Living with chronic back pain can be a challenging experience, ranging from mildly irritating to completely disabling. For some individuals, chronic back pain can interfere with their daily activities, including their ability to work. Certain jobs that involve extended periods of sitting, standing, or walking can exacerbate back conditions, making it difficult for affected individuals to carry out their work duties.
Research suggests that up to 80% of Americans will experience back pain at some point in their lives, and a significant number of them will continue to suffer from chronic back pain. If you are dealing with chronic back pain, it is important to understand how the Social Security Administration evaluates your condition for qualification in the Social Security Disability Insurance program.
5 Causes of Back Pain
Although there are numerous causes of back pain, some are more prevalent than others.
- Arthritis
- Injury or Accident
- Improper Posture
- Effects of Aging
- Bulging or Ruptured Discs
The Social Security Disability Insurance program is designed to assist American adults who are unable to work due to a disability. Unfortunately, chronic back pain is a major contributor to lost work hours, with over 265 million hours lost each year in the US, making it the leading cause of disability. Consequently, chronic back pain is also the most commonly cited reason for individuals to apply for Social Security disability benefits.
However, chronic back pain claims can be complicated to prove because the pain is subjective and challenging to quantify with objective medical evidence that assesses the extent of pain and its functional limitations.
If you intend to file a disability claim based on your chronic back pain, it’s important to understand the Social Security Administration’s evaluation process for determining disability claims.
1. Arthritis
Osteoarthritis, in particular, affects the lumbar region of the spine, leading to chronic and severe low back pain. Spinal stenosis, a narrowing of the space around the spinal cord, can occur due to osteoarthritis. Rheumatoid arthritis can also cause ankylosing spondylitis, which results in spinal fixation of at least 45 degrees.
2. Injury or Accident
Muscles and ligaments can easily become strained due to an injury or accident. Heavy lifting or sudden awkward movements can strain these structures, causing temporary pain. Severe and long-lasting injuries, such as car accidents, falls on ice, or high-impact injuries, can cause chronic pain.
3. Improper Posture
Poor posture and body mechanics can cause chronic back pain and strain the soft tissue surrounding the spine. Work environments can play a significant role in posture and body mechanics habits that lead to chronic pain, particularly when sitting for extended periods or hunching over a keyboard.
4. Effects of Aging
As we age, natural muscle atrophy can contribute to back pain. Weakening back muscles can no longer offer the necessary support, leading to irritation, inflammation, and strain. Additionally, it’s common for disc space between vertebrae to decrease with age.
5. Bulging or Ruptured Discs
Spinal discs act as cushions between our vertebrae, but when they bulge or rupture, they can compress nerves and cause long-lasting, intense pain. Degenerative disc disease can also lead to chronic bulging or ruptured discs.
Disability Benefits for Chronic Back Pain
Whether your chronic back pain qualifies as a disability under the Social Security Administration’s guidelines depends on your specific circumstances. The SSA will assess the severity of your symptoms, the effectiveness of your current treatment and medication, your age and education level, the nature of your work, and any relevant medical records that shed light on how your chronic back pain affects your daily life and ability to work.
The SSA follows a five-step process to evaluate disability claims, which can take several months or more to complete. It’s important to note that the appeals process can also prolong the evaluation process. However, in many cases, the SSA provides SSDI back pay that compensates for the period between your application submission and final approval.
Non-Medical Criteria
During the initial review stage, the adjudicator will evaluate whether you meet the Social Security requirements unrelated to your medical condition. This includes having a pre-tax income level below $1090. It’s essential to note that even if you have a valid medical condition, failing to meet the non-medical criteria set by the SSA will result in an automatic denial of your claim.
Severity of the Disability
In this stage, the SSA evaluates the severity of your condition by reviewing all medical documentation related to your disability claim. You will also be required to complete an Activities of Daily Living and Vocational questionnaire, which enables you to share how your symptoms have affected your day-to-day functioning. If you have a Social Security disability lawyer, they will be involved in guiding you through this stage.
You may be asked to undergo a consultative examination if the SSA requires additional medical documentation. This process involves being examined by a physician contracted by the SSA to gather any missing medical evidence or answer specific questions about your current medical condition.
Your medical documentation’s strength is critical to the SSA’s decision, as they need to see that your chronic back pain is linked to a specific medical condition. You may include objective medical evidence, such as MRI or X-ray results, that demonstrate the connection between your medical condition and chronic pain. This objective medical evidence carries significant weight with reviewers. Additionally, you can supplement this evidence with statements from treating physicians, friends, and family members who have observed how your medical condition has impacted your quality of life and ability to work.
Blue Book Listing of Impairments
In this step, reviewers evaluate whether your current condition meets the criteria for a pre-existing medical listing. The Social Security Administration keeps a Listing of Impairments, also called the Blue Book, which serves as a general reference to help reviewers understand various medical conditions and how they relate to compensation.
Although back pain is not listed separately, the Blue Book includes listings of specific medical conditions that can lead to back pain. For instance, back pain claims are typically evaluated under Listing 1.04 – Disorders of the Spine, which is a subset of Listing 1.00 – Musculoskeletal System Impairments.
To be approved under Listing 1.04, a disability claim must show documentation of at least one of the following: herniated disc, nerve compression, spinal pain radiating throughout the body, osteoarthritis, degenerative disc disease, arthritis in spinal joints, or a fractured vertebra leading to the compression of a nerve root or the spinal cord.
If your medical evidence clearly shows a disability that meets listing criteria, your application may be approved for SSDI benefits at step three, and additional steps may not be necessary.
Past Relevant Work
If your medical evidence does not support a clear condition in the Listing of Impairments, the next step is for reviewers to consider the type of work you previously performed. The SSA staff assesses whether your current medical condition allows you to continue working. They determine your Residual Functional Capacity (RFC), which assesses your ability to perform various work-related physical and mental functions, such as sitting, standing, crouching, lifting, carrying, comprehension, and decision-making.
Adjudicators evaluate the level of exertion associated with your past work and determine whether your current medical condition prevents you from performing that type of work. If the answer is affirmative, then your claim will proceed to the final step of the review process.
Common functional limitations that may lead to an approved claim include the need to lie down several times a day, the inability to bend or stoop to pick up something, or the need to keep one or both legs elevated throughout the day. If reviewers determine that your medical condition does not prevent you from performing the type of work you have done in the past, then your claim will be denied at this stage.
Performing Similar Work
The final step of the review process determines if your medical condition is severe enough to prevent you from completing any work you are qualified for, not just the work you have done before. This step considers your age, education, skill level, and Residual Functional Capacity results from the previous step.
The reviewers evaluate if your disability makes it impossible for you to do any work that is feasible for someone with your age and experience. If an adjudicator finds that your disability keeps you from doing any work, then your claim for disability insurance benefits may be approved. However, if the adjudicator determines that you can perform other types of work, then your Social Security disability claim will be denied.
Disability Benefits for Chronic Back Pain
SSDI claims for chronic back pain can be challenging to win since back pain has diverse causes that may be difficult to document with enough medical evidence.
Having assistance throughout the process is crucial. If chronic back pain hinders your ability to work, and you think you are eligible for disability benefits, seek help from a qualified and experienced Social Security attorney. The information presented here can help you start an informed conversation with an advocate who can help you navigate the approval process.