The Listing of Impairment manual has specific criteria for the evaluation of spinal impairments which can be found at here.

These problems can include osteoarthritis, spinal stenosis, herniated discs, spinal arachnoidtis, and degenerative disc disease.

These are common problems which are the basis of many social security disability applications and, unfortunately, many denials. Why is that?

There are two reasons. The first is that back problems are a common complaint the Social Security Administration (SSA) sees all the time and SSA just doesn’t take these complaints or problems seriously. The second is that your doctors don’t go to medical school to write reports that meet Social Security disability criteria.

If you click on the link above, you will see that there are very specific criteria for the diagnosis of your back complaints, exacting requirements for what must be seen on your physical examination including precise measurements, diagnostic studies which support your diagnosis, documentation of the treatment prescribed by your doctor in response to the treatment, specific comments on the effects of the treatment that you have been given, and specific descriptions of the drug or treatment given including dosages, frequency, description of any complications or side effects.

You will also see that Section 1.04, Disorders of the spine, includes specific definitions of spinal conditions including herniated discs, spinal arachnoiditis, lumbar spinal stenosis, and abnormal curvature of the spine. If your condition doesn’t perfectly fit the definition and the criteria required by the listing, the Social Security Administration is going to find that you do not need a listing. So, in many cases, your medical records simply don’t address all the factors that Social Security wants to see before they will agree that you need a listing.

Unfortunately, at Hurdle 4 and 5, most Disability Determination specialists are of the opinion that back problems are temporary and that you can return to the lightest job you’ve held in the last 15 years with the job you were doing at the time it became disabled. That, of course, means that your claim will be denied.

That isn’t to say that these cases can’t be won! In fact, with proper development of the medical evidence these cases are won every day.

What’s the key?

1. Make sure that your doctors notes show a proper diagnosis of disc herniation, back pain, lumbar problems, spinal stenosis, or degenerative joint disease.

2. Make sure that your medical records have objective evidence of the diagnosis in the form of x-ray reports, CAT scans, MRI studies, bone scans, EMG/NCS studies, and surgical reports.

3. Make sure your doctor documents your functional limitations on your activities such as bending, stooping, standing, walking, sitting, and alternating positions.

4. Make sure your doctor documents any side effects of medication.

5. Make sure your doctor documents you are physical findings on examination such as decreased range of motion, reduced muscular strength, how you walk, positive straight leg raising tests,  and any sensory or reflex changes.

6. Make sure that your doctor’s reports are consistent with what you’re reporting about your condition, physical problems, pain and side effects of medication.

7. When you fill out forms for the Social Security Administration explain what problems are having with pain and how it limits your ability to function 24/7.

8. Getting regular medical treatment so that there are medical records that backup your claim.

Back claims can be won with proper development of the evidence that meets the Social Security criteria and your best chance will be to contact skilled Social Security Disability lawyers Cavey & Barrett!

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Section 1 of the Listing of Impairments deals with disorders of the musculoskeletal system that results from “hereditary, congenital or acquired conditions.” This can include problems resulting from infections, inflammatory processes, degenerative processes, traumatic events, or vascular or metabolic diseases.

The Social Security Administration will expect to see in your medical records comments by your treating physician about changes in the range of motion of the joint involved, the condition of the muscles, sensory or reflex changes, laboratory findings, and the results of diagnostic testing including x-rays, CAT scans, MRIs, and bone scans.

Your medical records should have a detailed description of the findings your doctor made when you are examined. The Social Security Administration will reject comments like “He says his back hurts and he has tingling in his leg.”

The Social Security administration will also compare your reported complaints and your doctor’s examination findings with what you have reported to the Social Security Administration about your daily activities. There will be big problems if there are any inconsistencies.

The Social Security Administration focuses on “functional” loss as a result of these disorders. This includes the ability to walk effectively on a sustained basis or the inability to perform fine and gross movements which will last, or is expected to last, for at least 12 months.

The Social Security Administration will review your medical records and other evidence to determine if you have met this criteria. The introduction to Listing of Impairment – Section 1 notes that “musculoskeletal impairments greatly improve with time or respond to treatment.” As a result, the Social Security Administration wants to see medical records that show ongoing problems which are severe enough or which will be expected to last long enough.

What if there is no record of ongoing treatment? That makes proving your case hard to do! The Social Security administration will look at the current objective medical evidence, taking into consideration your medical history, symptoms, and medical opinions. Most likely you will not be able to establish that you meet a listing.

In any case in which you have a medically determinable impairment that is not listed, or your impairment doesn’t meet the requirements of the listing, or a combination of the impairments don’t meet required listing, the Social Security Administration will consider “medical “equivalency.” As a practical matter, I rarely see that happen.

The categories of impairment include dysfunctions of major joints such as the hip, knee, shoulder, elbow, wrist – hand, and ankle – foot, reconstructive surgery of a major joint; disorders of the spine; amputations; fractures of the femur, tibia, pelvis or one or more of the tarsal bones; fracture of an upper extremity with nonunion with continuing surgery, and soft tissue injuries which have resulted in surgeries without the restoration of function within 12 months of the onset.

One of the most common musculoskeletal impairments involves the spine. The Social Security Administration has specific requirements it wants to see before they will agree that any spine condition meets a listing. I will talk about that in our next posting. For now, If you need to file a claim for this disability you should consult experienced lawyers Cavey & Barrett.

Learn More About: Listing of Impairments,Social Security Benefts for Musculoskeletal and Spine | Comments (0)| Permalink | Trackback |  Print This Post |  Email This Post