Back Pain and Social security Disability Benefits
By Pitt Dickey

This column will take a look at how the Social Security Administration determines if a worker meets the requirements to receive Disability Insurance Benefits as a result of illness or injury to the spinal column. A substantial number of disability claimants develop back pain that can be so severe that they are no longer able to work. I frequently encounter clients who have severe back pain resulting from automobile accidents, repetitive movement injuries and sudden onset of back pain for no obvious reason. As discussed in last month’s column, the SSA uses what are called Listings to evaluate certain common health problems. This column will review some of the standards the SSA uses to evaluate back problems that are covered in Listing describing Disorders of the Spine. If a person’s health problems meet a listing then his claim will be approved without the need for a hearing by an Administrative Law Judge.

To better understand how the SSA applies the Listings to determine who qualifies for Disability Insurance Benefits resulting from back pain I will discuss the spine in some general terms. The spinal column consists of 26 vertebrae which are the bones in the spine. These vertebrae are stacked on top of each other from the tail bone to the skull. The spine is divided into five sections. The part of the spine that supports the skull in your neck is called the cervical spine. It consists of seven cervical vertebrae that are called C1 through C7 in medical reports.. Below the cervical spine, the next 12 vertebrae are called the thoracic vertebrae which are located behind your chest and connect with your twelve ribs. The thoracic vertebrae are referred to as T1 through T12. The next set of vertebrae are the five lumbar vertebrae. They are numbered L1 through L5. This is your low back region where back problems can really cause problems. Below the lumbar region is the sacrum which is slightly curved. This is one large fused bone. The last section of the spine is the coccyx which is a single fused bone that is the tailbone.

Each of the bones in the cervical, thoracic, and lumbar regions is called a vertebra. The vertebra consists of disk shaped bone called the vertebral body. Between the vertebral bodies are cartilaginous disks which are designed to act as shock absorbers between the vertebra. These disks can be damaged and result in what is sometimes referred to as a herniated disk if the disk itself actually is broken or a slipped disk if the disk gets out its normal position. The pressure from the disk against the spinal cord can cause severe pain that radiates into a person’s extremities.

In the rear part of the disk is the vertebral arch which is a bony arch through which the spinal cord passes between the arch and the vertebral body. This hollow area is called the neural canal through which your spinal cord must pass. Think of twenty six of the McDonald’s Golden Arches lined up next to each other. Imagine a pipe going through the arches carrying electricity. Your spinal cord is like the pipe as it passes through the 26 vertebral arches bearing information from the brain to the rest of the body. If one of the arches collapses on the spinal cord it can damage the ability of the cord to function normally.

If the neural canal becomes too narrow from injury or disease it will press down upon the spinal cord causing pain or even paralysis if the narrowing is extreme. This narrowing is called stenosis. Imagine a drinking straw. If you were to take your fingers and press in on the outside of the straw to the extent that you made the opening in the straw narrower you would have a straw with stenosis.

The SSA listing for Disorders of the Spine directs a finding that a worker is disabled if he has:

A. Fracture of the vertebra with cord involvement (substantiated by appropriate sensory and motor loss); or

Discussion: A fractured vertebra means a broken bone in your spine that involves the spinal cord such as pressing in on the cord. This fractured bone must produce appropriate symptoms such as pain, weakness or paralysis. It is not necessary to be paralyzed to meet this listing. A person can be disabled by pain itself if the pain is intense enough and imposes sufficient limitations that the person is not able to work.

B. Scoliosis (congenital idiopathic or neuromyopathic) With:

1. Major spine curve of 60 degrees or greater; or

   Discussion: Scoliosis is a condition where the spine is curved to the side across the back in an S shape. Scoliosis can occur from birth for an unknown reason, (congenital idiopathic). It can also occur as a result of a disease of the nerves or muscles (neuromyopathic). If the curvature is at least 60 degrees then the claimant meets the listing and will receive disability benefits.
   
   

2. Spinal fusion of six or more levels. Consider under disability for one year from the time of surgery; thereafter evaluate the residual impairment;

   Discussion: Spinal fusion is a surgical procedure to repair damaged vertebra by immobilizing them by inserting bones into the effected spinal column so that the column does not move as much to avoid further injury to the spinal cord. The source of this new bone is typically from the hip of the person undergoing the surgery or from bones from a cadaver. In severe cases a metal rod may be inserted in the spine to immobilize that section. To meet this listing the patient would have at least six levels of vertebra fused.

   If person meets this listing, the SSA will approve his disability claim but will review it again in one year from his surgery to see if he has recovered enough to return to work This is a fairly extreme listing as most patients tend to have one or two disks fused. It needs to be noted that a patient can still be found disabled with the fusion of a single disk if the surgery has left the patient in severe pain with limitations in movement, sitting and standings.

   
   
3. Kyphosis or lordosis measuring 90 degrees or greater;

   Kyphosis is a condition in which the thoracic segment of the spinal column is bent forward so that the patient appears to be hump backed. This is sometimes referred to as dowager’s hump and can effect women as they age and suffer from osteoporosis. Lordosis is a condition of the lumbar segment of the spinal column in which the spine is bent backwards so that the patient is leaning backwards. A measurement of 90 degrees is an extreme amount of bending in either direction.

Conclusion

It is not necessary for a patient to meet the listings to draw disability insurance benefits if all of the patients ailments in combination either exceed or are the equivalent of a listing. The listing serve as a basis for the disability determination review workers who review a claimant’s disability claim to decide if there is enough evidence on the record to award benefits. If a person does not meet the listings, they will deny his claim at the initial and reconsideration levels of review. However the person can then have a hearing before an Administrative Law Judge who will give the person a totally new review of his claim and make a decision based upon the medical evidence and the oral testimony of the claimant as to how the claimant’s back ailments have effected his ability to work. Everyone who appears before an Administrative Law Judge has been turned down twice by the system.

A disabled worker should not get discouraged because he has been denied twice by the SSA as many workers have their disability claims granted when they actually have a face to face hearing with the Administrative Law Judge. It is very important not to take no for an answer if you are truly unable to work. Just because the SSA turns you down the first two times is not a reason to drop out of the appeals process as a Judge can reverse the earlier denials of the person’s claim.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over eighteen years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 309 Person Street and can be reached at 484-8195.