If you have debilitating back pain that makes it hard to work, you may be wondering whether you could qualify for benefits through Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). To shed some light on that question, we surveyed readers across the U.S. who recently went through the process of applying for SSDI or SSI. Here's what we learned about the outcomes of claims based on back and other spine-related conditions.
Back and spine problems were by far the most common single medical problem experienced by our readers. Nearly a quarter (22%) said that their primary disability was some kind of back disorder or neck problem, such as a herniated disc, degenerative disc disease (DDD), or stenosis of the spine. (Government statistics reflect a similar percentage of applicants who reported back disorders.)
Unfortunately, even though back pain can be excruciating and even incapacitating, it may be particularly difficult to convince disability examiners and judges that you qualify for benefits based on this kind of impairment. Just over a third (34%) of our readers with back problems received benefits at some point in the Social Security disability process—below the approval rate (42%) for readers with any type of impairment.
There are several reasons for the relatively poor outlook for back problems, including how Social Security evaluates claims based on back pain. (To give you an indication, Social Security's impairment listing for back disorders requires compromise or impingement of the spinal cord or a nerve root.)
If the survey results are discouraging, keep in mind that some of our readers who didn't get benefits were denied for nonmedical reasons (known as "technical denials"). Government data show high numbers of technical denials (21% for SSI and 45% for SSDI, in 2015). If you meet the legal and financial requirements for SSDI or the income and asset limits for SSI, the likelihood of receiving an award based on a back disorder is somewhat higher.
Also, the outcome of your individual claim will depend on several factors, including some that you can control—such as how often you've been to the doctor, whether you appeal an initial denial, and whether you enlist the help of a lawyer (more on that below).
If your application is denied for medical reasons, you can appeal by requesting a hearing before an administrative law judge (ALJ). Applicants are much more likely to be approved for benefits after a hearing than at the initial application stage. According to government data from 2007-2015, 63% of SSDI and SSI claims based on disc-related and degenerative back disorders were approved at the hearing stage. (However, it's worth pointing out that chance of approval may be lower today, since hearing approval rates, in general, dropped significantly during this time period; the approval rate from recent years may be lower than the nine-year average of 63%.)
Besides requesting a hearing, our survey highlighted the most important thing you can do to increase your chances of getting benefits for your back condition: hiring a lawyer. Nearly half (49%) of readers with back disorders who had a lawyer were approved at some point in the process, compared to 24% of those who didn't have an attorney's help. So by hiring an attorney, they more than doubled the probability of receiving disability benefits.
A lawyer's help is particularly significant at the hearing stage. In fact, one of the reasons applicants have better outcomes at this point in the process is likely the fact that many more of them hire disability attorneys to represent them at the hearing. While only a third of our readers (33%) had a lawyer's help with their initial applications, the proportion with legal representation jumped to nearly three-quarters (71%) at the hearing stage.
These readers were onto something. Experienced disability attorneys can evaluate the strengths and weaknesses of your case, anticipate what a particular judge may focus on, prepare you for questioning, and gather the right kind of medical evidence to support your back claim (for instance, sending you for a straight-leg-raise test if you haven't had one). For more on the difference a lawyer makes, see our survey results on whether Social Security disability lawyers are worth it.
Need a lawyer? Start here.