Get Social Security Disability & SSI Benefits: Herniated Disc

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Social Security, Medical Evidence, And A Herniated Disc

Social Security intakes lumbar, thoracic, and cervical herniated disc disability cases every day. A spinal disc is a cartilage-type material that sits between the spinal vertebrae that acts as a cushion. When a disc herniates, it moves out of place. A herniated disc is most commonly caused by a traumatic injury or degenerative disc disease (deterioration of a spinal vertebrae). If the disc moves far enough, it can impinge or rub against a nerve or the spinal cord causing pain and a variety of neurological symptoms at either the localized point of contact which is called radiculopathy (nerve compression) or myelopathy (spinal cord compression) or at other parts of the body (usually the extremities) by sending abnormal signals to that body part.

How Social Security evaluates your herniated disc depends on the size of the herniation (6mm or more is considered large), whether the herniated disc contacts or impinges a nerve root or your spinal cord (Social Security regards this as a very significant disability factor), and your clinical findings (what your doctor observes about your functioning). The severity of the symptoms caused by a herniated disc vary considerably, and Social Security recognizes symptoms of a herniated disc are usually the following:

1. Pain,
2. Numbness,
3. Lower extremity neuropathy (lumbar or thoracic herniation),
4. Upper extremity neuropathy (cervical herniation),
5. Muscle spasms,
6. Muscle atrophy, and
7. Weakness.

A successful Social Security and SSI disability case begins with a diagnosis of your herniated disc which is done with an x-ray, MRI, or CT scan. However, x-rays are very poor tests to determine the extent of your herniated disc. It is important you push your doctors for an MRI or CT scan. Generally, Social Security will find your herniated disc disabling if your MRI or CT scan demonstrates a "marked," or "extreme" degree of severity. Social Security will in some cases find your herniated disc disabling with a "moderate" degree of severity (other case factors will have to be in your favor), and it will nearly never find your impairment disabling with a "mild" degree of severity. If your upper or lower extremities are affected by an impinged nerve root or spinal cord, you will need an EMG test to establish the existence of radiculopathy, neuropathy, or myelopathy. These three medical conditions indicate a severe degree of disc herniation, but they are also impairments, in and of themselves, that cause significant symptoms and limitations.

It is important to Social Security that you are getting treatment for your herniated disc disability which typically includes physical therapy, pain medications, muscle relaxers, steroid injections, and a TENS unit. In very severe cases, a pain pump or a spinal cord stimulator may be prescribed. Cervical and lumbar spine surgeries are common (thoracic much less common), and the particular type varies depending on the type of herniation. If you have had a surgery for a herniated disk, it will be a significant factor is your Social Security disability case - Back & Neck Surgeries And How They Affect Your SSDI/SSI Social Security Disability Case.

Herniated Disc Social Security & SSI Listing

For Adult Listing 1.04A, you must show compression of a nerve root with

1. Pain, limitation of motion of the spine, atrophy and muscle weakness, sensory or reflex loss, and positive straight leg raising (if the lower back is involved);
2. Spinal arachnoiditis (scar tissue surrounding nerves) with burning or painful dysesthesia, resulting in the need for changes in position or posture frequently; or
3. Lumbar spinal stenosis resulting in pseudoclaudication with pain, weakness, and the inability to ambulate effectively.

If your herniated disc is so severe that you suffer a spinal cord injury, you may satisfy the listing for Spinal Cord Disorders, Adult Listing 11.08 and Child Listing 111.08. An adult must meet points 1, 2, and 3. A child must only meet point 1.

1. Total loss of bodily function for at least three months,
2. An extreme reduction of use in two extremities for at least three months, or
3. A marked limitation in one area of physical functioning and in one area of mental health functioning for at least three months.

Helpful Resources

1. Lumbar Herniated Disc Video - Spine-health
2. Cervical Herniated Disc Video - Spine-health

A Successful Herniated Disc Case - Fear Of Surgery

Mr. Youst lived in Atlanta, GA. He had handled his own case, and been denied at the initial and reconsideration levels. He had applied for SSI disability benefits. He was planning on representing himself at his hearing, but about six months from his hearing, he changed his mind and hired counsel. He had been diagnosed with a herniated lumbar disk, neuropathy of his left leg, obesity with a BMI ranging from 32-36, mild diabetes, mild hearing loss, and depression. He was 53 years old. He was a pleasant man, married, and he had a perfect Georgia 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 for back and leg pain. Counsel ordered those three records as well. His doctors were not willing to make a doctor statement about his capabilities which is common. We obtained a statement from his oldest daughter and his best friend. We planned for his wife to testify at his hearing. Mr. Youst made some changes to his home because of his back and leg conditions: shower chair, bathroom bar, a taller toilet seat, and he moved his bed into his living room. I asked him to take pictures of his home modifications, and we submitted them to the Social Security hearing office.

We had one significant issue in his case - the orthopedic surgeon recommended a diskectomy, but Mr. Youst declined the surgery. In a Social Security disability case, it is generally presumed that a surgery will remedy a medical condition; perhaps if Mr. Youst had the surgery, his back and leg symptoms would be remedied, and he would not be disabled. In this case, it was critical that Mr. Yoast explain at the hearing why he was unwilling to undergo surgery. And sometimes the explanation works with Social Security, and sometimes it does not. There are a limited number of reasonable reasons for declining a surgery. In Mr. Yoast's case, it was because his older brother had undergone the very same surgery, and it did not work. His brother was forced thereafter to undergo a fusion which did not work as well. Ultimately, his brother was limited to a walker and a wheelchair. Mr. Yoast was fearful he would suffer the same fate.

The ALJ agreed Mr. Youst was unable to successfully stand and walk to perform light work. The ALJ agreed he was limited to sedentary work. At the hearing, the administrative law judge (ALJ) found that Mr. Yoast's reason for declining surgery justifiable. And, of course, not all surgeries are successful in remedying a medical condition. 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 was be found eligible for SSI disability benefits - Grid Rule 201.14.

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