Social Security Regulations List Disabling Spinal Conditions
The Social Security regulations list numerous conditions which render a person legally “disabled” for the purpose of receiving Social Security disability benefits. The conditions listed are collectively referred to as “the Listings.”
In prior articles we have explained that a person is disabled if Social Security finds a condition which impairs ability to work to an extent “equal to” that of a condition in the Listings. This article explains the Listings for “disorders of the spine.”
Please note that the Listings often call for not only a specific diagnosed condition, but also: 1) specific findings, such as range of motion limitations and palpable muscle spasms; and 2) the length of time the condition has lasted and is expected to last (to qualify for benefits, a person’s disability must last at least 12 months). All three – the diagnosis, the objective findings on which the diagnosis was based and how long the condition has persisted and is expected to persist – must appear in your records, or your patient’s disabling condition may not be properly recognized.
There are three categories of disorders of the spine: (1) arthritis; (2) osteoporosis; and (3) “other vertebrogenic disorders.” If your patient fits any one of these three, according to the following descriptions, your patient is disabled under Social Security law.
Arthritis must he manifested by ankylosis. or fixation of the cervical or dorsolumbar spine at 30 degrees or more of flexion measured from the neutral position. In addition, there must be X-ray evidence of either calcification of the anterior and lateral ligaments; OR bilateral ankylosis of the sacroiliac joints with abnormal apophyseal articulations.
Osteoporosis must he generalized, as established by X-ray, and there must be pain, limitation of back motion and paravertebral muscle spasm. Also, there must be X-ray evidence of either compression fracture of a vertebral body with loss of at least 50% of the estimated height of the vertebral body prior to the compression fracture, with no intervening direct traumatic episode; OR multiple fractures of vertebrae with no intervening direct traumatic episode.
Other vertebrogenic disorders include, but are not limited to, herniated nucleus pulposus and spinal stenosis and must involve 1) pain, muscle spasm, and significant limitation of motion in the spine; AND 2) appropriate radicular distribution of significant motor loss with muscle weakness and sensory and reflex loss. All of these must have persisted at least 3 months despite prescribed therapy AND be expected to last 12 months.
Remember, your patient is disabled also if the impairment to his/her functional limitations equals the impairment of one of these conditions, based on your objective observations and examination and/or the results of laboratory or diagnostic tests. Also, if your patient is suffering with multiple conditions and the combined effect of all those conditions impairs your patient to the same degree one of the above-listed conditions would, then such a patient is disabled as well. (See MEDICAL-LEGAL JOURNAL, Vol. 6.)
“Disorders of the spine” is but one sub-section of the Listings of the musculoskeletal system.
The Listings are set forth in full, along with general information on disabilities and the requirements for medical evidence in the publication, Disability Evaluation Under Social Security. For a copy, contact SOCIAL SECURITY ADMINISTRATION, HLTH & HMN SVCS DEPT, BALTIMORE MD 21235.