My back pain is driving me crazy!

This frequently heard statement is not funny. People who suffer from any back pain condition are not kidding; they are in real pain. Back pain is one of the most prevalent medical issues affecting people. It is the most common reason people see their doctors, the leading cause of work-lost time, and the largest disability claim Worldwide. See Brighter Stride ABA, July 2024.

According to the Centers for Disease Control and Prevention (CDC), nearly three in five adults (58.9%) experienced back pain of any kind in the past three months in 2019. Among adults, 39.0% experienced back pain specifically.” Id. Like other disabilities, Social Security recognizes chronic back pain-related problems as a disability, as outlined in Social Security’s Blue Book, officially titled “Disability Evaluation Under Social Security.” The Blue Book publication is also called the “Listing of Impairments.” However, because many back pain-related disabilities are difficult to verify, benefits are limited to verifiable conditions that have been medically diagnosed.

To receive back pain-related benefits, as with other listed medical conditions in Social Security’s Blue Book, the disability must prevent the claimant from working for at least 12 months or cause death. Even so, SSA will determine whether a claimant’s back pain is severe enough to meet SSA’s Blue Book listings based upon satisfaction of the stated conditions.

Although back pain is not explicitly listed in SSA’s Blue Book, historically, most back pain-related disabilities have been evaluated under Blue Book Section 1.04, “Disabilities of the Spine.” The entire Book of Listings is available from SSA’s website. Section 1.04 requires a diagnosis of nerve root compression, arachnoiditis, or lumbar spinal stenosis.

If a claimant can produce medical records and test results that satisfy the requirements, they have a good chance of winning their case. Specific symptoms may also include the need for changes in position or posture, limitation of motion in the spine, and an inability to ambulate effectively. Back pain can make it difficult to stand, sit, stoop, bend, raise arms overhead, walk, or lift. These restrictions often prevent people from continuing to work or from transferring past skills to new jobs.

To be approved for back pain benefits, you will need more than your own comments about how your pain restricts your ability to work. Potential claimants should gather medical and relevant non-medical evidence to develop their case. Medical evidence is based on “objective medical” records.

In contrast, relevant non-medical evidence includes established treatment plans, identified conditions, doctor-patient notes, patient interviews, a list of medications, and medical explanations about how a person’s chronic back pain affects the claimant’s daily activities. “Objective medical determinations” are established with diagnostic exams such as CT scans, X-rays, MRIs, and EMG (nerve root and conduction) tests. These forms of medical data can be persuasive and often show how a person’s chronic back pain impacts their current activities.

The Blue Book contains a set of criteria for each listed condition that must be met for SSA to approve disability benefits. The Blue Book was specially prepared to provide physicians and other health professionals with an understanding of SSA’s disability programs and how disabilities are evaluated. The book also explains how each program works and the information a health professional can provide to help ensure prompt decisions on disability claims.

In addition to objective medical documentation, a claimant can also submit doctor’s notes, medical bills, other test results, and different medical paperwork to help bolster their claim. You may also show discussions or conversations with your doctor about what activities have triggered past back pain events or disrupted established treatment plans. Still, these forms of evidence are not as persuasive as “objective medical records” based on established medical testing methods.

For example, if you suffered a spinal cord injury, you will need to meet a listing condition under Section 1.00 Musculoskeletal System. If you suffer from chronic back pain, you might need to satisfy the conditions discussed in Section 1.04, “Disorders of the Spine.” However, if your back pain is accompanied by nerve pain radiating down your leg, severe nerve root compression, or limited spine motion, Section 1.15 may be more appropriate.

Suppose you do not meet a listing under Section 1.00 or the impairments under Section 1.04 or Section 1.15. In that case, you may also be able to qualify under Section 11.08, Spinal Cord Disorders. To qualify under this listing, you may need to assert a complete loss of function, an extreme limitation in walking, sitting, or standing for three consecutive months, or no use of your upper extremities for three straight months.

These are just some of the complexities involving Blue Book listings for back-related pain matters. If you are unsure if your condition meets the criteria in the Blue Book, ask your doctor. Doctors have experience with Blue Book listings and understand the required conditions that must be shown for a claimant to be deemed “disabled.” If, after you have discussed your symptoms and pain with your doctor and you still are unable to perform your job correctly, you should contact a Social Security disability attorney because there may be other options to consider.

Although back-related disability benefits might be awarded under one of the different categories, undetermined back pain-related disabilities will take time to determine which condition applies. Also, every person involved in the claim must be on the same page and show a connection between the pain and the medically determined impairment and condition.

This means testing may need to go beyond X-rays because soft tissue injuries can cause disc and muscle tears, but those injuries are not always visible on an X-ray. If you are encountering back-related pain and the cause is undermined, don’t overlook related mental health issues brought on by chronic back pain. By working harmoniously with qualified medical providers and treating physicians, you can obtain persuasive medical records based on testing and objective observations.

If you find yourself at this crossroads of confusion, don’t fret. You are not alone. Back pain-related disability claims can be complicated. You might also consider engaging a disability attorney to guide you through this unique and complex disability theory. In some cases, without meeting every Blue Book condition, your case could still be won using a blend of medical and vocational evidence and requesting SSA apply its Five-Step Sequential Evaluation Process.

At the Law Office of Dan Wimmer, we will handle your back pain-related disability claim or any other type of Social Security Disability Insurance claim and offer a no-obligation claim evaluation for every denied back pain claim.