Disability & SSI: Neuropathy, Radiculopathy, & Myelopathy

Winning Your Case

Video

Neuropathy vs. Radiculopathy vs. Myelopathy In A Disability Case

General. Millions of neuropathy, radiculopathy, and myelopathy conditions are treated in America each year, and they are regularly evaluated in Social Security and SSI disability cases. Any of the three can cause symptoms in any part of the body, and any of the three can be caused by a variety of factors, most commonly, injury, infection, compression, and toxins.

If you spend some time studying how the medical community defines neuropathy, radiculopathy, and myelopathy, and specifically, what the differences are, you will get several answers - many of them unfortunately confusing. But, here's the clear answer:

1. Neuropathy - A damaged nerve causing abnormal nerve functioning.
2. Radiculopathy - A damaged nerve causing abnormal nerve functioning, and the damage is caused by a pinched, compressed, or impinged nerve located at the lumbar, thoracic, and cervical spine. This is a type of neuropathy.
3. Myelopathy - a damaged spinal cord causing abnormal body functioning.

Symptoms. It does not matter to Social Security whether you have neuropathy, radiculopathy, or myelopathy as the symptoms are the same for all three - pain, numbness, tingling sensation, muscle loss and weakness, and reduced range of motion. For all three conditions, the symptoms may be localized at a specific part of the body, or symptoms may travel to, or exist at, other parts of the body. For example, a pinched nerve located at the lumbar spine (radiculopathy) can cause symptoms in the legs. For example, a damaged nerve at the elbow (neuropathy) can cause symptoms in the fingers. In any case, Social Security knows how serious the symptoms can be.

Six Neuropathy Types.

1. Peripheral Neuropathy - this is common and affects nerves of the peripheral nervous system which is all nerves of the human body that are not part of the central nervous system (brain and spinal cord). Peripheral neuropathy most commonly includes the arms, fingers, legs, and feet.
2. Diabetic Neuropathy - this is common and is a peripheral neuropathy caused by diabetes.
3. Radiculopathy - we just discussed this above.
4. Cranial Neuropathy - this is rare and involves the cranial nerves.
5. Autonomic Neuropathy - this is rare and involves the nerves of the heart, digestive system, and urinary tract.
6. Focal Neuropathy - this is rare and involves one single nerve or an isolated group of nerves.

Diagnosis. Neuropathy, radiculopathy, and myelopathy are all diagnosed by MRI, CT scan, and EMG or nerve conduction testing. The MRI or CT scan will show the pinched, compressed, or impinged nerve. The EMG or nerve conduction study will show how severely the nerve is damaged and where the nerve damage is affecting the body. These diagnostic tests are critical in a Social Security disability case for two reasons. First, diagnostic testing is medical evidence that establishes the existence of the medical condition. Without the testing, your medical evidence is only complaints of pain and maybe some abnormal clinical evaluation findings, and it is much, much harder to win a disability case with this type of evidence. Second, diagnostic testing will, in part, establish the severity of your condition and hence the severity of your disability.

Treatment. Ongoing medical treatment produces medical records. Medical records also establish to Social Security the severity of your disability. Primary treatment is an attempt to cure the cause of your neuropathy, radiculopathy, or myelopathy; and this is specific to your specific medical condition. For example, if you have lumbar or cervical radiculopathy, a surgery will be necessary to alleviate the pressure on the nerve. For example, if you have diabetes, you will need to make lifestyle choices and take medications or insulin to improve your blood sugar levels. Secondary treatment is a recognition that the nerve or spinal cord damage is permanent, and attempts must be made to control symptoms which usually include some combination of pain medications, anti-inflammatories, seizure medications, antidepressants, or serotonin uptake inhibitors. In severe cases, a TENS unit or a nerve stimulator is prescribed.

Neuropathy, Radiculopathy, Or Myelopathy Social Security & SSI Listings

Peripheral Neuropathy is evaluated under Adult Listing 11.14 and Child Listing 111.14. An adult needs to satisfy point 1 or 2, and a child needs to satisfy point 1.

