Getting benefits with back pain can be very difficult, especially if you have no root cause or formal diagnosis for your impairment. To make matters more challenging, the Social Security Administration (SSA) often denies claims filed for back issues because they believe most people are able to return to work prior to the 12-month minimum requirement for receiving benefits. Use the following hints to improve your chances of getting Social Security Disability (SSD).
See a Doctor Regularly and Build a Detailed Medical History
The SSA needs to see thorough medical records to approve any claim. They additionally must have information that provides them adequate evidence that you meet:
AND
- The minimum 12-month duration
- Severity level requirements.
You’ll need a medical history that shows progressive issues with back pain, and that substantiates your argument that you can no longer work in any job. Regular visits to the doctor ensure your records build on one another, showing your problems are persistent and worsening over time.
Get a Formal Diagnosis, if Possible
To get Social Security Disability (SSD) benefits, you must have a “medically determinable impairment,” which basically means you need a formal diagnosis of what is causing your back pain. The SSA’s disability examiner will review your medical records under the listing for Disorders of the Spine, which appears in Section 1.04.
To meet this listing, your back issues must be due to one of the following:
- Nerve root compression
- Spinal arachnoiditis
- Lumbar spinal stenosis
Even with a formal diagnosis, you may not be able to meet the disability listing in Section 1.04. Whether you do or not, the SSA needs to see a root cause or reason for your long-term disability and inability to work before benefits can be granted.
See the Right Kind of Physician
Back pain, especially when the reason for it is unknown, often leads patients to chiropractors for management and care. Perhaps you’ve seen other doctors in the past and have run out of treatment options. Or maybe you went to a chiropractor straight off the bat. Either way, the SSA will not consider the option of a chiropractor or even most of the records you have from your visits and treatment. Instead, you must ensure your medical records include opinions, exam notes, and diagnostic test results from either:
- A medical doctor (MD)
OR
- An osteopath (OD)
Without records from a qualified physician, the disability examiner will not have what he or she needs to make a decision on your claim. Although the examiner can order a consultative exam (CE) from an SSA contracted physician, claims for back pain are rarely approved after a CE.
Be Ready for Additional Review Steps and to Wait for a Decision
Most back pain applications must proceed through additional reviews, including:
AND
- A “residual functional capacity” (RFC) analysis,
- A reconsideration review,
- An appeal hearing.
You will need to go into the application process knowing your claim will take a long time and will likely require additional steps.
- An RFC analysis requires you to provide more information about how your back issues affect your everyday functioning, including your ability to complete normal tasks, like housekeeping, cooking, and shopping.
- The reconsideration review and appeal hearing only happen after your claim is initially denied and you must file more paperwork and share more documentation to be able to continue trying to get benefits.
Continue collecting evidence and more medical records even after submitting your application. You will also want to continue to forward copies of new medical evidence and other documentation to the SSA throughout your wait for benefits.
Hire a Lawyer or Seek Other Assistance
Back pain applications, especially when filed without a formal diagnosis, have one of the highest denial rates. A disability advocate or attorney can help you increase your chances of approval by:
AND
- Assisting with the application and other required forms,
- Explaining the review process and the appeals process, if necessary,
- Gathering documentation and giving advice on other types of evidence that can be useful
An advocate or attorney can help at each stage of the disability application and review. If you need to appeal a denial, a lawyer or advocate can help you prepare for the hearing as well.
