Degenerative disc disease (DDD) is probably the most common impairment for which people apply for disability benefits, aside from high blood pressure and diabetes (and the neuropathies that generally follow diabetes). Despite the many disability claims for this impairment, it is not an easy one to win cases on, especially for individuals younger than fifty (and particularly for individuals under the age of forty).
How Does Social Security View Degenerative Disc Disease?
Social Security knows that many people suffer from degenerative disc disease, a natural part of again in which the vertebral discs shrink. For most people, the pain is intermittent and they are able to go on working, for the most part.
As a former disability examiner, myself, I can explicitly state the following: in many cases, Social Security will expect an individual who has performed work of a certain exertional level to go back to that same job after a period of time off after a back injury, or to a job where the physical exertional requirements are similar. This usually means that the person who performed medium-level work in the past (medium exertion is defined as the ability to lift 50 lbs occasionally and 25 lbs frequently) is expected to return to such work. Obviously, in many cases this is unfair and not at all realistic. Anyone who has ever experienced severe and continuous back pain (myself included) knows how debilitating the effect can be. And anyone in perfect health who has ever picked up a 50 pound weight knows how heavy that weight is.
But this is one of the fundamental problems regarding impairments that involve pain: only the person experiencing the pain can actually know how bad it is, and the degree to which it affects them. For this reason, and because disability examiners give little consideration to complaints of pain, medical records become that much more important in cases involving back conditions. The Social Security Administration (SSA) ends up granting disability benefits only for those whose disc disease has progressed into severely impacted vertebrae that cause chronic pain and the inability to sit or stand for periods of time, which can be proven by medical imaging.
What Does Social Security Look for in Degenerative Disc Disease Cases?
When a disability examiner opens a newly assigned disability application and sees either degenerative disc disease, back pain, lumbar problems, spinal stenosis, degenerative joint disease, or the acronym DJD (which stands for degenerative joint disease), the examiner begins to look for the following evidence (once they have in hand, of course, the records they've requested from a claimant's doctor):
- Physician treatment notes indicating one of these diagnoses.
- Objective evidence of disc deterioration, such as xray reports, CAT scans, and MRI studies.
Preferably, a disability examiner wants to see clinical evidence of nerve root compression (such as a positive result on a straight-leg-raising test), arachnoiditis (such as imaging showing thickening and swelling of nerve roots), or stenosis (such as an MRI showing narrowing of the spinal column). In addition, the examiner will want to see that your back problem severely affects your ability to function, such as by limiting:
- your ability to walk effectively
- the range of motion in your spine, or
- the time you can sit or stand with changing your position or posture to less than two hours.
The Significance of Medical Evidence in DJD or DDD Cases
Interpretations of imaging studies (where a doctor reads an x-ray film and gives an opinion as to its meaning) are extremely important, since x-rays, CAT scans, and MRIs are the only purely objective evidence that will come into play in a disability case involving back problems. In other words, while a physician can easily diagnose degenerative disc disease based on a patient's symptom's, without the imaging studies, there will be no way to prove the extent to which the condition exists. For this reason, disability claimants should always follow through on appointments for x-rays and the like.
Additionally, disability examiners look for certain other indications in the notes recorded by a claimant's treating physician, regarding decreased range of motion, reduced muscular strength (doctors use a five point scale; for example, 5/5 right leg strength indicates full right leg strength while 1/5 indicates severely diminished right leg strength), poor gait, and positive straight leg raises. Obviously, just as crucial as it is in a disc disease case to have the necessary imaging studies performed, it is also crucial to be followed closely by a physician, particularly an orthopedist. Diagnosis and treatment by a chiropractor will not be accepted as evidence of degenerative disc disease by the SSA.
Getting regular medical treatment from a medical doctor (M.D.) or osteopath (D.O.) can help ensure that you have sufficient medical records to substantiate your disability claim for a degenerative back condition.
Written by: Tim Moore, former Social Security disability claims examiner