Cervical and Lumbar Back Disorders and Social Securitys Medical Listings.For any back disorder
the first thing to do when pursuing Social Security Disability is to examine the medical listing of impairments for disorders
of the spine. If you meet or equal the listing Social Security will find you disabled for SSDI or SSI. The following
is listing 1.04 but the entire
listing for the musculoskeletal system should be read to fully understand this listing.
1.04 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 equina) 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 pseudoclaudication, 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.
Notice to meet listing 1.04C. it states must have an inability to
ambulate effectively. Social Security defines this as: Inability to ambulate effectively means an extreme
limitation of the ability to walk; i.e., an impairment(s) that interferes very seriously with the individual's ability
to independently initiate, sustain, or complete activities. Ineffective ambulation is defined generally as having insufficient
lower extremity functioning (see 1.00J) to permit independent ambulation without the use of a hand-held assistive device(s)
that limits the functioning of both upper extremities. (Listing 1.05C is an exception to this general definition because
the individual has the use of only one upper extremity due to amputation of a hand.)
(2)
To ambulate effectively, individuals must be capable of sustaining a reasonable walking pace over a sufficient distance to
be able to carry out activities of daily living. They must have the ability to travel without companion assistance to and
from a place of employment or school. Therefore, examples of ineffective ambulation include, but are not limited to, the inability
to walk without the use of a walker, two crutches or two canes, the inability to walk a block at a reasonable pace on rough
or uneven surfaces, the inability to use standard public transportation, the inability to carry out routine ambulatory activities,
such as shopping and banking, and the inability to climb a few steps at a reasonable pace with the use of a single hand rail.
The ability to walk independently about one's home without the use of assistive devices does not, in and of itself, constitute
effective ambulation.
As you will notice there is allot of medical termonology
here and it can be difficult to know if you actually meet this listing. It will take a doctor to determine that the
evidence in your file supports the fact that you meet or equal this listing. It is important for you to know what evidence
you need in the file that Social Security will use to determine if you meet or equal this listing. Detailed physical
exams performed by doctors and preferabbly by orthopedic doctors are essential. They should include detailed evaluation
of the back including range of motion, condition of musculature (examples: weakness and atrophy), sensory or reflex loss,
and circulation defecits. You should also have all your medical imageing in the file including any MRIs, X Rays
and CAT scans. Electrodiagnostic procedures such as an EMG can also be helpful. The physical exam should
be based on the objective observations of the doctor and not on subjective complaints of the patient. Social Security
says examination of the spine should include the following:
Examination of the spine should include
a detailed description of gait, range of motion of the spine given quantitatively in degrees from the vertical position (zero degrees)
or, for straight-leg raising from the sitting and supine position (zero degrees), any other appropriate tension signs,
motor and sensory abnormalities, muscle spasm, when present, and deep tendon reflexes. Observations of the individual during
the examination should be reported; e.g., how he or she gets on and off the examination table. Inability to walk on the heels
or toes, to squat, or to arise from a squatting position, when appropriate, may be considered evidence of significant motor
loss. However, a report of atrophy is not acceptable as evidence of significant motor loss without circumferential measurements
of both thighs and lower legs, or both upper and lower arms, as appropriate, at a stated point above and below the knee or
elbow given in inches or centimeters. Additionally, a report of atrophy should be accompanied by measurement of the strength
of the muscle(s) in question generally based on a grading system of 0 to 5 , with 0 being complete loss of strength and 5
being maximum strength. A specific description of atrophy of hand muscles is acceptable without measurements of atrophy but
should include measurements of grip and pinch strength.
You probably read the above and still don't know if
you meet or equal a listing but you should have an idea of the information you need in your file for a doctor to determine
if you do. The ideal situation is to have your treating doctor look at the entire medical listing for musculoskeletal system and give his opinion to Social Security as to whether you meet or equal any of the listings and a detailed report supported
by medical findings as to why.
