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Herniated Disc and Social Security Disability Benefits

Severe back conditions which cause chronic back pain or which limit the claimant’s movements and ability to work may be considered disabling by the Social Security Administration. Common back disorders which can be extremely debilitating can include osteoporosis, lumbar strain, osteoarthritis, trauma, tumors, degenerative disc disease, scoliosis, disc herniations and spinal stenosis.

What is Disc Herniation?

Disc herniation is caused when the cushion or disc located between the spinal vertebrate is pushed and relocated outside of its normal position. Unfortunately, when the disc bulges and sticks out between the vertebrate the spinal cord or the spinal nerves may be pinched and compressed irritating the nerve.

What types of symptoms are caused by a herniated disc?

• Numbness and tingling
• Muscle weakness
• Bowel issues
• Radiating pain – for claimants who have a disc herniation in their cervical spine, the pain generally radiates down their arms. If the herniation is in the lumbar spine, the pain generally radiates down the claimant’s legs.

How is a Herniated Disc Diagnosed?

Herniated discs may be diagnosed through physical examination, muscle strength testing, reflex testing and MRIs of the spine. Unfortunately, many claimants, especially older ones, may have abnormal MRI results which show signs of disc deterioration which may not conclusively substantiate a severe back condition.

Approving Disability for Chronic Back Pain and Disc Herniation

The Social Security Administration awards benefits for back pain in several ways:

• Does the claimant’s back condition meet or exceed a listing as outlined in the SSA Listing of Impairments or Blue Book? If their conditions meet or equal a listing the SSA will assume that it is so severe that they are unable to work and they will be awarded disability benefits (assuming they meet the nonmedical criteria of the disability program).

• If the claimant’s back condition does not meet or equal a listing the SSA will have to evaluate their residual functional capacity to work.

Although some claimants may “meeting a listing’ for their back condition, most will not. If the claimant’s condition is not severe enough to meet a listing what must the claimant prove to win benefits for disc herniation? The SSA will evaluate the claimant’s residual functional capacity to work.

First, the SSA will evaluate the claimant’s medical records and determine their limitations. For example, does the condition severely limit the claimant’s ability to walk, bend, stoop, sit or lift heavy objects?

The SSA will also assess the claimant’s back pain. Unfortunately, even if the claimant has clearly defined abnormalities on either an X-ray, computerized tomography (CT) or magnetic resonance imaging (MRI) of their spine, this does not exactly correlate to the level of pain they are experiencing.

Surprisingly, there are many claimants who have substantial abnormalities on their tests but experience little to no pain and few other symptoms. Other claimants claim to have severely debilitating back pain and have few objective abnormalities on their laboratory tests.

So if the SSA cannot make their decision solely based on “objective” medical evidence such as the MRI, what can they use? The SSA evaluates not only the objective medical evidence but also evidence of other symptoms such as pain.

How does the claimant handle the pain?

One interesting factor that the SSA will evaluate is how the claimant has dealt with their alleged pain. For instance, what has the claimant done to find pain relief? Have they avoided certain activities, sought consistent medical care, and taken prescribed medication?

The thought, although it may be controversial, is that if the claimant was in severe pain they would do whatever it took to help alleviate the pain.

Another issue that has been discussed in medical circles is what other social or psychological factors should be considered. The SSA also considers whether the claimant has in their view an “exaggerated fear of pain which can lead to an avoidance of beneficial activities”, other disputed compensation claims (such as workers compensation), whether they have been involved in a personal injury claim or medical malpractice claim, if they have other psychological issues or if they are simply unhappy at work.

Oddly enough, evidence suggests that the psychological issues discussed above are more prevalent for claimants who have only degenerative changes evidenced on their X-rays, CT scans or MRI tests as opposed to those patients whose imaging studies reveal definite pathologic processes.