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Back Problems And Social Security Disability
By Pitt Dickey

Have the words "Oh, my aching back" ever crossed your lips? The spine is an intricate assembly of bones, disks, and nerves. If everything works perfectly with your back, you hardly notice it. You can twist, bend, lift and move effortlessly. If something serious goes wrong with your back, it's hard to think of anything else but the pain you are enduring.

This column will look at how the Social Security Administration (SSA) evaluates disability claims from people with back pain. The SSA uses what are called Listings for various health problems to determine if a disability claimant is eligible for Disability Insurance Benefits. The Listing for disorders of the spine sets out certain clinical diagnoses and specific symptoms to qualify for the payment of Disability payments. This column will attempt to make SSA decision making regarding back problems understandable.

The SSA uses seven main diagnoses for spinal disorders. The diagnoses are: herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disk disease, facet arthritis and vertebral fracture . In addition to requiring the applicant with back trouble to have at least one of the diagnoses set out above, the Listing requires that the condition must also "result in the compromise of a nerve root ... or the spinal cord." The compromise of the nerve or spinal cord must also result in "neurantomic distribution of the pain, limitation of range of motion of the spine, motor loss (atrophy with associated muscle weakness) accompanied by sensory or reflex loss, and, if there is involvement of the lower back, positive straight leg raising test."

What does all that mean in English? We'll look at each of the seven main diagnoses. Your spine consists of a series of bones called vertebra each sitting on top of a pad called a disk. The disk serves essentially like a shock absorber in a car and keeps the bones away from each other and the nerves which pass between the bones. A herniated nucleus pulposus occurs when the spinal disk pushes out from its normal shape and presses against the spinal cord or nerves. This causes pain. Spinal arachnoiditis is a condition when one of the layers of tissue called the arachnoid level which surrounds the spinal cord becomes thicker than normal and presses against nerves or the spinal column. Arachnoiditis can result in period burning pain and numbness. It can also cause bladder or bowel incontinence. Osteoarthritis is a fairly common condition that results from degeneration of the joints and cartilage which cause pain when the person moves. Degenerative disk disease is a progressive disease that causes the spinal disks to lose their original shape resulting in pain and stiffness. Spinal stenosis is a condition in which the opening inside of the vertebrae in the spinal column which contains the spinal cord narrows like someone squeezing on a straw. The stenosis or narrowing presses against the spinal cord and can result in back pain, leg pain and weakness. Stenosis can be caused by degenerative disk disease, trauma or other bone disease. Facet arthritis involves arthritis in the facet joint which is a small joint between the vertebra in the spine. A vertebral fracture is a broken vertebra in the person's spine.

If the claimant has one of these seven diagnoses then the SSA will look for clinical evidence which shows "the compromise of a nerve root". Compromise of a nerve root essentially means that the bones in the spine are pressing against a nerve in a manner that is not normal. This pressure typically results in pain. After determining that the claimant has one of the diagnoses and nerve root compression, the SSA will then examine the person's medical records to determine if there is "neuro-anatomic distribution of pain". Does the pain from the compromised nerve show up where it should show up based on the nerve damage? Is there limitation of spinal movement? Is there loss of muscle strength and loss of reflexes which should be expected with such nerve compromise? If the claimant has lower back pain the SSA will determine if he has a positive straight leg raising test. A positive straight leg raising test occurs when the patient has pain in his back when lifting his leg. If the pain occurs between 30 to 60 degrees this indicates nerve root irritation and a possible herniated disk.

Spinal arachnoiditis can be proven for SSA purposes by a pathology report or operative note diagnosing the condition. A related symptom is severe burning or pain which requires the claimant to change his position more than once every two hours.

As complex as the SSA disability system is, it is important not to become discouraged and abandon a claim because it is denied initially. Typically most claims are denied at least twice before being approved by an Administrative Law Judge. There are a number of appeals available which can lead to a favorable decision on a disability claim.