Does My Bad Back Qualify Me for Social Security?

Older man having back pain

If you have a disability caused by a bad back, it may be time to see if you qualify for Social Security.

Back pain is one of the most common reasons a person may seek medical treatment or miss days of work. Back conditions can also cause lasting disabilities. These disabilities could be so severe that they impair your ability to perform your job or everyday tasks.

In fact, the U.S. Department of Health and Human Services (HHS) found that low back pain is the second leading cause of disability, with over 80% of people experiencing low back pain at some point during their lives.

These issues may be congenital, degenerative, nerve or spine related, caused by an injury, or even connected to conditions such as fibromyalgia or tumors.

Those with chronic back conditions and pain know that it can be debilitating. The good news is that having a back disability can qualify you for Social Security disability benefits.

An experienced disability attorney can help you understand how a disability is defined for Social Security, what medical evidence you need, how to apply and appeal a benefits denial, and more.

Here is what you need to know about qualifying for benefits with a back disability.

Qualifying Back Disabilities

The Social Security Administration (SSA) may qualify a disability connected to your bad back based on certain disability listings.

Some common back conditions which may be covered by these listings are:

  •       herniated nucleus pulposus
  •       spinal arachnoiditis
  •       spinal stenosis
  •       osteoarthritis
  •       degenerative disc disease
  •       facet arthritis
  •       vertebral fracture
  •       syringomyelia
  •       rheumatoid arthritis
  •       spondylitis
  •       scoliosis

However, extensive medical evidence of a chronic, disabling condition must be provided in order to meet one of these narrow listings.

Many back and spine conditions are listed by the SSA under the musculoskeletal system in their disability “blue book.” Some spinal disabilities may also be connected to nervous system conditions, such as Multiple Sclerosis.

However, if you can’t qualify under one of the blue book listings, you can also qualify based on Residual Functional Capacity (RFC), or ability to perform past work following your injury or deterioration of your condition—as well as your ability to perform other types of work in the U.S. economy, as determined by an adjudicator.

The main challenge with back-related disabilities is that, while back pain is a common condition, you must be able to medically prove it is physically disabling, chronic, and prevents you from working.

What the SSA wants to know about your disability:

  •       Will your condition persist for more than one year?
  •       How does it physically impact your ability to walk, move, lift objects, reach, et cetera?
  •       How severely does it impact your ability to work?
  •       Do you have medical evidence of your condition, such as testing, written doctors’ opinions, proof of therapies and medications tried, and a timeline of your disability’s progression?
  •       Can you provide imaging results such as x-rays, MRIs, CT scans, myelograms, or testing for nerve function?

Proving your disability can be complicated and stressful. The right attorney can help you determine what evidence you may need to provide.

What Else You Need to Know about Qualifying for Social Security

The Social Security Administration (SSA) determines disability based on whether the severity of your condition prevents you from engaging in “Substantial Gainful Activity (SGA).” Typically, your condition must either meet a strict disability listing, as discussed above, or be determined to prevent you from doing a past relevant job or other jobs in the U.S. economy.

In most cases, you cannot be gainfully employed above the SGA monthly income level or you will be disqualified.

For SSDI, you must acquire work credits, or “quarters” (up to four per year), to qualify.

According to the SSA, “Generally, you need 40 credits, 20 of which were earned in the last 10 years ending with the year you become disabled. However, younger workers may qualify with fewer credits.”

For SSI, you must meet a certain income level to qualify. SSI is a means-based program for those who make little to no income. You must not make more than a certain amount of income to qualify. This is not connected to the credits you earn for SSDI.

For both programs, medically proving your claim is the same process.

What Happens if Your Claims Is Denied

Though back-related Social Security claims are extremely common, a majority of disability claims are initially denied. If your claim is denied, you’ll need to appeal the decision.

The SSA offers several levels of appeal, including:

  •       Reconsideration of your claim
  •       Hearing with an Administrative Law Judge (ALJ)
  •       Consideration by the Appeals Council in Falls Church, Virginia
  •       Federal court

Your best chance of reversing a claim denial is during an ALJ hearing. A disability attorney can be a crucial advocate during the appeals process. They can help you prepare for your hearing and play an active role representing you during the hearing itself.

A local attorney will also have a working relationship with local judges and other court personnel and be able to help you navigate their expectations during your hearing.

However, it may be in your best interest to consult an attorney before you apply or early in the process, to give yourself the best possible chance of winning your case.

You often won’t pay an attorney’s fee up front for Social Security disability claims.

If you win your claim, the fee is typically limited to 25 percent of the past-due benefits you are awarded, up to a maximum of $6,000. Note that, in these instances, the attorney will be paid only out of your past-due benefits, or “back pay.” If no back benefits are awarded, the attorney will not receive a fee.

If your Social Security claim has been denied, or you’re thinking about filing and don’t know where to start, Affleck & Gordon can help. We’ve been helping people in Georgia just like you for over 45 years. Sign up for a free case evaluation here, or call us (404) 990-3945.

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