If you suffer from lumbar stenosis that has rendered you unable to work, you may be eligible to receive Social Security Disability benefits. The Social Security Administration (SSA) administers the Social Security Disability Insurance (SSDI) program, which provides monthly financial benefits to workers who have suffered an injury or medical condition that has rendered them unable to work.
In order to be eligible for SSDI, you have to have worked enough to earn sufficient credits and to have paid in enough taxes to the SSA. If you are approved for benefits, you may have some dependents who are also eligible for benefits, such as your minor children. Usually a result of the aging process, spinal stenosis usually occurs in people who are older than 50.
Spinal stenosis is a condition that causes your spinal canal to narrow and your spinal cord and nerves to compress. Sometimes it may be caused by a ruptured or bulging disc. It can occur in the lumbar and cervical areas of the spine. The symptoms of cervical stenosis can vary significantly, including reflex abnormalities, weakness in the lower or upper limbs, sensory deficits, wasting of muscles, and radicular pain in the arms.
Lumbar stenosis may cause loss of deep tendon reflexes, weakness in the legs, and leg pain. Walking can aggravate lumbar stenosis pain. The treatment options for lumbar or cervical spinal stenosis varies and are dependent upon the affected area. There are surgical options available for both kinds of spinal stenosis, and the option selected is dependent upon the severity of the symptoms.
The Cost of Treating Spinal Stenosis
There are many treatment options for spinal stenosis. There are doctor visits, prescriptions, and hospitalizations. The most expensive aspect is surgical procedures. According to Becker’s Spine Review, a laminectomy is estimated to cost about $77,000 while spinal fusion surgery is estimated to cost about $115,000. Of course, there is always a risk of complications resulting from a surgical procedure, which would add to the cost.
There are different kinds of fusion surgery, including the instrumented fusion which cost about $107,056 or non-instrumented, which runs around $100,471. Research shows that 80% of those who underwent surgery were pleased with the results 8 to 10 years after the procedure. In addition to your primary physician, you will need to see an orthopedic specialist or a spinal surgeon for treatment.
Medical Qualifications and the SSA Evaluation
The SSA uses the Blue Book, which is a medical guide that lists bodily systems, medical conditions, and the specific criteria that must be met in order to qualify for disability benefits.
Lumbar spinal stenosis is listed under impairments in the Blue Book in Section 1.04 under Disorders of the Spine.
If you meet the specified requirements set forth in the Blue Book, you may automatically qualify for disability benefits. Here are the specifications:
- You must have pain in your thighs, buttocks, and lower back along with weakness in your lower extremities.
- Have continual pain that doesn’t radiate from a nerve.
- Have a CT scan or MRI that shows positive for lumbar spinal stenosis.
- Not be able to walk unassisted without a walker, two crutches, or someone’s help to get around.
When you apply for disability, you need to include as much information as possible including the results of an MRI or CT scan. Your records should include detailed notes from a physical exam that include the results from a test conducted to determine your muscle strength and range of motion. Your doctor needs to also indicate the medications that you take and any side effects they cause and treatments you have undergone, such as steroid injections or physical therapy.
Applying for disability is a complicated process, so you need to provide as much information and documentation as possible with the original claim. Disability Determination Services needs notes, test results, treatment plans, and a detailed explanation about your condition so they can make an informed decision about your condition and your particular symptoms and how your life is impacted.
Qualifying for Disability with a Residual Functioning Capacity and a Medical-Vocational Allowance
If you condition doesn’t meet the criteria set forth in the Blue Book, you may still be eligible for disability benefits using a medical-vocational allowance and a residual functioning capacity (RFC). The RFC will detail your limitations and how your condition impacts your daily life as well as your ability to work. If the RFC and medical-vocational allowance show that your condition is as disabling as it would be for someone who met the criteria set forth in the Blue Book.
In order to qualify for Social Security disability benefits for spinal stenosis, your medical tests have to show that you have been diagnosed with spinal stenosis, your condition impacts your daily living and your ability to work. A straight-leg raising test must be performed to show that your range of motion has been impacted and that you have experienced reflex or sensory loss.
Your medical records to also show evidence of leg pain that worsens with walking and that it severity renders you unable to walk effectively. Imaging study results, such as MRIs, CT scans, and x-rays must be included to support your claim. Your medical records should also clearly indicate any limitations on your everyday activities. The RFC needs to indicate, for example, that pain and muscle weakness causes you to reposition every two hours, or that the pain and limited movement keeps you from bending and lifting frequently.
If the RFC can show the severity of your condition and limitations, you may be approved for disability benefits. Understand that the disability claims process can be lengthy and detailed. With the medical-vocational allowance, your age, work experience, educational level, and transferable skills are considered along with the severity of your condition to determine if you can do another kind of work that is lighter duty or sedentary.
Applying Specific Medical Tests to Your Disability Case
Your disability case will consider medical tests that have confirmed your diagnosis, as mentioned earlier. In some instances, the SSA may order a medical evaluation, at their cost, with the physician that they choose. This is for informational purposes only and to help confirm the severity of your symptoms and condition.
Any mental conditions should also be considered such as depression or anxiety caused by the severity of a chronic condition like spinal stenosis. In some cases, a mental evaluation may be ordered by the SSA for informational purposes only. Documentation and evidence are key to proving your case and being awarded benefits.