Back Pain Claims Can be Challenging, But Can be Won

Cases of back pain, especially involving lower back problems, are some of the most challenging to prove in a Social Security Disability claim. Unfortunately, “objective medical findings” such as x-rays may not fully support a patient’s experience of pain and limited movement.

A case of disability based on low back problems is sometimes a clear one – such as a case of a ruptured disk, particularly when surgery has failed to improve the condition. A case may also fall into the category of “other vertebrogenic disorders,” in the words of the regulation.

In either case, in order to win the case, a claimant’s records must show:
1. Pain, muscle spasm, and significant limitation of motion in spine, and
2. Appropriate pain distribution and significant motor loss with muscle weakness, sensory and reflex loss.
3. These factors must have persisted for at least three months despite prescribed therapy, and be expected to last at least 12 months.

Social Security wants a patient’s pain symptoms to be supported by “objective” findings of physical abnormalities, such as x-rays, CT scan, MRI or Lumbar myleogram. Keep in mind that soft tissue damage such as a bulging disk may not show up on an x-ray. The claimant’s testimony is also considered.
Ideally, a treating physician will supply records or a report that describes:
• The character, location, and radiation of the patient’s pain
• Activities that increase or relieve pain
• Prescribed treatment, including frequency of medication
• The patient’s typical daily activities
• Description of gait, limitation of movement of the spine, any numbness or muscle spasm.

Medical reports must be based on objective observations during the patient’s examination, not simply from patient’s statements.

If surgery has been performed, records should also be provided. Records should include a copy of the operative note and pathology reports.

Many low back pain cases, however, simply do not present the objective medical findings necessary for an automatic finding of disability. These patients still have pain, muscle spasms, and limitation of motion prevents performance of past work Social Security applies a complex set of guidelines to these cases, evaluating other work for which the claimant is suited. This is done by taking into consideration age, education, and transferable skills.

A 57-year-old man who has a high school education and has always done heavy manual labor will have an easier time proving his case than a 40-year-old college educated manager who has many transferable skills. Disability can still be proven with evidence that the impairment prevents full-time work. If a claimant is unable to maintain a typical work schedule–eight hours a day, five days a week, functional disability can be demonstrated and the case can be won.