So you’ve been working your whole life as a laborer. Maybe you get hurt on the job, or maybe it’s as simple as over the course of time your back pain has worsened with the manual labor. Whatever the cause of your back pain, you are unable to continue working as a laborer. What do you do next?
Does this situation sound familiar? If it does, you should consider applying for Social Security disability (SSD) benefits. SSD benefits are available to individuals who have paid taxes into the Social Security system. This program is essentially a government-run insurance program, in place to help you if you are expected to be out of work for 12 months or more.
When Social Security determines an individual’s eligibility for benefits they look at everything that is limiting you, starting with your most severe condition. Some of the more common back conditions include bulging or herniated disc, spinal stenosis, nerve root compression, or spinal cord injury, or paralysis.
Degenerative disc disease is probably the most common impairment alleged for disability claims. Individuals who have a significant amount of objective medical testing including MRIs and X-rays documenting the severity of the back condition usually will have an easier time being approved for disability benefits. Especially if you are over the age of 50. However, if you have limited imaging or the imaging you do have shows mild to moderate limitations, a claim for disability can be a bit more difficult. This is because the Social Security Administration (SSA) will then need to rely on treatment notes and your own explanation regarding your symptoms, limitations, and pain levels. It is easier for SSA to make a decision based on objective medical evidence because that type of evidence cannot be refuted. It is what it is. But in terms of describing your pain level and symptoms, those are descriptions that are personal to you and vary from person to person.
SSA uses a five-step evaluation process when determining if your back condition merits a finding of disability. The first step is to consider whether you are currently working. The next step is whether your condition is severe, meaning does it have more than a minimal impact upon your ability to work. In most cases, the answer is yes and you would move on to the next step.
The third step is whether you meet a Social Security Listing. Listings are those conditions Social Security has deemed to be disabling if supported by the medical evidence. Back conditions are typically evaluated under the Musculoskeletal System Listing (1.00). Listing 1.04 considers disorders of the spine. SSA evaluates your medical records to see if there is enough evidence to either meet or equal the Listing. For example, Listing 1.04(C) would require a diagnosis of lumbar spinal stenosis, manifested by chronic pain and weakness resulting in an inability to ambulate effectively. Generally, if SSA has not determined you meet or equal a listing with your initial application you probably will not be approved based on a Listing argument.
If you don’t meet or equal a listing then the next step in your disability analysis would be determining your residual functional capacity. Your residual functional capacity is the most you can do considering the effects of your back pain. SSA learns what your capabilities are by performing a residual functional capacity assessment. Depending upon your disability, the residual functional capacity assessment that is performed will be either physical or mental.
Your physical RFC determines what level of activity you are capable of. Whether you are able to perform a sit down type of job or whether you could do very heavy work like construction. There are five possible exertional levels for your physical RFC.
Sedentary work. You are able to lift up to 10 lbs occasionally and sit for at least 6 hours and stand for at least 2 hours.
Light work. You are able to lift 10-20 lbs occasionally, and sit for at least 2 hours and stand for at least 6 hours.
Medium work. You are able to lift 25-50 lbs occasionally, and stand for at least 6 hours and sit for at least 2 hours.
Heavy work. You are able to lift up to 100 lbs at one time and can frequently lift 50 lbs.
Very heavy work. You are able to lift objects that weigh more than 100 lbs.
Once SSA determines your RFC they will then move on to step 4 in the evaluation process which considers your ability to do your past relevant work. Past relevant work is defined as any work you have done in the past 15 years in which you have worked long enough to learn the job and earned over the SGA amount for that year. SGA stands for substantial gainful activity. This is a monthly threshold earning amount which if you earn more than SGA you will not be eligible for disability benefits. SGA changes every year. In 2015 the SGA amount is $1,090 whereas in 2012 SGA was $1,010.
If SSA determines you are unable to perform the work you have done in the past then they will move on to Step 5. Step 5 considers your RFC and your ability to do any other type of work in the national economy. Step 5 is really where the Social Security program differs from other programs. The analysis for Social Security benefits doesn’t just stop with considering your ability to perform your past work like unemployment benefits or workers’ compensation. You must show you are unable to do your past work AND unable to perform other work. Even if you have done labor-intensive jobs your whole life, SSA will still consider whether you are able to do other work like a cashier or factory line worker.
Alleging disability based on back conditions is fairly common. This is because most people perform labor-intensive jobs and overtime their back degenerates from the wear and tear. To be able to get past Step 4 and Step 5 you need to have medical records documenting the severity of your back condition. The most helpful evidence in these types of cases comes from MRIs, X-rays, or even nerve testing. A statement from your own treating doctor discussing your restrictions and limitations will also be helpful.
This is a very brief synopsis of how SSA will analyze your disability claim. If you are suffering from a severe back condition that affects your ability to work you should seek help from an experienced SSD attorney.