Can you receive disability for stenosis? Yes, there are options to receive disability benefits for stenosis. Spinal stenosis is a spinal disorder that affects thousands of people across the U.S. The condition usually develops in those over the age of 50, and the symptoms vary from person to person. Some people experience intermittent pain or numbness when walking, while others need to undergo surgical treatment due to severe pain and limited mobility. In patients over 65, it is the most common reason for spinal surgery.
If you have severe stenosis and your symptoms are preventing you from doing any gainful activity, you may be eligible for Social Security Disability benefits or long-term disability benefits through your employer. A disability attorney at Bross & Frankel, PA, can help you successfully apply for the medical and cash benefits that cover your treatment and provide an income for yourself and your family.
What is Spinal Stenosis?
With spinal stenosis, the spinal canal size narrows due to age-related changes and the stresses of daily activity. (There are, however, a small number of people born with conditions that narrow their spinal canal, such as scoliosis.) A narrowing of the spinal canal due to bone spurs, swelling, herniated discs, degenerative disc disease, or a spinal injury can cause chronic pain, nerve compression, and weakness that may eventually lead to spinal stenosis disability.
Depending on where the narrowing occurs, you might experience different clinical symptoms:
- Cervical spinal stenosis: In addition to neck pain, common symptoms include numbness and tingling in your shoulders, arms, hands, and legs. If the problem is severe, cervical stenosis can cause reduced muscle strength, balance problems, and even paralysis.
- Lumbar spinal stenosis: Spinal canal narrowing can cause burning, shooting pain down your leg (sometimes called sciatica), leg weakness, and foot drop. With lumbar spine problems, standing or walking for long periods of time might aggravate your pain, while leaning forward or sitting may alleviate it.
- Thoracic spinal stenosis: In this rare form of spinal canal stenosis, you may experience mid-back pain, numbness and tingling in your legs, and balance problems.
The diagnosis of spinal stenosis is typically made by examining the patient and reviewing diagnostic studies such as X-rays, MRIs, and CT scans.
Is Spinal Stenosis a Permanent Disability?
Spinal stenosis can cause debilitating pain and mobility problems. Your physician will determine which treatment is best suited to your specific symptoms and condition. Prescribed treatment options include:
- Physical exercise
- Physical therapy
- Spinal nerve pain medication
- Non-steroidal anti-inflammatory drugs
However, some patients may find that they don’t respond to treatment well enough to overcome the numbness, weakness, and balance problems associated with spinal canal stenosis, making it a permanent disability. If this happens to you and you can’t work or earn a living, you may file a spinal stenosis disability claim.
Can You Get Disability For Spinal Stenosis?
You may be eligible for disability benefits through the Social Security Administration (SSA) if you have spinal stenosis and the symptoms are expected to last a minimum of 12 months. Although only lumbar spinal stenosis is listed as a disability, the symptoms of cervical and thoracic spinal stenosis can be so debilitating that you can’t maintain gainful employment, especially in occupations that require you to walk frequently (e.g. food service, construction). Even sitting can be too much for some people.
If you plan to apply for spinal stenosis disability benefits, you must have your claim backed up by medical providers who can confirm the severity of your disability as well as its impact on your daily life. A copy of your medical records, including imaging reports, is required, along with supporting documentation such as letters from friends, family, and employers who have seen first-hand how living with spinal stenosis has affected you physically and even psychologically.
What Disability Benefits Are Available?
The Social Security Administration (SSA) pays regular benefits to those who are unable to work because they have a medical disability that will last a minimum of one year or end in death. There are two main disability types, each one structured to meet a particular need.
- Social Security Disability Insurance (SSDI): This program pays monthly benefits that are based on a disabled worker’s past earnings. To be eligible for SSDI, you must have paid into Social Security at your previous jobs. Once approved, you will be eligible for Medicare after two years.
- Supplemental Security Income (SSI): SSI is intended for those who have never worked, such as children, and people with low income, such as the elderly. To qualify, your income (if any cannot exceed the limit for your household size. SSI recipients are also eligible for Medicaid.
If you have long-term disability (LTD) insurance through your employer, you may also be eligible for benefits under their policy once you receive a diagnosis of stenosis. LTD benefits pay a percentage of your income (usually between 50% and 80%, up to a maximum). You will have to refer to the terms of your specific policy to determine how long your benefits will last: some plans pay benefits until retirement age, but others pay for a fixed period, usually five or ten years. The majority of plans allow you to receive benefits after 65 if you become disabled after 60.
How to Qualify for SSA Benefits with Spinal Stenosis
SSA evaluates disability applications using a medical reference book called the Blue Book, which covers all recognized disabling medical conditions and medical criteria for meeting them. Lumbar stenosis is recognized under Section 1.04- Disorders of the Spine. In order to qualify as disabled under this listing, you must have the following:
- The cauda equina (bundle of nerve roots at the end of the spinal cord) shows at least one sign of neurological compromise, such as non-radiating pain in a leg or foot, loss of sensation in a leg or foot, or pseudoclaudication (pain is made worse by standing or walking).
- A physical examination or diagnostic test shows non-radiating neurological signs of sensory changes and muscle weakness as evidenced by decreased sensation; electrodiagnostic test results showing sensory nerve deficit; bladder or bowel incontinence, trophic ulceration, or absence of reflexes, or reduced deep tendon reflexes in one or both legs.
