Low Back Pain and Social Security Disability

By Kimberly Bishop | April 27, 2022 | Disability and Diseases

This post discusses low back (lumbar) pain and Social Security Disability. If you are experiencing cervical (neck) pain, consult our article on cervical radiculopathy.

Social Security Disability benefits are evaluated under federal SSA rules based on medical evidence, work history, and functional limitations—not under personal injury or workers’ compensation law.

There are generally two types of Social Security Disability benefits - Social Security Disability Insurance Benefits (SSDI) and Supplemental Security Income (SSI).

SSDI (Social Security Disability Insurance) is based on the credits from the work you have done in your life.

SSDI monthly benefits are the amount that you would receive if you waited until full retirement age to retire, except that you are drawing them early due to your disability.

SSI (Supplemental Security Income) is a need-based program, and you must meet income/asset standards in addition to being found disabled.

If you have not paid Social Security taxes (work credits) to qualify for SSDI or if your SSDI monthly payment is low enough, you will need to apply for SSI.

You must be found disabled before you are entitled to either benefit.

Main Causes of Low Back Pain

The first step is to find out the cause of your low back pain. According to the Mayo Clinic, muscle strain, inflammation (arachnoiditis), ruptured or bulging discs, arthritis (DDD), and osteoporosis are all possible causes of low back pain.

In addition, trauma can cause significant back problems. It is imperative to seek medical treatment to find the cause of your pain for your health and your disability case. Preferabl,y this treatment is received from a specialist (orthopedist, neurologist, etc.).

Doctors usually start off with an X-ray, MRI, or CT and then recommend exercise, pain medication, physical therapy, and injections for back pain based on objective findings. If these remedies fail to heal your back pain, the next step is usually back surgery.

There are different forms of back surgery: spinal fusion (most common); laminectomy; foraminotomy; diskectomy; disc replacement and interlaminar implant. Found here. Surgery benefits/risks should be discussed in depth with your doctor. Some people benefit from back surgery, and some do not.

A client can have a long list of impairments, but usually, back pain is what causes them the most pain and aggravation. Problems getting out of bed, putting on shoes, and sometimes even getting on/off the toilet are frequently reported.

In addition to low back pain, many clients experience radiculopathy (radiation of pain to the hips, legs, and even the feet). If you are unable to work because of your back pain, you need to file for Social Security Disability as soon as possible.

Back problems affect many Americans. According to the University of Maryland Medical Center:

"About 60 - 80% of the adult U.S. population has low back pain, and it is the second most common reason people go to the doctor. Low back problems can affect the spine's flexibility, stability, and strength, leading to pain, discomfort, and stiffness.

Back pain is the leading cause of disability in Americans under 45 years old. Each year 13 million people go to the doctor for chronic back pain. The condition leaves about 2.4 million Americans chronically disabled and another 2.4 million temporarily disabled." Found here.

Also, watch our video on Radiculopathy and Social Security Disability.

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After applying for Social Security Disability (SSDI) and/or Supplemental Security Income (SSI), your case is evaluated under the Five Step Sequential Evaluation Process. At Step 3, SSA can evaluate your lumbar issues under Listing 1.015, Disorders of the skeletal spine resulting in a compromise of a nerve root.

This listing requires pain, paresthesia, or muscle fatigue AND neurological signs on physical exam (i.e. muscle weakness, signs of nerve root involvement) AND objective testing demonstrating nerve root compromise (CT, MRI or x-ray) AND the need for bilateral assistive devices OR the inability to use one of the upper extremities while needing to use the other extremity for the assistive device.

In simple terms, to meet 1.015, you have to have pain symptoms, tell your doctor about your pain, have a diagnostic test showing the cause of your pain, and have problems ambulating or using your hands. This, like many listings, is difficult to meet. It should be noted that X-rays only show bone, so they usually will not show nerve compression. MRI provides a clearer image of the spine, but it is expensive.

What happens if someone is unable to afford an MRI? The listing also requires documentation of the use of an assistive device (e.g., a cane, walker, or other aid), including a prescription from a physician.

Many physicians instruct their patients verbally to obtain a cane or walker because insurance doesn't always cover these expenses. Without an MRI or prescription for an assistive device, you will not meet this SSA listing.

In addition to the above listing, a claimant may be found disabled under the Medical Vocational Guidelines (Grids) if they are 50 years of age or older; however, younger individuals will find little assistance from the Grids. For a discussion about the Grids, look here.

During my Social Security and/or SSI Disability hearings, clients with low back pain are often asked the following questions:

What makes your low back pain better? Worse?
Has your pain gotten worse, stayed the same or gotten better since you filed for disability?
How much weight can you lift without pain? When you lift more than X, where do you have pain?
Does your pain stay in your low back or does it radiate? How far down the leg (s) does the pain radiate? Is one leg worse than the other?
Do you experience low back pain when walking? How far (in minutes) can you walk without pain?
Do you use a cane or other assistive device?
Did a doctor prescribe you the cane? How often do you use a cane?
Have you tried pain medications, physical therapy, injections, a pain stimulator, etc.?
Did any of the above therapies help you as a patient?
Have your doctors discussed a lumbar spine surgery with you?
Have you had any previous lumbar surgeries?
Did your previous lumbar surgery help with any of your symptoms?
Did your symptoms return after surgery? Did your symptoms change after surgery?

I always advise clients to follow their doctor's advice about their low back pain. If you are still unable to work even after following your doctor's advice about your low back pain, you may still be found disabled, although you don't meet the SSA listing.

Delay can cause you to lose benefits, so apply for Social Security Disability or Supplemental Security Income as soon as possible and call the Bishop Law Firm, 919-615-3095! You can also start your free case review right now!

The Bishop Law Firm represents Social Security Disability clients in Raleigh, Durham, Fayetteville, Cary, Rocky Mount, Wilson, Smithfield, Louisburg, Chapel Hill, Roanoke Rapids, Winston Salem, Garner, Greensboro, Greenville, and surrounding areas in North Carolina.