Disability Determination for Back Problems

Back injuries  can be caused by natural aging processes and deterioration like osteoarthritis  or osteoporosis, from illnesses like inflammatory arthritis (including rheumatoid arthritis), or from postural problems resulting from scoliosis, improper lifting, extended periods of sitting, bad posture, or years of wear and tear from heavy lifting and bending at work. Back injuries can also occur from car accidents, sports injuries, and falls.  

Most applicants for disability based on back pain suffer from osteoarthritis or disc degeneration rather than a traumatic accident or injury. And quite a few applicants are those who have gone through a back surgery and have not recovered well.

How the Social Security Administration Views Back Problems

Claims for Social Security disability because of back pain resulting from disc problems and arthritis are extremely common. The SSA knows that many working people have back problems once they reach their forties and fifties, and it expects most of them to be able to continue working until retirement age with moderate discomfort. As a result, it can be very difficult to win a Social Security disability claim based on common back problems.

To win a disability claim based on back pain, you’ll have to show the Social Security Administration (SSA) that your pain is beyond the moderate back pain that many people experience, and instead is severe and debilitating. Depending on your condition, you may have to prove that you either cannot sit or stand for several hours at a time or cannot walk without assistance. For all conditions, your back problems must have lasted or be expected to last 12 months or more.

Qualifying for Disability Due to Back Problems

If your back condition, as described in your treating doctor’s reports, matches an “impairment listing” in the SSA’s “blue book” of impairments, you will automatically be approved for disability benefits. This is not easy to do; only very severe and well documented cases of back pain will match (“meet,” in SSA lingo) the SSA’s listing for disorders of the spine. Your condition can also be considered to be equivalent to the listing for disorders of the spine, if it doesn’t match a listing exactly but it is similar and has the same level of severity. The SSA will decide with the help of a medical consultant whether your back condition is equivalent to the spinal disorders impairment listing.

There are three main categories of back problems that can qualify for disability under the SSA’s official impairment listing for disorders of the spine. The SSA specifies the symptoms and severity required to match each of these listings. Specifically, to match the listing for disorders of the spine (listing 1.04), the SSA requires that your spinal disorder includes one of the following three conditions:

• nerve root compression
• arachnoiditis, or
• stenosis.

The SSA notes several examples of back conditions that involve nerve root or spinal cord compression, which can cause problems from mild chronic pain to paraplegia in the worst cases:

• 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
• facet arthritis, and
• vertebral fracture.

If your back problems don’t match the SSA’s particular requirements for nerve root compression, arachnoiditis, or stenosis, the SSA will evaluate your condition to give you a functional capacity rating for the level of work you should be able to do (sedentary, light, medium, or heavy). The SSA will then look at your age, education, and past experience to see if there are any jobs you can do with the reduced capacity caused by your back problems.  

Medical Evidence Required

In order to determine whether your back condition meets the listing for disorders of the spine, the SSA will need to see all of you medical records. If you haven't already, the SSA will require that you undergo a comprehensive spinal exam. Preferably, you have visited an orthopedic doctor who has conducted a detailed physical exam, including testing your reflexes, sensation, muscle strength, and range of motion,   as well as your ability to walk, bend, squat and rise. Any muscle atrophy should be recorded over time, and if you have back spasms, be sure your doctor has recorded them.

To evaluate the validity and severity of your pain, the SSA may look at how often you have been to the doctor and what treatments you have tried. A longitudinal record is most helpful (a medical record and doctor's notes over a long period of time). The various treatments you have undergone (e.g., pain medication, steroid injections, muscle relaxants, physical therapy) should be thoroughly documented, including how long the effects of treatment lasted and whether the side effects of any mediation or treatment impairs your ability to work or function.

Obviously, any MRIs, X-Rays, CT scans, or myelography reports should be included. Because the SSA doesn't like to rely on a patient's subjective symptoms of pain as an indicator of whether you can work or not, the results of these imaging tests can be extremely important for your case (if they indicate deterioration or compression, that is. If the tests don't show any compression, deterioration, or impairment, yet you insist you have extreme back pain, the SSA might ask you to see a psychiatrist for a mental examination.)

Starting a Disability Claim for Back Pain

Call the SSA at 800-772-1213 to set up an appointment to fill out an application for disability If you don’t know whether you are eligible for Social Security disability insurance (SSDI, where you must have paid enough taxes into Social Security) or Supplemental Security Income (SSI, for low-income filers), you can apply for both. When you fill out your application, include both how your back pain affects your life outside of work and how it impairs your ability to work. If you have both severe back problems and a mental impairment, such as depression (as many people with back problems do), be sure to include symptoms and documentation of the mental impairment as well.