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, extended periods of sitting, bad posture, or years of wear and tear from heavy lifting and bending at work. Car accidents, sports injuries, and falls can also cause back injuries.

Most applicants for disability based on back pain suffer from osteoarthritis or disc degeneration, rather than a traumatic accident or injury. Quite a few applicants have also gone through back surgery and have not recovered well.

How the Social Security Administration Views Back Problems

Claims for Social Security disability because of back pain caused by disc problems and arthritis are extremely common. Claims examiners and judges who work for Social Security know that many people (and sometimes they themselves) have back problems once they reach their forties and fifties, and they expect most people 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 Social Security 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. And for all conditions, your back problems must have lasted or be expected to last 12 months or more.

Can I Qualify for Disability Benefits for Back Pain?

To determine if someone qualifies for Social Security disability benefits, Social Security uses its disability evaluation handbook, called the "blue book," which outlines the criteria for disability that are specific to certain medical conditions. These criteria are found in what's called "listings." If your back condition, as described in your treating doctor's reports, matches ("meets" in SSA lingo) a listing, you'll be approved for disability benefits. But this isn't always 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.

The only two listings Social Security will apply to most claims for back problems are listing 1.15 and 1.16 (both are for lower back pain). These two listings require that evidence of either nerve root compression of the lumbar spine (1.15) or compromise of the cauda equina (1.16) can be seen on imaging, such as an x-ray, CT, or MRI. You must also 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), while you're unable to use the other arm for fine and gross motor activities (like gripping, grasping, holding, turning, and reaching).

Listing 1.15 will also consider whether you're unable to use both arms for activities fine and gross motor activities.

Here is the medical evidence required to show that you have either nerve root compression or stenosis of the lumbar spine.

Listing 1.15, Nerve Root Involvement

If you have compressed nerves, Social Security will evaluate your condition under listing 1.15 for "disorders of the skeletal spine resulting in compromise of a nerve root(s)." To meet listing 1.15, your medical records must show that you experience pain, muscle fatigue, or burning/prickling sensation (called "paresthesia") that starts in your back and travels into one or both legs. 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:

• sensory changes, evidenced by either decreased sensation or abnormal "sensory nerve latency" on electrodiagnostic testing (like an EMG), or
• decreased sleep tendon reflexes (usually caused by peripheral neuropathy).

Social Security gives several examples of back conditions that involve nerve root 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 (DDD)
• facet joint arthritis, and
• vertebral fracture.

Listing 1.16, Spinal Stenosis

If you have narrowing of the spinal canal, Social Security will evaluate your back pain under listing 1.16 for "lumbar spinal stenosis resulting in compromise of the cauda equina." To meet the criteria in listing 1.16, your medical records must show lumbar spinal stenosis causing either non-radiating pain in one or both leg(s), non-radiating sensory loss in one or both leg(s), or leg pain caused by decreased blood flow (called "neurogenic claudication"). Additionally, an examination and/or X-ray or MRI imaging by your doctor must show muscle weakness with either:

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

What Should Your Medical Records Include?

In order 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. If you haven't already, Social Security will require that you undergo a comprehensive spinal exam. Preferably, you have already 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.

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. A longitudinal record is most helpful (a medical record and doctor's notes over a long period of time).

Your medical records should document the various treatments you've undergone (such as pain medication, steroid injections, muscle relaxants, physical therapy), including 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 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 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.

What if I Don't Meet a 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 criteria of one of the listings contained in Social Security's evaluation handbook. Instead, Social Security approves them because a disability applicant's 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 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 is 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 will 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've suffered a heart attack, your doctor might limit you to standing or walking a certain number of hours per day due to fatigue or shortness of breath.

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 would be unable to complete a full work shift. For more information on how Social Security decides whether your RFC prevents you from doing any jobs, see our section on disability determinations based on RFCs.

Starting a Disability Claim for Back Pain

A convenient way to apply for Social Security disability benefits is to file your claim online at www.ssa.gov/applyfordisability. You may also file a claim over the phone by contacting Social Security at 800-772-1213, but be prepared for long wait times. But if you have questions before you apply, or you'd like help with your application, click for a free case evaluation with a legal professional.

And for more information on the application process, please see our article about applying for Social Security disability benefits.

_{Updated March 9, 2022}