disabled. Ideally, you'll have clinical notes from your doctor documenting your symptoms, signs, and objective tests, as well as a treating source opinion stating what your limitations are and why they're medically necessary.

Social Security wants to see that your subjective experiences with back pain aren't at odds with the rest of the medical record as a whole. You should make sure that both your doctors and the SSA are aware of how your pain feels in as much relevant detail as possible. You should be able to describe your pain using the following terms:

• where the pain is located, such as in your lower back or between your shoulder blades
• the quality of the pain (for example, if it's stabbing, shooting, dull, throbbing, or electric)
• what causes the pain or what makes it worse
• what medications you take to relieve the pain, how well they work, and any side effects you have
• anything else other than medication that you use to relieve pain (such as taking a hot shower, sleeping in a recliner, or shifting positions every few minutes).

The more specific you can be in describing your pain, the better. Don't feel tempted to exaggerate your symptoms, which is very damaging to your disability claim. The SSA is skeptical of applicants who constantly rate their pain at a 10 out of 10, especially if they haven't been diligent in seeking out medical treatment or have X-rays that show minimal spinal damage. But if you have an MRI showing severe disc degeneration, the agency is more likely to agree with you that you can't sit for longer than 15 minutes without sharp pain in your lower back.

Can I Get a VA Disability Rating for Back Injury Pain?

The VA provides disability pay for veterans who have a service-connected injury or illness. Unlike the SSA, where you can only be either "disabled" or "not disabled," the VA "rates" each service-connected condition based on the percentage that the VA thinks the condition interferes with your ability to work. The amount of disability compensation you'll receive is determined by your overall percentage rating.

After reviewing the medical records, the VA uses the Schedule of Rating Disabilities to assign a percentage rating to each qualifying condition. Back injuries are rated under 38 CFR 4.71(a), covering musculoskeletal disorders. Spinal disorders range from 0% to 100% disabling, in increments of 10% depending on how severe the condition is. For example, unfavorable (fixed in an abnormal position) ankylosis of the entire spine is given a 100% disability rating, while favorable (fixed in a neutral position) ankylosis is rated at 30% disabling.

Do I Need a Lawyer to Get Social Security or VA Disability Pay?

You aren't required to have an attorney when applying for SSDI, SSI, or VA disability benefits, but it's generally a smart move, especially if you've already been denied. An experienced disability lawyer can help shore up any weaknesses in your claim, such as missing medical records or an unhelpful doctor's opinion, and (perhaps most importantly) represent you at a hearing with an administrative law judge. Most disability attorneys offer free consultations, so don't hesitate to ask around to find one that best suits your needs.