The Social Security Administration has strict standards on when it will grant a claim for Social Security Disability Insurance benefits (SSDI). The agency has a very high rate of denial of initial claims, forcing claimants into the appeals process. You have a high burden of proof to meet to show that you deserve benefits based on “objective medical evidence.”
Depending on your type of disability, it is not always easy to obtain this evidence. If you have a severe back injury or condition, you can demonstrate the disability through objective medical evidence.
One of the first questions our attorneys ask is whether a medical condition like spinal stenosis will be considered a disability for SSDI benefits. The good news is that severe spinal stenosis is treated as a disability that can entitle you to benefits if you can prove it through objective medical evidence.
Whether You Qualify for Spinal Stenosis Benefits Depends on Your Own Symptoms
Lumbar spinal stenosis is a condition in which the spinal cord narrows. The spinal cord and the nerves become compressed and pressured. The severity of the condition will vary among patients. Some patients may have intermittent pain and numbness. Others may have difficulty working but can still perform their job. Still, other patients can have such severe cases of the condition that they cannot work again.
The Social Security Administration recognizes spinal stenosis as a condition that may entitle you to benefits. The SSA maintains a Blue Book of the conditions that can qualify you for benefits, and spinal stenosis is included in Section 1.04 of the book. The SSA has a long list of criteria you must meet, and you must have experienced the condition for 12 months or be expected to suffer from it for that time.
What the SSA Requires for Benefits for Spinal Stenosis
The SSA requires spinal stenosis to be accompanied by a collapse of the cauda equina. In layperson’s terms, this condition will compromise your ability to stand or walk. The pain will begin in your lower back and reach down to your lower extremities. You will need to sit to adjust your spine to make the pain recede. When these symptoms are severe, it can make it very difficult for you to work.
In the relevant Blue Book section, at a minimum, the SSA requires:
- Results from a physical examination or diagnostic test
- Findings on imaging or a diagnostic report
- Documentation of your need for a device for mobility assistance or the need for a one-hand device to help you walk
In other words, your case of spinal stenosis must be a significant one to qualify for benefits. Not every case of the condition is serious enough to meet the extensive criteria that SSA has laid out, and the agency can be very particular and discerning.
Medical Evidence That Can Help Strengthen Your SSDI Claim
Much depends on the strength and persuasiveness of the medical proof you submit with your claim.
Even if you have medical evidence, you may still not be granted benefits when you apply. The Social Security Administration may feel that your case is not severe enough to warrant disability benefits. The claims processor may question the strength of the evidence or not be persuaded that you are disabled.
With lumbar spinal stenosis, the main issue is that there is not one specific “yes or no” test that diagnoses the condition. Then, there is no surefire way to know the severity of the condition. Not only will you submit test results and scans, but your doctor will also need to give their own opinion of your condition and the medical history of it.
Accordingly, you will submit the following with your claim:
- Treatment records that detail your condition
- The history of your symptoms as relayed by your physician
- The symptoms that you are experiencing
- Evidence of your ability (or inability) to live your life and care for yourself
- The results of a straight leg test (standing and sitting)
- A pathology report from any surgical procedure that you have had.
Appealing a Denial of a Spinal Stenosis SSDI Claim
If the SSA denies your claim, you have the right to appeal. There are multiple ways to get the decision reviewed, and you must proceed in order of the following four steps:
- You can request reconsideration from a person who was not involved in the initial decision.
- You can then file a request for a hearing in front of an administrative law judge, who will review the evidence in your file and determine whether SSA erred.
- The Social Security’s Appeals Council can review the ALJ’s decision.
- If you have not been successful in the above three steps, you can take the case to federal court.
Contact a Little Rock Social Security Disability Attorney
The lawyers at Denton & Zachary can help you fight back when the SSA has wrongfully denied your claim for benefits. The government can make a mistake, and we will help you make them answer when they do.
Your first step is to get a lawyer because SSDI appeals require understanding complex medical principles and how to explain them. To schedule your free initial consultation, you can message us online or call us today at (501) 273-1965.
What are the chances that my initial claim will be approved?
The agency only approves slightly more than one in five initial claims.
How can I afford an SSDI lawyer?
We work for you on a contingency basis, meaning that we are paid nothing upfront and are only paid if you win your case.
Can my application be denied for reasons other than medical issues?
Yes. You can have a technical denial when you do not meet the other requirements for the SSDI program, such as work history.