Social Security & SSI Disability: Degenerative Disc Disease

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Video:

Social Security's Medical Evidence Review For Degenerative Disc Disease

A Common Case

Social Security and SSI disability cases involving lumbar or cervical degenerative disc disease are very common - the thoracic type is less common. Degenerative disk disease is degeneration of a spinal disc (the cartilage-like material that rests between your vertebrae). The degeneration often causes a herniation (the disc moves to where it shouldn't) which causes the disc or the vertebrae above or below it to rub against a nerve or the spinal cord. Sometimes the nerve affects only a particular area of the spine, and sometimes the nerve affects an extremity by sending abnormal signals into it (radiculopathy). If the degenerative disc disease is severe enough, it can affect the spinal cord causing myelopathy (damage to the cord) which affects other body parts - usually the limbs.

Diagnosis Evidence

When you file your claim, or any appeal, Social Security first looks at your medical records for your diagnostic evidence which is done by x-ray, MRI, or CT. MRI evidence is by far the best, and Social Security generally wants to see a marked or severe degree of abnormality. X-rays are rarely sufficient to establish the severity of your degenerative disk disease. If a nerve is compromised, and it affects an extremity, an EMG is needed to establish the existence and severity of radiculopathy - usually, any degree of severity is sufficient to establish you have a severe impairment.

Symptom and Treatment Evidence

Social Security will read your medical records. For a disability case to be awarded, it expects to see degenerative disc disease and radiculopathy symptoms such as -

1. Pain,
2. Numbness,
3. Tingling sensation,
4. Muscle spasms,
5. Lower extremity radiculopathy for a lumbar herniation, and
6. Upper extremity radiculopathy for a cervical herniation.

On clinical examination by your doctor, Social Security generally expects to see the following:

1. Reduced range of motion,
2. Reduced strength,
3. Muscle atrophy,
4. Diminished sensation and reflexes,
5. Tenderness, and
6. Positive straight leg raising.

Social Security will also review the medical treatment of your degenerative disc disease disability which generally consists of -

1. Physical therapy, and
2. Pain management including -
• Pain medications,
• Muscle relaxers,
• Anti-inflammatories,
• Steroid injections,
• TENS unit, or
• A spinal cord stimulator in severe cases.

Treatment will include surgery in severe cases - laminectomy, discectomy, or a fusion - Back & Neck Surgeries And How They Affect Your SSDI/SSI Social Security Disability Case. Any back or neck surgery is a very strong indicator that you suffer a severe medical condition.

Functional Limitations - Degenerative Disc Disease

In your Social Security and SSI disability case, your degenerative disc disease must cause you to have day-to-day restrictions with physical movements like sitting, walking, standing, lifting and handling weight, etc. These restrictions are necessary to prove disability with either a residual functional capacity (RFC) argument or a listing argument. Degenerative disc disease is usually a whole body impairment; that is, it affects the functioning of your whole body. If you are under age 50, you will need to prove you need to lie down to be found disabled. If you are over 50, you will need to prove the same or that you have trouble standing and walking to be found disabled (however, if you are over age 50 and you only have trouble standing and walking, disability will depend on what your past work is). Functional limitations and their relation to disability are discussed further on the next page.

The Adult Degenerative Disk Disease Social Security & SSI Listing

At Step 3, the degenerative disc disease Adult Listing 1.04A requires you demonstrate spinal nerve root compression and also

1. Pain (back, thoracic, cervical), limited spine motion, both loss of strength and muscle atrophy, reduced reflex or sensory, and (if your lumbar spine is involved) positive straight leg raising;
2. Arachnoiditis (build-up of scar tissue around nerve roots); or
3. Lumbar stenosis causing pseudoclaudication, lumbar pain, weakness, and an inability to move about well.

Helpful Resources: Herniated Disc

1. Lumbar Degenerative Disc Disease Video - Spine-health
2. Cervical Degenerative Disc Disease Video - Spine-health

A Success Story - Meeting A Grid Rule

Mr. Youst lived in Atlanta, GA. He had been handling his own case. He had been denied at the initial and reconsideration levels. He was planning on representing himself at his hearing, but about six months from his hearing, he changed his mind. He had been diagnosed with a herniated lumbar disk, radiculopathy of his left leg, obesity, and hearing loss. He was 53 years old. He was a pleasant man, married, and he had a strong southern accent. His past relevant work consisted of construction, long-haul trucking, and a wide variety of general labor.

Counsel ordered his medical records from his primary doctor, his orthopedist, and his chiropractor. He had a consult with a neurologist, a consult with an orthopedic surgeon, and an ER visit. Counsel ordered those three records as well. Mr. Youst's MRI showed a marked degree of degenerative disk disease at the L4 and L5 back levels with nerve root compromise. Mr. Youst's EMG testing showed moderate radiculopathy of the left lower extremity. The orthopedic surgeon recommended surgery but only if Mr. Youst could lose weight. This was not possible for Mr. Youst since his back condition had rendered him nearly bedbound. Unfortunately, his doctor was unwilling to make a statement about Mr. Youst's RFC.

We obtained a statement from his oldest daughter and his best friend. We planned for his wife to testify at his hearing. Mr. Youst had made some changes to his home because of his back and leg conditions: shower chair, bathroom bar, and he moved his bed into his living room. Counsel asked him to take pictures of his home modifications, and we submitted them to the Social Security hearing office.

Because Mr. Youst was over age 50 at all times since his alleged onset date, and because all his past relevant work was performed at the light level or higher with no transferrable work skills to sedentary work, he could be found disabled even if he was capable of sedentary work. Therefore, we simply had to argue at the hearing that he was limited to sedentary physical exertion. The ALJ agreed he was limited to sedentary work. The vocational expert at the hearing testified Mr. Youst did not have work skills at the sedentary level. Therefore, the ALJ found Mr. Youst met Grid Rule 201.14 and awarded benefits.