Getting Social Security Disability for Back Problems

When your back is injured, whether due to an accident or illness, your ability to go about your daily routine can be severely affected. Debilitating back injuries can be caused by many things, including:

• natural aging processes and deterioration like osteoarthritis and osteoporosis
• illnesses like inflammatory arthritis (including rheumatoid arthritis)
• traumatic injuries from car accidents, sports injuries, and falls
• postural problems resulting from:
  • scoliosis
  • extended periods of sitting
  • bad posture, or
  • years of wear and tear from heavy lifting and bending at work.

No matter the cause, chronic back problems anywhere along your spine can cause unbearable pain that makes it difficult or impossible for you to work.

Most people who apply for disability based on back pain suffer from osteoarthritis or disc degeneration rather than a traumatic accident or injury. Many have also gone through back surgery and haven't recovered well.

Here's a look at how Social Security evaluates back problems and how you can qualify for disability benefits based on back trouble.

How Social Security Views Back Problems

The Social Security Administration (SSA) sees a lot of disability claims for back pain caused by disc problems and arthritis. Claims examiners and judges who work for Social Security know that many people (and sometimes they themselves) have back problems that cause moderate discomfort once they reach their forties and fifties.

As a result, they expect most people with moderate back trouble to be able to continue working until retirement age. So it can be very difficult to win a Social Security disability claim based on common back problems.

To get disability benefits because of your back pain, you'll have to show Social Security that your pain is beyond the moderate level many people experience and is instead severe and debilitating. Depending on your condition, you might also have to prove that:

• you can't sit or stand for several hours at a time, or
• you can't walk without assistance.

And no matter the cause, you'll need to show that your back problems have lasted or are expected to last 12 months or more.

Can I Qualify for Disability Benefits for Back Pain?

There are two ways to qualify for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits because of your back pain. You must either meet the requirements of a "listing" in Social Security's disability evaluation handbook, called the "Blue Book," or prove that you're unable to do any kind of work because of your back problem.

If your back condition, as described in your doctor's reports, matches the criteria of a listing, you'll be approved for disability benefits. But this isn't easy to do—only very severe and well-documented cases of back pain will meet one of Social Security's listings for disorders of the spine.

Back trouble is evaluated under two listings (both for lower back pain):

• Listing 1.15, for spinal disorders causing nerve root compression, requires evidence that a nerve root in the lumbar spine (the five vertebrae between the ribs and the pelvis) is compromised.
• Listing 1.16, for lumbar spinal stenosis causing cauda equina compression, requires evidence that the nerves at the base of the spine (which connect to other parts of the body) are compromised.

For both listings, your condition must be detectable using medical imaging like an X-ray, CT, or MRI. And you must have such severe difficulty functioning that you need either:

• a walker, two canes, two crutches, or a wheeled/seated mobility device that requires the use of both hands (like a mobility scooter), or
• a hand-held assistive device (like one cane), and you can't use the other arm for activities like gripping, grasping, holding, turning, and reaching.

No matter how much pain you have, to meet one of these listings, you'll need solid medical evidence to show that you have either nerve root compression or stenosis of the lumbar spine.

Social Security Listing 1.15, Nerve Root Involvement

Social Security gives several examples of back conditions that involve nerve root compression:

• herniated disc (technically known as "herniated nucleus pulposis," or HNP, but also known as a slipped or prolapsed disc)
• osteoarthritis (degenerative arthritis)
• degenerative disc disease (DDD)
• facet joint arthritis, and
• vertebral fracture.

If you have a compressed nerve root, Social Security will evaluate your condition under listing 1.15, To meet the requirements of the listing, your medical records must show that you experience at least one of the following conditions that starts in your back and travels to one or both legs:

• pain
• muscle fatigue, or
• a burning/prickling sensation (called "paresthesia").

An examination by your doctor or imaging like an X-ray or MRI must also show muscle weakness and signs that something is pushing on the nerve root ("nerve root compression") with one of the following:

• decreased sensation (numbness or lack of feeling)
• abnormal "sensory nerve latency" on electrodiagnostic testing (like an EMG), or
• decreased deep tendon reflexes (usually caused by peripheral neuropathy).

