Here's what a disability examiner looks for in a DDD disability claim.
Degenerative disc disease (DDD) happens when the discs of the spine wear out over time. Spinal discs are like cushions that are supposed to act as shock absorbers, but they can dry out or become damaged. While the neck or back pain that DDD causes can make life miserable and can make it very difficult to continue working, it's not easy to get disability benefits for the condition, especially for individuals younger than fifty (and particularly for individuals under the age of forty).
Causes and Symptoms of Degenerative Disc Disease
Disc degeneration in the lower back or neck can be caused by:
- disc desiccation (the drying out of the discs, which happens with age)
- injuries from daily activities like lifting heavy boxes or carrying kids, and
- sports injuries that cause minor tears in the discs.
Not everyone has symptoms from degenerating discs, but common symptoms include:
- pain that gets worse when lifting items, bending over, or twisting the back
- pain that gets worse while sitting, and
- numbness and tingling in the arms or legs.
Complications From Degenerated or Desiccated Discs
When the intervertebral discs become dried out or damaged, the vertebrae can rub against each other, causing bone spurs (bony growths) and muscle weakness. Over time, disc degeneration can lead to:
- spinal stenosis (narrowing of the spaces within the spine) and weakness
- spondylolisthesis, retrolisthesis, or lateral listhesis (vertebrae slipping out of place)
- herniated discs compressing a spinal nerve
- degenerative adult scoliosis (degeneration on one side of the spine causes the spine to curve)
- loss of motion in the spine and leg weakness, and
- sciatica and nerve root compression.
How Does Social Security View Degenerative Disc Disease?
DDD is one of the most common impairments for which people apply for disability benefits, and Social Security doesn't approve many claims.
"Normal" Part of Aging
Social Security knows that many people suffer from degenerative disc disease and considers mild cases to be a natural part of aging. For some people, the pain is intermittent and they are able to go on working.
Most Social Security claims examiners expect people to go back to their same or similar jobs after a period of time off after a back injury. This usually means that an individual who did medium-level work in the past (the ability to lift 50 pounds occasionally and 25 pounds frequently) is expected to return to such work. Obviously, in many cases, this isn't realistic. Anyone who has ever experienced severe and continuous back pain knows how debilitating it can be.
Chronic Pain and Proving Back Disabilities
One big problem regarding back pain is that only the person experiencing the pain can actually know how bad it is and the degree to which it affects them. Claims examiners will give little consideration to complaints of severe pain unless your medical records include objective evidence that backs up your level of pain. That's why x-rays and MRIs are very important in cases involving back conditions.
Social Security will generally only grant disability benefits for those with medical imaging (x-rays, MRIs, or CT scans) that show the DDD has severely impacted the vertebrae or spine. During the disability determination process, a doctor who works for Social Security has to agree that the imaging explains why the applicant has severe, chronic pain and is unable to sit or stand for periods of time without assistance. That's why medical records are so important in these cases.
What Does Social Security Look for in Degenerative Disc Disease Cases?
When a disability examiner opens an application and sees degenerative disc disease, back pain, lumbar problems, or degenerative joint disease, the examiner looks for evidence that the applicant has a severe impairment. So the examiner will look for the following in the medical records:
- physician treatment notes indicating one of these diagnoses, and
- objective evidence of disc deterioration, such as x-ray reports, CT scans, or MRI studies.
Do You Meet a Spinal Listing?
Next, the disability examiner will look to see if there's enough evidence in your medical records to meet one of Social Security's spinal disorder listings:
- nerve root compression (such as a positive result on a straight-leg-raising test), or
- spinal stenosis (such as an MRI showing narrowing of the spinal column).
If your DDD has advanced enough to cause one of these conditions, visit the above links to learn about the criteria needed to meet Social Security's listing for that condition.
Does Your RFC Mean There's No Work You Can Do?
If you don't have one of the listed conditions above, Social Security will look at your functional limitations. Functional limitations are limitations on what you can do, such as having trouble walking, an inability to stoop or bend, or an inability to lift more than 25 pounds. Social Security will create a residual functional capacity, or "RFC," form for you that will include any limitations and restrictions your doctors have included in their treatment notes.
Disability examiners will also look for indications regarding a decreased range of motion, poor gait, positive straight leg raises, and reduced muscular strength. For strength, doctors use a five-point scale; for example, "5/5 right leg strength" indicates full right leg strength, while "1/5 left leg strength" indicates severely diminished left leg strength.
Whether you meet one of the above listings above or will need to rely on your RFC, your disability examiner will want to see that your back problem severely affects your ability to function, such as by limiting:
- your ability to walk effectively without a walker or two canes
- the range of motion in your spine, and
- the amount of time you can sit or stand with changing your position or posture. (If it's less than two hours, there are few jobs you could do, and Social Security should find you disabled).
