Back Pain
As a nurse, and an attorney who focuses solely on assisting people with claims for Social Security disability benefits, I receive a significant number of phone calls, online inquiries, and texts from people with back pain . One of the most common causes of long term disability is back pain or other musculoskeletal problem, whether caused by arthritis, trauma, or other bone and joint problems.
Some back problems, such as a “bulging disc,” may or may not cause significant pain. A bulging disc may be expected to resolve, or improve on its own over a period of weeks – – some say six to eight weeks. The material which is bulging from the disc may be reabsorbed by the body. Believe it or not, some people who have bulging discs do not experience significant discomfort. If you are told you have “bulging discs,” and that is your only problem, you may have difficulty obtaining Social Security disability benefits. Bulging discs are common as we age. The fact you have bulging discs does not necessarily mean you will be significantly limited and unable to work. Whether you will be unable to work will depend on your individual situation.
But, for some people, who have other types of back problems, and who have had conservative treatment, for example, heating pad, over the counter medication, and physical therapy, significant relief is not obtained. Furthermore, some people with back pain, may be treated with epidural injections, and a transcutaneous electrical nerve stimulation (TENS) unit and still not obtain relief. Many people undergo back surgery. Some people who have had back surgery may still have pain. Even if surgery fixes the mechanical condition, or problem in the back, a person may be left with intractable pain and therefore unable to return to normal daily activities.
In addition to sitting, standing, walking, toileting, bathing, dressing, obtaining food and preparing meals, and cleaning one’s living space, another activity affected by a severe back problem may be one’s ability to maintain a job which requires one’s presence eight hours per day, five days per week. Without the ability to maintain a job, also referred to by the Social Security Administration (SSA), as “substantial gainful activity or (SGA),” people may need another source of income, and therefore turn to the SSA to file an application for Social Security (SSDI) disability benefits, and/or Supplemental (SSI) Security Income.
Medical evidence, that is, your medical records created by your medical provider(s) over a period of at least six to twelve months in which you were in treatment for a back problem, are essential for you to have in order to have a chance to obtain SSDI and/or SSI for a back problem. Imaging, that is X-rays, and optimally an MRI, should be part of the evaluation process when a back problem does not resolve after conservative treatment. When evaluating your claim, and considering whether or not to award you disability benefits, the SSA reviews the medical records related to your treatment, including a radiologist’s report related to imaging you had. The SSA will not rely on your word alone when you apply for disability benefits. The SSA must see objective (statements by your medical provider) evidence which demonstrates you meet the medical criteria for eligibility for SSDI and/or SSI.
Some people have minimal to no abnormalities seen on imagining of the back. However, they may state their pain is severe and significantly limits their ability to complete daily activities. This situation may present difficulty obtaining SSDI and/or SSI. The SSA not only needs medical evidence of the existence of pain, but optimally evidence of the cause of the pain. If imaging does not reveal a structural problem, for instance of the spine, the SSA may not award benefits related to back pain.
Some people have a radiology report related to imaging of the spine which demonstrates the existence of spinal issue which could cause significant discomfort. Yet the person has no complaints of pain or dysfunction. Whether you will be able to obtain Social Security disability benefits depends on your individual situation, that is, how the spinal problem affects you, and what your medical records, including imaging/radiology reports demonstrate.
Your diagnosis, or the name of your condition, may not be as significant to your chance of obtaining SSDI and/or SSI as what the objective evidence, (medical records including an MRI and radiology report), states are the affects of your condition on your ability to function. In other words, a significant impairment in your ability to function is more important than the name of your condition. Some people may have the same condition as you and have no significant impairment in functioning. Or, some people with your diagnosis may have an insignificant enough impairment that they can still maintain substantial gainful activity.
When you visit your medical provider it is important to speak with specificity about the affect your condition has on your ability to do your daily activities. Make sure your provider is listening and writing into your medical records what you say about the affects of your condition. If you have pain, be specific about the location of the pain, and whether the pain remains in one place or whether it travels.
Mention how often you have pain and how long the pain lasts. Specify this information in units of time, that is, minutes, and hours. Include information about what triggers your pain, as well as what, if anything, relieves your pain. Discuss with your medical provider your ability to sit, stand, and walk. Specify the duration, or how long, in minutes or hours, you can do these activities before you need a break. If lifting and carrying are affected, state the amount of weight you can lift and how far, in feet, yards, or city blocks, you can carry the weight. In other words, specifically discuss with your medical provider how your condition affects your ability to do everyday activities.
If you need breaks while doing activities, tell your medical provider and specify the number of breaks needed, as well as the amount of time you need per break. If you have difficulty with your bowels or bladder because of a spinal issue, tell your provider the details. If you are prescribed medication which affects the number of times you must use the bathroom and/or how much time you spend in the bathroom due to medication side effects, tell your medical provider and make sure your provider documents your statements.
If your claim for Social Security disability benefits is not awarded prior to your having a hearing with an Administrative Law Judge (ALJ) for the Social Security Administration, know that a judge is looking to see if you would be a reliable worker in a simple entry level job over the course of, for example, three, six, and twelve months. Excessive absences, whether due to illness, pain, or bathroom breaks during the work day are not tolerated by employers. Reliable workers show up and perform the tasks required of the job.
The ALJ is looking at the long term view, not just a week. If you could force yourself to do something for a few days, but then be unable to function for three, five, or more days, explain. Testifying in front of a Social Security Administration ALJ about your condition and pain may not provide enough information for you to obtain disability benefits, if you are without medical records which demonstrate an ongoing and severe functional impairment.
In order for an ALJ to award you SSDI and/or SSI, your medical records must corroborate your testimony as well as state your medical provider’s observations, and include a radiologist’s report of imaging. Most judges are familiar with medical terminology and the issues you encounter. When testifying in front of an ALJ you must be very specific. An ALJ listens to numerous people testify each day. A lot of those people have back pain. The ALJ will review your medical evidence and consider whether or not the evidence is consistent with your testimony regarding the severity of your impairment.