Disability Benefits for Spinal Fusion or Back Surgery

Back surgery, such as spinal fusion, is often recommended to treat the compression of spinal nerves caused by arthritis, scoliosis, degenerative disc disease, or herniated discs. Spinal fusion can also stabilize the back for people with conditions that cause spine instability, like fractured vertebrae ("back bones"), lumbar spondylolisthesis (slipped vertebrae), or tumors.

If you have permanent restrictions after a spinal fusion or a back surgery that keeps you from working full-time for at least 12 months, you may qualify for Social Security disability benefits.

What Kinds of Back Surgery Can Qualify for Disability?

While the majority of back surgeries are successful, some kinds of common back surgeries can cause disabling limitations. Some of the most frequent surgeries seen by Social Security disability claims examiners and administrative law judges include:

• spinal fusion, where two or more of the vertebrae in your spine are connected to become one solid piece
• discectomy or laminectomy, where part of the herniated disc that is pressing on your spinal cord is removed or reshaped, and
• disc replacement, which involves putting an artificial disc in between two vertebrae.

Keep in mind that the Social Security Administration (SSA) is more concerned with any functional limitations you have as a result of your back surgery than the specific kind of surgery you had. Somebody who recovered from a laminectomy with minimal limitations is less likely to qualify for disability than somebody who is unable to sit for 30 minutes following an unsuccessful spinal fusion.

How Back Surgery, Including Spinal Fusion, Can Be a Disabling Impairment

Back surgeries are often used to relieve spinal stenosis or bone spurs. Some people experience a great deal of relief following these procedures, while others have mixed results and remain unable to work. If you haven't recovered from a laminectomy, discectomy, or spinal fusion after one year, you might qualify for disability.

Back surgeries that don't have the intended result of reducing back pain or improving mobility are called "failed back surgeries." Sometimes referred to as post-discectomy or post-laminectomy syndrome (depending on the type of initial surgery), failed back surgeries can cause the following complications:

• infection at the opening from the surgery or in the vertebra itself
• instability in the spine when vertebrae are not fused together
• degeneration (wearing down) of the bones next to the fused bones
• spinal arachnoiditis (inflammation of a membrane that protects the nerves of the spinal cord)
• scar tissue that builds near a spinal nerve root (epidural fibrosis), or
• damage to the spinal nerve.

Symptoms of failed back surgery can include a reduced range of motion in the affected area of the spine; numbness, weakness, and pain in the legs and arms; and bladder or bowel incontinence. In order to help reduce these symptoms, doctors sometimes need to perform a revision surgery in order to fix what went wrong the first time. But if your symptoms persist despite a revision surgery, medication, and physical therapy, you might be unable to work full-time—and the SSA can award you disability benefits.

How to Get Disability Benefits for Back Surgery or Spinal Fusion

You can receive Social Security disability benefits in one of two ways:

• You have medical evidence of a spinal impairment that matches one of the SSA's Blue Book listings for back disorders (called "meeting a listed impairment"), or
• Your back problems limit your functioning so much that no jobs exist that you can do (called getting a "medical-vocational allowance").

Getting Disability by Meeting a Listing for Spinal Surgery or Fusion

The SSA doesn't have a specific disability listing for back surgery or spinal fusion, but if the surgery didn't improve your back symptoms, you might meet the requirements of a listing based on the initial disorder that made surgery necessary. Or, if your surgery caused nerve compression, you might qualify for benefits under the listings for those conditions.

Three back-related listings. Social Security evaluates back impairments under the category for musculoskeletal disorders. Included are two spinal disorders:

• listing 1.15, compression of a spinal nerve root, and
• listing 1.16, lumbar spinal stenosis compressing a nerve root known as the cauda equina.

Spinal cord conditions that aren't covered by the above listings—such as arachnoiditis—are evaluated as neurological (nerve) disorders under listing 11.08.

Social Security also has a listing for the surgical fusion of weight-bearing joints—listing 1.17—that applies to hips, knees, ankles, and feet. Because spinal disorders often affect mobility in the lower extremities, you may meet this listing if you've had a hip replacement or knee replacement surgery.

Evidence needed to meet the listings. In order to determine whether you meet the requirements of a listing, the SSA will want to see the following evidence in your medical records:

• medical imaging, such as an X-ray, MRI, or CT scan, showing abnormalities in your spine
• doctor's notes that include observations on any difficulties you have while at the appointment, like trouble getting off or onto the examination table
• results of a physical examination that indicate limitations in your range of motion
• admission and discharge notes from the hospital where you had your spinal fusion or back surgery
• tests such as a nerve conduction study showing latency (a measurement of how well your nerves are responding)
• a list of any medications you're taking to help manage your symptoms, and
• notes from a physical therapist or rehabilitation specialist documenting your healing process.

Getting Disability by Showing Your Functioning Is Too Limited for Any Jobs

Many people who apply for disability following back surgery won't have the right evidence to meet (or "equal") a listing. But if they have too many functional limitations to perform full-time work, they can still qualify for benefits.

Social Security will look at your medical records and your activities of daily living to determine what kinds of tasks you'd have difficulty performing in a work environment, a process called assessing your residual functional capacity (RFC). Your RFC is a set of restrictions that reflect the most you're able to do, physically and mentally, at work.

How Does Social Security Assess Your RFC? First, the SSA will look at your ability to do physically challenging work, such as walking, lifting, or carrying. Any difficulty you have in performing these strength-related activities is considered an exertional limitation.

Then, the agency will determine whether you have non-exertional limitations, such as difficulty with stooping, grasping, speaking, concentrating, or remembering instructions. Both exertional and non-exertional limitations must be included in your RFC.

How Does Social Security Use Your RFC? Social Security will review every job you've done in the past five years to see if you could do any of them now, with your current RFC. If your past work is too physically or mentally demanding for you to perform today, then the agency will need to determine whether any other jobs exist in significant numbers that you can do with your current RFC, given your age, education, and work experience.

Most disability applicants under 50 years old need to show that they can't do even the easiest, least demanding jobs before Social Security can award them benefits. But if you're 50 years of age or older, you might be able to use the medical-vocational grid rules to qualify for benefits if you could physically perform lighter work, but have never done it before (and can't learn).

How to Apply for Disability Benefits

If you're going to apply for Social Security Disability Insurance (SSDI), you can file your entire claim online on Social Security's website. (Note that to be eligible for SSDI, you must have enough work credits to qualify.)

If you're not comfortable filling out forms online, you can call Social Security at 800-772-1213 between 8 a.m. and 7 p.m., Monday through Friday, to get your claim started. If you're deaf or hard of hearing, you can use the TTY number at 800-325-0778.

If you don't have enough work credits and you have low income, you can apply for Supplemental Security Income (SSI). Most individuals filing for SSI can't file the whole application online, but they can get started on Social Security's website. For more information, see our article on how to apply for Social Security disability benefits.

For both SSDI and SSI benefits, you can make an appointment at your local Social Security field office to speak with a representative. And if you're a veteran who needs help getting a VA disability rating for spinal fusion, you can learn more in our article on how disability ratings work for veterans' benefits.