Getting Disability Benefits for a Spinal Fusion

Spinal fusion surgery (also called "arthrodesis") involves fusing together multiple vertebrae using bone graft material with rods, plates, or screws to hold the vertebrae in place. As the graft heals, the bones become permanently connected and immobilized. The procedure may be recommended for people who have chronic pain in the lumbar spine, degenerative disc disease, arthritis, or severe spinal stenosis, among other back disorders.

When the surgery is successful, it can relieve back pain and improve spinal stability. But having a spinal fusion done typically requires many months of recovery, and a successful outcome isn't a sure thing. If complications from the surgery, lingering pain, or other physical limitations keep you from returning to full-time work for at least twelve months following the spinal fusion, you may qualify for Social Security disability benefits.

Is Spinal Fusion a Disability?

It can be. If you're no longer able to engage in substantial gainful activity for one year or more due to limitations from your spinal fusion, the Social Security Administration (SSA) can award you disability benefits. However, establishing that you're unable to perform substantial gainful activity isn't always an easy task. You'll need to provide medical evidence showing that you either meet the requirements of a listing in the SSA's "Blue Book" of automatically disabling conditions, or you'll need to show that you aren't able to perform any job in the national economy on a consistent basis.;

So if your spinal fusion is successful and your restrictions don't have a significant impact on your ability to do everyday activities, it's unlikely that you'll qualify for benefits. But because spinal fusion is an invasive procedure that carries risks (such as spinal cord damage, graft rejection, and infection) that can cause lasting limitations, with the proper medical documentation you can show that you're disabled according to the SSA's definition of the term.

Meeting One of the Blue Book Listings When You've Had a Spinal Fusion

The "Blue Book" is a category of conditions that the SSA considers severe enough to potentially warrant an automatic approval of benefits, as long as you have medical records that document specific criteria related to that condition. Getting disability benefits this way is called "meeting a listing." Although you won't meet a listing simply by undergoing a spinal fusion, it's possible that you could meet a listing for the underlying back problem that required a spinal fusion to fix or after going through an unsuccessful spinal fusion.;

Meeting a listing requires that you have a spinal disorder that affects your nerves in some way, causing mobility issues. For example, fusion of the cervical spine can compress the nerves in your neck and make it difficult for you to use your hands. Lumbar spinal fusion can compress the "cauda equina," a bundle of nerves in your lower back, which can limit your ability to stand and walk. Here's how the relevant listings work and what you need in your medical record to meet them.

Listing 1.15, Compromise of a Nerve Root

To qualify under listing 1.15 for "disorders of the skeletal spine resulting in compromise of a nerve root," you must have medical evidence of the following:

• radiating pain, paresthesia (a prickling or "pins and needles" sensation), or muscle fatigue indicating that a nerve root is compressed
• physical examinations or laboratory tests demonstrating that you have muscle weakness, signs of nerve root irritation, and sensory changes (decreased sensation, reduced nerve conductivity, or poor deep tendon reflexes)
• X-rays or MRI results consistent with compromise of a nerve root, and
• a documented need for an assistive device that requires the use of both hands (walker, bilateral canes or crutches, wheelchair), or a device that requires use of one hand (if you're unable to use the other hand for work-related activities), or the inability to use both hands for work-related activities.

Somebody who has had a fusion for a vertebral fracture with spinal cord injury, for example, would likely meet the above listing because they have a serious back disorder affecting the nerve root that is likely to be accompanied by symptoms of intense pain, muscle weakness, and even paralysis.

Listing 1.16, Lumbar Spinal Stenosis

To qualify under listing 1.16 for "lumbar spinal stenosis resulting in compromise of the cauda equina," you need medical evidence of the following:

• non-radiating pain in at least one leg, non-radiating sensory loss in at least one leg, or neurogenic claudication (pain or cramping caused by nerve compression)
• examination or test results showing signs of muscle weakness and either sensory changes (decreased sensation, sensory nerve deficits, traumatic ulcers, or incontinence) or decreased deep tendon reflexes in at least one leg
• imaging results or notes in an operative report consistent with compromise of the cauda equina with lumbar spinal stenosis, and
• a documented need for an assistive device that requires the use of both hands (walker, bilateral canes or crutches, wheelchair), or a device that requires use of one hand (if you're unable to use the other hand for work-related activities).

If your spinal fusion didn't repair your underlying back condition and you experience the symptoms listed above, you may meet a listing. But meeting a listing in this category is very difficult, and only the most serious cases are likely to qualify.

