The most straightforward answer is to hire the right attorney. What does an attorney need to be successful in a claim for Social Security Disability or SSI benefits? MEDICAL EVIDENCE.
Every person who applies for disability benefits says they’re disabled. It is unheard of for someone to apply for benefits and say “I’m fine. I want money.” The way Social Security separates those that are disabled, from those who think they’re disabled but aren’t, from those who are faking a disability is medical evidence. Medical evidence is the medical records created when patients see doctors. Social Security looks to the records under the theory that an MRI cannot be faked and it is difficult to argue with years of mental health treatment.
The reality is just going to doctors is unlikely to result in a favorable decision for Social Security Disability. The medical evidence needs to be presented and argued in the right way to result in a successful claim for disability benefits. Having an experienced, knowledgable, attorney who cares for his clients will put a claimant in the best possible position to receive benefits.
A herniated disc is a condition that affects the back and/or neck. A herniated disc can cause enormous amounts of pain that can leave a patient unable to do the most basic activities of daily living. The pain often isn’t limited to the back and neck regions but will travel into the legs and arms, leaving them compromised or immobile. People with herniated discs can be limited to using a cane, walker, or even a wheelchair. Surgeries can vary from shaving down the spine, fusing sections of it, replacing parts of it, and installing metal rods. Social Security analyzes disabilities due to herniated discs under LISTING 1.04. The most commonly considered listing is 1.04(A).
If you meet the elements of listing 1.04, you will have automatically met the medical requirements to be found disabled. Listing 1.04 is broken into different parts. It is titled disorders of the spine.
The preamble to listing 1.04 states:
“Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With: ”
These are all various conditions of the spine. They are very similar and translate to large amounts of pain.
If the elements of the preamble are satisfied, the analysis moves on to see if the claimant meets 1.04(A), 1.04(B), or 1.04(C). If the claimant meets the elements of one of the sections and has the condition in the preamble, they will be found to have met the medical requirements to be found disabled.
1.04(A) is the one usually achieved.
Listing 1.04(A) states:
“A. Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine)”
Perhaps the most critical part of 1.04(A) is the requirement the condition results in “compromise of the nerve root…or the spinal cord.” There are a few different ways to prove the existence of nerve root compression. Social Security, however, puts the most significant weight on imaging, namely an MRI. Anything other than an MRI will be viewed cautiously by social security when determining whether nerve root impingement is present.
The listing then talks about the “neuro-anatomic distribution of pain.” The pain is most commonly known as radiculopathy. Radiculopathy is the presence of pain in the extremities (shoulders, legs, hands, arms, feet) caused by the compromise of nerve roots in the neck or back. The nerves are being affected and sending signals to other parts of the body to feel pain. The pain can be debilitating.
The next requirement of listing 1.04(A) is “limitation of motion of the spine.” Most people with back conditions meet this particular element. It merely means the ability of the claimant to twist and maneuver the spine is more limited than the average person who doesn’t have the same spinal disorder.
“Motor Loss” is one of the rarer elements of the listing. Atrophy is the rarest form of motor loss. More commonly, loss of strength is found. This is usually done in the form of a resistance test. A doctor will test the ability of each hand and leg to push against resistance. The disparity between one side and the other can indicate there is a loss of strength due to an underlying neck or back condition.
Motor loss must also be accompanied by reflex loss or loss of sensation. Loss of sensation can come in the form of numbness or tingling. It means the ability to feel light touches or pinpricks is less than that of the average person. It’s not uncommon for people who routinely drop glasses or fall to have a loss of sensation. Reflex loss is similar but different. Reflex loss is found when people don’t respond to the standard reflex tests with a reflexive reaction. An Achilles reflex can be absent while sensation is still normal, but only one has to be present to meet the listing.
If you have a neck condition and all of the above is present, you meet 1.04(A), and you will be found to have satisfied all the medical requirements to obtain disability. If the condition is in the back, however, there is still one more requirement. Back conditions must have a “positive” finding on the “Straight leg raising” exam. The exam is while the patient is seated and supine (lying down). The leg will be lifted, and if this induces pain before the leg reaching a 45-degree angle, then a positive finding will be found.
More frequently, claimants with back conditions will have some of the elements in 1.04(A), but not all. All hope is not lost. In such a situation, social security will look to see if the claimant “equals” a listing. Equalling a listing occurs when all the elements aren’t met, but the condition creates limitations equal to that of someone who fits the listing. If a claimant equals a listing, they will be found to have met the medical requirements for disability.
If a claimant does not meet or equal a listing, social security will turn to the grid rules to determine disability status. The grids take into account the restrictions and compare them to a claimant’s past work and jobs currently available. If the grids call for a finding of disability, then a claimant will be found medically disabled.