Social Security Listing 1.16, Spinal Stenosis

If the space inside your backbones is too small, putting pressure on your spinal cord and other nerves that run through your spine, Social Security will evaluate your back pain under listing 1.16. To meet the criteria in the listing, your medical records must show lumbar spinal stenosis (narrowing of the spinal canal) causing:

• non-radiating pain in one or both legs
• non-radiating sensory loss (numbness or loss of feeling) in one or both legs, or
• leg pain caused by decreased blood flow (called "neurogenic claudication").

Additionally, an examination by your doctor or imaging tests like an X-ray or MRI must show muscle weakness and at least one of the following:

• sensory changes evidenced by either decreased sensation (numbness) or abnormal "sensory nerve latency" on electrodiagnostic testing (like an EMG)
• decreased deep tendon reflexes (usually caused by peripheral neuropathy) or the absence of deep tendon reflexes (called "areflexia")
• bowel or bladder incontinence, or
• a pressure ulcer (called "trophic ulceration").

What Should Your Medical Records Include to Meet a Listing?

To determine whether your back condition meets the listing for disorders of the spine, Social Security will need to see all of your medical records from the various doctors you've seen. Social Security will require that you undergo a comprehensive spinal exam if you haven't already done so.

You should have already visited an orthopedic doctor who's conducted a detailed physical exam, including testing your:

• reflexes
• sensation (reaction to pain, temperature, touch, and more)
• muscle strength
• range of motion, and
• ability to walk, bend, squat and rise.

When Social Security is evaluating the validity and severity of your pain, the agency will look at how often you've been to the doctor and what treatments you've tried. Long-term medical records (test results and doctor's notes over a long period of time) are most helpful.

Your medical records should document the various treatments you've tried, including:

• pain medication
• steroid injections
• muscle relaxants
• physical therapy, and
• any other treatment you've tried.

Your records should detail how long the effects of treatment lasted and whether the side effects of any medication or treatment impair your ability to work or function.

Your medical records should also include an X-ray, MRI, CT scan, or myelogram (a spinal X-ray with a dye injection). Because Social Security won't solely rely on your pain symptoms as an indicator of whether or not you can work, the results of these imaging tests can be extremely important for your case.

What if I Don't Meet a Disability Listing?

Meeting the criteria explained in the listings can be difficult. In fact, most disability claims that are approved for benefits don't meet the requirements of one of the listings. Most people who successfully win disability benefits do so by proving to Social Security that:

• their severe symptoms and limitations make them unable to perform their previous jobs, and
• they're unable to transition into another type of work.

To decide if you're unable to work, Social Security will look at your medical records to see whether there's enough evidence that you have a serious medical condition that limits your ability to do many work-related activities. This means you must have a medical diagnosis of a severe condition that's backed up by medical findings, like lab tests or imaging, not just your reports about back or leg pain.

If Social Security agrees that you have a severe medical condition, a claims examiner must next determine your residual functional capacity (RFC). Your RFC is the most intensive work you can still do (medium, light, or sedentary), despite the limitations caused by your medical condition. For example, if you have several bulging discs, your doctor might limit you to standing or walking a certain number of hours per day.

An RFC for someone suffering from severe back pain might include the following limitations:

• walk and stand no more than two hours of an eight-hour workday
• sit no more than four hours of an eight-hour workday
• lift and carry no more than twenty pounds occasionally and ten pounds frequently
• stoop, crouch, crawl, kneel, or bend only occasionally
• never climb ladders, ropes, or scaffolds, and
• climb ramps or stairs only occasionally.

Someone with these limitations would likely be unable to perform most jobs because they couldn't complete an entire eight-hour work shift. To let Social Security know what your limitations should be, ask your doctor to complete an RFC assessment form and include it with your application.

Learn more about how to qualify for a medical-vocational allowance because of the combined effect of your condition, age, education, and job skills.

Starting a Social Security Disability Claim for Back Pain

A convenient way to apply for Social Security disability benefits is to file your claim online. You can access the online application anytime, no matter where you are. And you can pause the application as often as needed.

You can also file a claim over the phone by contacting Social Security at 800-772-1213 (be prepared for long hold times). Or file your disability claim in person at your local Social Security office. (You might need an appointment to speak with a Social Security representative.) Learn more about the disability application process.

If you have questions before applying or want help with your application, you might benefit from talking with a disability attorney.