Qualifying for Benefits When Your Spinal Fusion Doesn't Meet a Listing

If Social Security doesn't think that your condition meets the requirements of a listed impairment, the agency will then use the medical evidence in your file—including physical examinations of your spine, range of motion tests, medical imaging (like X-rays, MRIs, and CT scans), and your doctor's notes—to determine your residual functional capacity, or "RFC." Your RFC describes your ability to perform work-related activities, such as lifting equipment, following instructions, or sitting at a desk.

When it comes to crafting your RFC, your doctor's opinion can play a very important role. Social Security claims examiners value input from doctors who've treated you regularly and may have special insight as to your limitations. If your physician or neurologist is willing to complete an RFC form or write a statement about your condition, ask them to offer specific opinions as to your physical limitations. For instance, your doctor should address the following questions:

• How long are you able to sit at one time?
• How long can you stand at one time?
• Are you able to bend, squat, and stoop?
• How much can you lift occasionally (up to one-third of an eight-hour workday)?
• How much can you lift frequently (up to two-thirds of an eight-hour workday)?

Your doctor should also address whether you need to use an assistive device for walking, whether you must lie down or recline during the day, whether you must be able to switch between sitting or standing at will, and whether you must elevate your legs to relieve pain. These "non-exertional" limitations can restrict the type of potential jobs you could do.

It's also helpful for your doctor to include a discussion of medications you're taking and their side effects. Note that it's not necessary for your doctor to give an opinion as to whether you're "disabled," as that is a legal determination reserved for Social Security. If your doctor seems reluctant to write a letter or says they're too busy, making an appointment specifically to discuss your disabling limitations might persuade them to help you with your claim.

Social Security will determine, based on your RFC, whether you can do your prior job and whether there is some type of less demanding job you could do. If not, your claim will be approved in what's called a medical-vocational allowance. So even though you don't qualify for benefits simply by undergoing a spinal fusion, you may qualify for benefits based on the remaining limitations that prevent you from performing work-related tasks.

VA Disability Benefits After a Spinal Fusion

Veterans who have a spinal fusion following a service-connected injury may be eligible for disability compensation from the VA. Under the Schedule for Rating Disabilities, veterans may be assigned a disability rating for spinal fusions (diagnostic code 5241) based on how significantly their range of motion is interrupted. The lower your spine flexibility is, the higher your VA disability rating will be.;

Using the General Rating Formula for Diseases and Injuries of the Spine, your percentage rating is based partly on whether you have favorable or unfavorable anklyosis (stiffening) of your spine. "Favorable" ankylosis means that your spine is fused in a position that is functionally useful (neutral or upright). "Unfavorable" ankylosis means that your spine is fused in a poor position (twisted or bent) that makes it difficult to move around. Below is the chart the VA uses to determine how severe your spinal fusion is and what the corresponding disability rating should be.

Your VA base compensation rate is based in large part on your disability rating, so check your claims file to make sure that the VA isn't missing any medical records that would help establish a higher disability percentage.

What Are the Disability Benefit Amounts for Spinal Fusion?

Social Security doesn't award benefits based on the type of disabling condition. Instead, the amount you'll receive if you're awarded benefits will depend on whether you're eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). SSDI eligibility is determined by your work history and how much you've contributed to the program in payroll taxes, while SSI is a needs-based benefit available to people with limited resources. For more information, check out our articles on how much you can get in SSDI and how much you can get in SSI. (Veterans can visit the VA webpage with the current disability compensation rates to see how much they can get every month based on their disability rating and living situation.)

Applying for Social Security Disability Following a Back Fusion

You can apply for disability benefits online at www.ssa.gov, over the phone by calling 800-772-1213 (TTY 800-325-0778) from 8 a.m. to 7 p.m., Monday through Friday, or by going in person to your nearest Social Security field office. To complete the disability application, you'll need detailed information, including the contact information and dates of treatment for all of your medical providers, the dates of any medical tests, and the names, addresses, and dates of employment for all of your employers in the last 15 years. For more detailed information, see our article on applying for SSDI benefits.

You don't need to hire an attorney to file your initial application—many claimants are able to do so without legal assistance—but it can be a good idea. If you'd like help with your application (or you've received a denial and want to increase your chances of winning an appeal), you may want to consider contacting an experienced disability attorney. Disability lawyers work on contingency, meaning they don't get paid unless (and until) you win, so there's little upfront risk in asking around to find a representative who's a good fit for your case.