- Diagnostic imaging studies showing that stenosis has compromised the cauda equina on the spinal cord.
- A medically-documented physical limitation that requires you to use mobility or assistive devices for one or both hands.
The four required symptoms or tests must occur simultaneously or close together. Close proximity of time is generally defined by Social Security as being within four months of each other.
If you don’t have lumbar stenosis, you may (depending on the reason for the stenosis) qualify for benefits for another listed condition, such as:
- Ankylosing spondylitis
- Rheumatoid arthritis
Even if your medical condition doesn’t appear in the SSA list of impairments, you may be able to qualify for benefits through a medical-vocational allowance. The allowance is intended for genuinely disabled applicants who do not meet a listed condition. Medical records received from your treating doctor will be used by the SSA to determine whether you can maintain gainful employment. If spinal stenosis prevents you from doing work you are trained and equipped to do and you don’t have transferable skills, you will likely be approved for benefits.
Applying for SSDI and SSI with Spinal Stenosis
Medical documentation is crucial when seeking disability for spinal stenosis. The following should be obtained:
- Confirmation of your diagnosis from a doctor, including a complete physical examination report. The report should describe your range of motion, sensory and motor abnormalities, and any symptoms of muscle spasms.
- The results of X-rays, MRIs, CT scans, or other medical imaging procedures may help to confirm the diagnosis of spinal stenosis.
- Surgical treatment reports (if applicable)
You may also need notes from specialists, physical therapists, or other health care providers. Having medical evidence on your side will increase your chances of receiving spinal stenosis disability benefits.
The SSA will use a residual functional capacity form (RFC) that your doctor fills out to determine if scoliosis has hindered your ability to work. You will also be evaluated for transferable skills that might make changing jobs possible. If you apply for SSI, which is means-tested, a representative from the Social Security Administration will interview you. You will need to provide documentation proving that your monthly income and assets don’t exceed a certain threshold.
What is the Disability Rating for Stenosis?
If you are seeking disability benefits through the Department of Veterans Affairs (VA), the amount you receive will depend on your disability rating. According to the VA’s General Rating Formula for Diseases and Injuries of the Spine, spinal stenosis is rated as follows:
- 100%: Unfavorable ankylosis of the entire spinal column, meaning that it is fixed in extension or flexion.
- 50%: The entire thoracolumbar spine has unfavorable ankylosis
- 40%: Unfavorable ankylosis appears in the entire cervical spine, there is favorable ankylosis of the entire thoracolumbar spine, or the forward flexion of the thoracolumbar spine is no more than 30 degrees.
- 30%: Favorable ankylosis appears in the entire cervical spine (meaning that it is fixed in a neutral position) or forward flexion is no greater than 15 degrees.
- 20%: The thoracolumbar spine has a forward flexion of 30 to 60 degrees; forward flexion of the cervical spine is between 15 and 30 degrees; the thoracolumbar spine has a combined range of motion of 120 degrees maximum; the combined range of motion for the cervical spine is no more than 170 degrees, or the muscles are spasming or guarding enough to cause abnormal spinal contouring or an abnormal gait.
- 10%: The thoracolumbar spine has a forward flexion of 60 to 85 degrees; forward flexion of the cervical spine is between 30 and 40 degrees; the thoracolumbar spine has a combined range of motion of between 120 and 235 degrees; the combined range of motion for the cervical spine is between 170 and 335 degrees; the muscles are spasming or guarding enough to cause abnormal spinal contouring or an abnormal gait, or vertebral fracture (bone collapse) with height loss of 50%.
What If My Application for Disability Benefits is Denied?
If you receive a denial letter from the SSA, it’s disheartening but not unusual. Fewer than 40% of initial disability applications are approved.
You can file a request for reconsideration within 60 days of the date of the denial letter; during this stage of the appeal process, an SSA examiner who wasn’t involved with the original denial will review your claim and decide whether you should receive disability benefits. If their decision is not favorable, you can request a hearing before an administrative law judge (ALJ). Should the ALJ deny your claim you can ask for the SSA Appeals Council to review your claim or, if the Council declines, file a lawsuit in federal court.
Appealing a denial can be a difficult and time-consuming process, which is why you should seek help from an experienced disability lawyer. They can confirm that you meet the SSA disability qualifications, submit the claim on your behalf, and represent you through any necessary appeal hearings. Your chances of being approved for benefits actually go up when you hire an SSD attorney to manage your disability for spinal stenosis claim.
If you have been denied Social Security, long-term disability, or VA benefits for spinal stenosis, contact Bross & Frankel, PA today. Our attorneys have been assisting people with disability claims in Southern New Jersey, Pennsylvania, and Delaware for years and will use our experience to get the best possible results for your disability claim.
Get a Free Consultation About Your Spinal Stenosis Disability Claim
Spinal stenosis can be so painful and debilitating that you can’t work. If you’ve been denied the SSA, VA, or long-term disability benefits you need, contact Bross & Frankel, PA for a confidential case review. We understand what’s at stake for you and will present your claim to the SSA, VA, or disability insurance company in the strongest light. We only get paid if you win, so you have nothing to lose by reaching out. To schedule your free consultation, call 856-210-3345 or contact us online.