Any impairment that leaves a person “disabled” according to the Social Security Administration’s (SSA) definition will qualify for Social Security Disability Insurance (SSDI or SSD) benefit payments. But the criteria used by the SSA to determine the severity of a claim based on back pain was changed in 2021. In this blog post, we at Liner Legal Disability Lawyers want you to learn what is required now to win the approval of your disability claim if it involves back-related impairments.

How Social Security Defines a Disability

To ensure that everyone understands what the government considers to be a “disability” qualifying for monthly SSD benefit payments, the Social Security Administration defines what constitutes a  disability in their evaluation process:

A disability is a medically determinable physical or mental impairment that lasts 12 months or is expected to last 12 months (or result in death) and prevents the person from performing substantial gainful activities.

The real issue in every SSD claim filed by an impaired person is whether the SSA will agree that the medical records and other supporting material submitted by the disabled claimant and their lawyer that the claimed impairment is severe enough to prevent them from “performing substantial gainful activities.” In other words, can the person work and earn a minimum amount of income?

In 2022, if the person claiming to be disabled can earn more than $1,350 per month, then the applicant might not be deemed disabled.

How SSDI Determines if Your Impairment Qualifies You for Disability Benefits

How does the Social Security Disability bureaucracy decide if your impairment is severe enough to qualify for benefits? The wide range of possible impairments would make the task nearly impossible to manage unless there were specific criteria that each impairment needed to meet to qualify.

The Social Security Administration publishes a Listing of Impairments that is commonly known as the Blue Book. The Blue Book separates impairments into categories (e.g., musculoskeletal disorders, disorders of the special senses and speech, respiratory disorders, etc.). Within each category, the Blue Book “lists” particular disorders and details what criteria the applicant’s case needs to meet to be judged severe enough for benefit payments to be approved.

Back Pain and Back-Related Disorders

For disability claims based on back pain, the SSA’s new Listing requires the evidence submitted in the claimant’s application to include the following:

Disorders of the skeletal spine resulting in compromise of a nerve root(s) must include documentation of the presence of symptoms and features in each section A, B, C, and D:

A)   one of the following radiating sensations in the neuroanatomical (nervous system)

  • pain
  • paresthesia (pins and needles)
  • muscle weakness

AND B) Evidence during an examination or on diagnostic tests of radiation of the following:

  • muscle weakness AND signs of nerve root irritation, tension, or compression consistent with compromise of the affected nerve root

and either

  • sensory changes by either decreased sensation, or sensory nerve deficit shown on electrodiagnostic testing, or

or

  • decreased deep tendon reflexes.

AND C)  Findings on imaging consistent with the compromise of a nerve root(s) in the cervical or lumbosacral spine.

AND D)  an impairment-related physical limitation of musculoskeletal function that has lasted 12 consecutive months, and medical documentation of at least one of the following:

  • A documented medical need for a walker, two canes, or two crutches or a wheeled and seated mobility device involving the use of both hands, or
  • An inability to use one arm to independently initiate, sustain, and complete work-related activities involving fine and gross movements, and a documented medical need for a one-handed, hand-held assistive device that requires the use of the other arm or a wheeled and seated mobility device involving the use of one hand, or
  • An inability to use both arms to the extent that neither can be used to independently initiate, sustain, and complete work-related activities involving fine and gross movements.

Notice that your back pain impairment and the supporting medical evidence must meet all components of the Blue Book, A, B, C, and D.

But there is another way to qualify for SSD benefits in a back pain case if you don’t quite meet all of the criteria required by the Blue Book listing.

Residual Functional Capacity — An Alternative Way to Back Pain Benefits

If your back pain impairment is severe enough to affect your life to the point at which you and your family and friends all know you are unable to work, the SSD case reviewers will look at your evidence to determine your Residual Functional Capacity (RFC). This is a process in which the SSD will send you to a consultant they choose to examine you. It may be a medical doctor, or it may be a physical therapist.

The evaluation is largely based on your reported limitations and on what the consultant can observe or document regarding your range of motion, your ability to perform basic tasks (lifting, standing, etc.). Your own input is very important. You can describe what your daily experience is like while living with your impairment. So too can your family and friends provide letters describing what they have observed over the course of months as they watch you and interact with you.

Do you wince when you stand up? Do you need help reaching or carrying objects?

Also of great importance to the RFC assessment is your age, education, training, nature of work in your work history, skills, etc.  When everything is considered in the totality of the circumstances, you may well be determined to be disabled and approved for SSD benefits.