1. Two of your extremities are subject to an extreme limitation; or
2. Both your physical and mental functions are markedly reduced in one of the following ways -
1. Processing information to perform job duties,
2. Associating with co-workers and the public,
3. Completing work duties, or
4. Regulating your behavior.

Radiculopathy is evaluated under two listings:

1. Disorders of the spine Adult Listing 1.04 and Child Listing 101.04, and
2. Peripheral neuropathy cited above.

Myelopathy is evaluated under two listings:

1. Disorders of the spine Adult Listing 1.04 and Child Listing 101.04, and
2. Spinal cord disorders Adult Listing 11.08 and Child Listing 111.08.

A Success Story - Power of an EMG

Mr. Herberts was a fun client. He lived in Denver, CO. He called counsel after he was denied at the reconsideration level. He suffered from four impairments: 1) a cervical herniation, 2) marked right upper extremity radiculopathy, 3) mild left upper extremity radiculopathy, and 4) obesity. His right arm radiculopathy was his worst impairment and included three fingers and the thumb of the right hand. He was right-handed.

His symptoms included minimal neck pain and left upper arm pain and significant right arm and hand pain and numbness. Social Security evaluates upper extremity use in three categories: reaching, handling (gross-manipulation), and fingering (fine-manipulation). Social Security defines the extent of upper extremity use as occasional, frequent, or constant. In all three categories of use, Mr. Herberts was only able to use his right arm and hand about 20% of the time (occasional), and he could only lift about two pounds with his right upper extremity.

Mr. Herberts was 52 years old. His past work was as a warehouse manager. He used his bilateral arms constantly at his job lifting up to 50 pounds - medium physical exertion.

He did not meet a Listing. At Step 4, it would be easy to prove he could not do his past work. At Step 5, we had to show he could not other work that utilized his past work skills. At the initial and reconsideration levels, Social Security denied his case. It found he could perform light exertional level physical activity and therefore he could do other work (Step 5) - a warehouse manager wherein lifting was limited to 20 pounds (light exertion).

With Mr. Herberts's age and past work, Mr. Herberts could win his case two ways. First, he was limited to sedentary work - Grid Rule 201.14: he was over 50 and had no skills that could be transferred to sedentary work. Second, he was so limited with the right arm and hand that he could not perform his past work or other work with transferable work skills. Both arguments were made at his eventual hearing.

His cervical MRI showed C4-5 and C5-6 disk bulges and moderate foraminal narrowing at both levels. Moderate foraminal narrowing does not USUALLY result in significant radiculopathy. Hence, we had an evidence problem. Counsel recommended Mr. Herberts undergo an EMG. He did; it showed marked right upper extremity radiculopathy and mild left upper extremity radiculopathy. There are a couple possible reasons the MRI and right upper extremity EMG results were inconsistent. First, the radiologist was wrong when assessing the MRI and the severity of the foraminal narrowing. Second, the nature of his cervical spine worsened from the time of the MRI to the time of the EMG (8 months in this case). Third, moderate foraminal narrowing was affecting a nerve in a specific or particular way causing marked problems.

Counsel asked Mr. Herberts's treating primary doctor, pain management doctor, and neurologist to offer an opinion about his functioning - a residual functional capacity (RFC) assessment; all three declined. However, counsel was able to obtain an opinion from the treating neurologist that the abnormal EMG findings were the result of the moderate foraminal narrowing, that nerve root impingement existed, and that Mr. Herberts's right arm and hand symptoms were the result of the impingement.

At the hearing, counsel and Mr. Herberts focused on limitations of the right arm. He testified he was limited to lifting about ten pounds (gallon of liquid is eight pounds), and that he could only use his arm around the house for a few minutes at a time before he had to stop. His testimony precluded all work at the Light Exertional Level.

At the hearing, the administrative law judge (ALJ) agreed that Mr. Herberts's upper extremity use was limited to occasional reaching, handling (gross manipulation), and fingering (fine manipulation); and that Mr. Herberts could only lift a couple pounds. The hearing vocational expert (VE) testified that because of the limitations determined by the ALJ, Mr. Herberts could not perform work at the Light Exertional Level. Therefore, he was limitied to sedentary work - he met Grid Rule 201.14 (Mr. Herberts won his case).