Winning Social Security Disability Benefits for Back Problems by Meeting a Listing

Winning Social Security Disability Benefits for Back Problems by Meeting a Listing

To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will consider whether your back problems are severe enough to meet or equal the listing for spine disorders. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that Social Security Administration presumes would prevent a person from performing substantial work. If your back pain or mobility is severe enough to meet or equal the listing, you will be considered disabled.

Most claimants with back problems do not qualify for Social Security disability benefits under the listing, and require a residual functional capacity assessment. See Residual Functional Capacity Assessment for Back Pain.

The listing for spine disorders is 1.04. It has 3 parts: A, B, and C. You will meet the listing and be eligible for Social Security disability benefits if you meet any of the three parts.

Meeting Social Security Administration Listing 1.04A for Disorders of the Spine

You will meet listing 1.04A if you have:

• A disorder of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture);
• Resulting in compromise of a nerve root (including the cauda equina) or the spinal cord;
• With evidence of nerve root compression;
• Characterized by–
  • neuro-anatomic distribution of pain,
  • limitation of motion of the spine,
  • motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss, and
  • if there is involvement of the lower back, positive straight-leg raising test (sitting and supine).

Bone spurs, herniated disks, cancerous or benign tumors, arachnoiditis, or other abnormalities may put pressure on a spinal nerve root. Most of these problems occur in the lumbar spine, especially the intervertebral disk between the 5th lumbar vertebra and the lower vertebra. CT and MRI scans can provide non-invasive and accurate diagnosis of herniated disks and other disorders impinging a nerve root, but image results do not necessarily imply a particular level of symptoms or severity.

“Motor loss” refers to muscle weakness as objectively determined by measurement of muscle size to determine if there is muscle wasting (atrophy). While atrophy is more convincing evidence of severe nerve root compression than weakness alone, part A clearly specifies that muscle weakness alone is sufficient. Thus, for example, a claimant’s ability to walk on the left toes and not the right toes would indicate significant right calf weakness.

Changes in deep tendon reflex (DTR) will occur if there is pressure on a nerve root. Most reflex changes are related to arthritic spurs or a herniated disk (HNP) pressuring a nerve root as it leaves the spinal cord. In these instances, reflexes related to the part of the body that the nerve root serves (the “radicular distribution”) will be decreased (hypoactive). Similarly, sensation in that body area (sensory dermatome) may be decreased because of injury to nerve fibers.

It is almost impossible to satisfy this part of the listing for several reasons. Often, a person has an acutely painful herniated disk (HNP) but no significant neurological changes; especially lacking are the classical findings of sensory, motor, and reflex changes that are required. If a person has these abnormalities, he or she is extremely likely to have surgery to relieve significant nerve root compression. Once surgery is done to decompress a nerve root, scarring around the nerve root may be a source of some degree of chronic pain. However, the persistence of reflex and sensory abnormalities after surgery is not proof of ongoing nerve root compression.

Meeting Social Security Administration Listing 1.04B for Disorders of the Spine

You will meet listing 1.04B if you have:

• A disorder of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture),
• With spinal arachnoiditis,
• Confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging,
• Manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours.

The preferable “acceptable imaging” for part B is MRI. Plain X-rays and CT scan X-rays of the spine cannot image the soft tissues well enough to provide any useful information regarding arachnoiditis.

It helps your claim greatly if your treating physician provides longitudinal medical records supporting the allegation of painful dysesthesia (impairment of the sense of touch) and your need to change position or posture more than once every 2 hours. The Social Security Administration should try to obtain the needed information regarding your time-tolerance for body position and posture from your treating doctor, if the medical records are not clear. A detailed analysis of your activities of daily living (ADLs) can also be helpful. It is important that you provide specific examples of the pain and your need to change positions. The Social Security Administration should ask you clear questions that elicit these examples.

Changes in body position or posture need to be significant, like the need to stand up or sit down—not merely moving around in a chair a little to get more comfortable.

Meeting Social Security Administration Listing 1.04C for Disorders of the Spine

You will meet listing 1.04C if you have:

• A disorder of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture),
• With lumbar spinal stenosis resulting in pseudoclaudication (pain and weakness usually in the low back and buttocks),
• Established by findings on appropriate medically acceptable imaging,
• Manifested by chronic nonradicular pain and weakness,
• Resulting in inability to ambulate effectively.

Inability to ambulate effectively means an extreme limitation of the ability to walk. Ineffective ambulation is defined generally as having insufficient lower extremity functioning to permit independent ambulation without the use of a hand-held assistive device(s) that limits the functioning of both upper extremities. To ambulate effectively, you must be capable of sustaining a reasonable walking pace over a sufficient distance to be able to carry out activities of daily living. You must have the ability to travel without companion assistance to and from a place of employment or school. Therefore, examples of ineffective ambulation include, but are not limited to:

• The inability to walk without the use of a walker, two crutches or two canes,
• The inability to walk a block at a reasonable pace on rough or uneven surfaces,
• The inability to use standard public transportation,
• The inability to carry out routine ambulatory activities, such as shopping and banking, and
• The inability to climb a few steps at a reasonable pace with the use of a single hand rail.

The ability to walk independently about your home without the use of assistive devices does not, in and of itself, constitute effective ambulation.

Spinal stenosis is not rare, but can be missed by the Social Security Administration if your medical records consist only of a physical examination and plain X-rays. That’s why the examining doctor should take a careful history to rule out the symptoms of pseudoclaudication that might be caused by spinal stenosis. If you have severe lower lumbar arthritis and symptoms of pseudoclaudication, then the Social Security Administration should send you for a lumbar CT scan or MRI, if one has not been done. The Social Security Administration wants confirmation of lumbar stenosis on imaging, but provides no guidance regarding what is acceptable as diagnostic of abnormality. Measurements on imaging procedures that are diagnostic of lumbar stenosis have not been established in the medical literature. Therefore, the Social Security Administration must be willing to accept this imaging diagnosis as a matter of judgment by the interpreting radiologist, orthopedic surgeon, or neurosurgeon.

“Nonradicular” pain means the pain does not have to follow the pattern of a particular nerve root; it can occur more diffusely in the buttocks, back, or thighs.

As in other types of back impairments, careful development of your daily activities and the opinion of your treating physician are critical in deciding whether you satisfy the listing in regard to effective ambulation, once the diagnosis is established.

If your spinal cord is damaged enough to cause significant neurological abnormalities (a possibility with spinal stenosis), the affected deep tendon reflexes (DTRs) are expected to be abnormally brisk (hyperactive). For example, eliciting the knee-jerk reflex will cause your leg to move with a quicker than normal reaction. Contrast this to damage to a spinal cord nerve root as from a herniated disk, in which the affected DTR will be slower than expected. However, unlike part A of the listing that deals with nerve root compression, part C does not require reflex abnormalities to be present. In spinal stenosis, reflex changes are specific enough to be diagnostic.