(For more information on this process, see our article on how Social Security assesses RFCs for back problems.)
How to Strengthen Your Claim With More Documentation
To have the best chance of getting approved for disability, try to submit a few of the following types of evidence to your claims examiner:
- a history of any treatments you've tried and what the results were
- a record of any hospital or ER visits
- any results of tests such as x-rays or MRIs or those that measure the range of motion of the spine
- a statement from a former employer about how your condition limited you
- any performance evaluations reflecting your physical or psychological difficulties
- a record of sick days or medical leave from your last job
- a statement from your doctor about your restrictions and limitations, and
- a statement from a family member about how your condition makes it difficult to do daily activities.
To rise above the many disability claims for degenerative disc disease that Social Security sees, the more evidence you have to corroborate your back pain, the better. This is why it's crucial to be followed closely by a physician.
Tips on Winning Disability for Degenerative Disc Disease
Well, while it's true that doctors determine what goes into medical files, it's also true that patients can exercise a small degree of influence over that process. Here are some tips that may help tips the scales in your favor.
Tip 1: Get Regular Medical Treatment
Get regular medical treatment. The importance of this cannot be overemphasized. Disability examiners and administrative law judges (ALJs) who work for Social Security find it difficult to approve cases in which the newest medical records are more than two months old. (This is true even in situations with good long-term medical records. Try to go to a doctor at least once every two months.
Tip 2: Go to the Right Kind of Medical Provider
Getting medical treatment from a medical doctor (M.D.) or osteopath (D.O.) can help ensure that you have strong medical records to support your disability claim for a degenerative back condition. Social Security can't accept a diagnosis from a chiropractor or physical therapist. If you can get a referral to an orthopedist, that's even better.
Tip 3: Stick with One Doctor
Try to be seen by the same physician on an ongoing basis. By doing this, you can develop a relationship with a doctor who, in turn, may be more attentive and responsive to your condition.
The simple truth is that most doctors see an incredible number of patients and tend to be more responsive to the ones they are more familiar with. By seeing one physician more frequently, as opposed to several physicians infrequently, you may end up with better records, as well as a more sympathetic doctor. And when the time comes to ask your doctor for a statement supporting your disability case, your doctor may be more willing to take the time to write one up.
Tip 4: Mention Your Difficulties to Your Doctor
Make your doctors aware of your physical limitations when you visit them. If, for example, you have trouble bending, stooping, or crouching, let the doctor know. Doctors seldom check a patient's ability to stoop, bend, or crouch during an examination, and yet bending, stooping, and crouching are the three primary nonexertional limitations that disability examiners look for when they evaluate the RFC of applicants with degenerative disc disease. If you are completely unable to stoop, for example, you have a good chance of getting benefits, since most jobs require a least some stooping.
For this reason, disability examiners will often call applicants and ask them questions such as:
- "Are you able to bend down and pick up light items?"
- "Can you use a vacuum cleaner?"
- "Are you able to stoop down to lift a package?
- "Are you able to sit in one position for very long?"
Since your regular physician may not test you for these limitations when you have a doctor's appointment, it's a good idea to mention them to your doctors in the hopes that they will record them in their treatment notes.
Tip 5: Keep Your Friends and Family Up to Date
Keep your family and friends up to date on your physical limitations. Disability examiners often call applicants to ask questions about their daily activities, but they also routinely contact the relatives and friends of applicants. Examiners refer to these calls as ADL calls ("activities of daily living" calls).
Technically, examiners are supposed to make ADL calls for the purpose of gathering "supporting" information on claims, but they usually use them to gather evidence to deny cases. Examiners can ask tricky questions to try to get applicants to give responses that aren't helpful to their case. For this reason, disability examiners aren't allowed to make ADL calls to applicants who are represented by legal representatives. (Social Security must contact their representatives instead.)
How to Apply for Disability Based on DDD
If you're applying for Social Security disability insurance (SSDI), you can file your whole claim online on Social Security's website. If you're not comfortable online, you can call Social Security at 800-772-1213 to start your claim. Most individuals filing for SSI only cannot file the entire application online, but they can get started on Social Security's website. For more information, see our article on applying for Social Security disability benefits.
If you'd like help with your application, think about contacting a legal representative or disability firm that specializes in SSDI. According to a survey of our readers, applicants who filed an initial application without expert help were denied 80% of the time. Click for a free case evaluation with a legal professional to determine if your back problems qualify you for benefits.
After You Apply for Benefits
If you receive a denial letter and feel your case is strong enough to win an appeal—maybe your back has gotten worse or you have a new MRI—consider contacting a disability lawyer for help appealing your claim. Applicants who go to an appeal hearing represented by a lawyer have a better approval rate than applicants who represent themselves.
Updated October 28, 2021