HOW TO GET DISABILITY FOR BACK PAIN

Back or spinal impairments are the leading cause of Social Security disability awards. In other words, more people are awarded benefits for back or spinal problems than for any other type of impairment.

So, is a claim with back pain an "easy win"? No, it isn't--for the following reasons:

• Back pain is very common in the population; most people have it.

• Back pain can be from an unknown or medically non-determinable cause.

• Most people with back pain keep working; it doesn't stop them.

• There are many jobs that individuals with severe back pain can still perform.

"Over half the people on disability are either anxious or their back hurts. Join the club. Who doesn't get up a little anxious about work every day and their back hurts? Everyone over 40 years has back pain."

--Senator Rand Paul

This pretty much explains the attitude Social Security has about back pain, too. Back pain can be terrible, it may require surgery, and it can be incapacitating. But with treatment it may get better and you may not be disabled. Back pain must be very severe and very proven to be disabling.

Social Security wants something to prove that your back pain is severe, prevents functioning in the workplace, and has a known physical cause. The regulations require that you must have a "medically determinable disease." This means a disease that has a clear medical cause that can be demonstrated on imaging, tests or objective medical studies. Back pain that is described as "non-specific" by your doctor is unlikely to win disability.

The government needs to know the exact cause of your back pain. For example, if you had an MRI or CT scan which shows a severe L4-L5 disc herniation and stenosis of the L4 nerve root impacting the thecal sac--that is a medically determined impairment. The doctor's objective evidence clearly shows the cause of the back pain. It will also explain the severity of the back pain. This evidence also makes it very believable that this individual will have severe functional limitations int he workplace. In short, he or she will have difficulty sitting, standing or walking for long periods of time; will be restricted in lifting, carrying, bending, reaching, kneeling, crouching and crawling. Depending on the claimant's age, this may be enough for a judge to find that there is no work in the national economy that this person can still perform, especially if the claimant has tried everything to lessen the pain and it has all failed.

If I were about to file a Social Security disability claim for back problems, here's what I would do before filing:

1. See a specialist--an orthopedic doctor--for the back pain.

2. Get objective tests: X-rays, MRI, CT scan, etc. to find the cause of the pain. Social Security doesn't like mystery pain that has no medically explained cause.

3. Follow my doctor's advice to try to get better: Medications, exercise, physical therapy, spinal injections, etc.

4. Follow up with the doctor at least every 3 months to report progress or lack thereof.

5. Seek my orthopedic doctor's specific opinions as to how my back problem restricts my ability to function in the work environment: What is the maximum I can sit, stand or walk each 8-hour shift? What is the most I can lift/carry repeatedly at work--and how often can I lift and carry it? Constantly, frequently, occasionally, rarely or never? How are my posturals limited? What about bending, reaching, kneeling, crouching, crawling, climbing ramps and stair, ladders, scaffolds? Attorneys have a 'RESIDUAL FUNCTIONAL CAPACITY" form for doctors to use.

6. I would explain my back pain very specifically on my disability application paperwork: where is the pain (low back, mid-back or upper back to shoulders?); is the pain in one location or does it rotate? Is it burning, aching or stabbing pain? One a scale of 1 to 10, how severe is the pain? What makes it worse? What makes it better?

7. I would try to get on my employer's short term disability (STD) plan before I stop working and convert over to their long term disability (LTD) plan. These private insurance plans, purchased by your employer, bridge the gap between the time you stop working and the time you get SSDI benefits ( which may be 12 to 24 months). You can have a weekly income while you fight Social Security for your benefits.

"The PATH TO DISABILITY runs through your doctor's office. Good objective medical evidence is required. Statements in the medical record such as, "Complains of non-specific pain in the low back, but the MRI shows only mild degenerative changes" do not win benefits. The words "mild" or "non-specific" don't fare well at Social Security. And mere "complaints of back pain" fall into the "everybody has it" category. Social Security needs to see SEVERE disease that cannot be overcome with medication, exercise, physical therapy, lifestyle changes (losing weight, quit smoking), injections, etc.

An experienced Social Security attorney/advocate will be most useful in guiding you through the SSDI process. Choose one who understands Social Security, it's complex rules and regulations and knows how to find the evidence required to win. Be sure you won't have to pay any fees unless and until your SSDI claim is approved.