SOCIAL SECURITY DISABILITY AND SSI FOR SPINE CONDITIONS

Claimants applying for Social Security Disability and SSI can sometimes qualify for benefits due to serious spinal conditions or disorders. Affected people may qualify under the Listing 1.04 of Part 404, Subpart P, Appendix 1 or under Step Five of the sequential decision making process because of the reduced Residual Functional Capacity resulting from the spine conditions.

Listing 1.04 reads as follows:

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 equine) or the spinal cord. With:

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);

or

B. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours;

or

C. Lumbar spinal stenosis resulting in pseudo claudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.

Inability to ambulate effectively is an extreme limitation of ability to independently initiate, sustain, or complete walking activities and ineffective ambulation generally is having insufficient lower extremity functioning to permit independent ambulation without the use of a hand-held assistive device that limits the function of both upper extremities.

To meet or equal the listing, the claimant must have credible medical evidence proving the existence of one of the subcategories of Listing 1.04. As always, evidence from a treating source will be more influential.

In addition to the listing, the claimant could be found disabled because his residual functional capacity is such that he would be unable to perform even sedentary level work. In determining whether a successful adjustment to other work can be made, consideration must be given to the residual functional capacity, age, education, and work experience in conjunction with the Medical Vocational Guidelines, 20 C.F.R. Part 404, Subpart B, Appendix 2. If the claimant can perform all, or substantially all, of the exertional demands at a given level of exertion, the Medical Vocational Guidelines direct a conclusion of either “disabled “or “not disabled” depending upon the claimant’s specific vocational profile. SSR 83-11. 

When the claimant cannot perform substantially all the exertional demands at a given level of exertion and/or has non-exertional limitations, the Medical Vocational Guidelines are used a framework for decision making unless they are ruled to direct a conclusion of disabled without considering the additional exertional and/or non-exertional limitations. SSR 83-12 and 83-14. If the claimant has solely non-exertional limitations, Section 204.00 in the Medical Vocational Guidelines provides a framework for decision making. SSR 85-15.

If the claimant has a residual functional capacity to perform a full range of sedentary work, considering the claimant’s age, education, and work experience, a finding of “not disabled” would be directed. However, if the full range of sedentary work has been significantly compromised, the Vocational Grid Preamble, Sect. 201.00(h) of Appendix 2, Subpart B of Part 404, provides that a finding of disabled is not precluded for even younger individuals. Thus, the additional limitations or non-exertional limitations can create a substantial erosion of the sedentary occupational base so there would not be significant numbers of jobs existing in the local regional or national economies, which the claimant could perform.

If you need more information about a personal injury matter (car wreck, truck accident, boating accident, slip and fall, etc.), SSD/SSI matter, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611 or through our website at www.farmerdreiser.com.