Chronic back pain is persistent pain that lasts for more than three months. It can result from back injuries, spinal stenosis, degenerative disc disease, or herniated discs and can significantly impact people’s quality of life and daily activities.
Due to chronic pain, people with back conditions are often exhausted and require additional assistance, especially if the pain is work-related. This article will clarify whether your back pain qualifies you for disability.
Disability and the Law
Research indicates that long-lasting back pain affects a significant portion of the US population and is the primary cause of disability. A survey found that approximately 28% of adults in the United States report experiencing chronic low back or sciatic pain. [1]
Legal Definition of Disability
Disability is defined by two laws that aim to help people with disabilities in different ways:
Under the Americans with Disabilities Act (ADA), a disability is a physical or mental impairment substantially limiting one or more major life activities.
Within this framework, chronic back pain is considered a disability if it significantly restricts daily functions such as walking or working. ADA is focused on protecting people from discrimination and ensuring they receive accommodations.
The Social Security Disability Insurance (SSDI) program has a more specific definition, as it determines who qualifies for Social Security disability benefits.
According to the SSDI, a person is disabled if their condition prevents them from substantial gainful activity (SGA) — meaning they are terminal or unable to earn over a certain amount for at least 12 months [2]. The SSDI focuses on providing disability benefits to people who cannot support themselves entirely.
Criteria for Disability
To qualify for disability benefits, individuals must meet the following criteria:
- Severe physical or mental impairment – They must have medical conditions that prevent or significantly limit them from performing activities such as lifting, standing, walking, sitting, or remembering.
- Inability to work – The condition must prevent the individual from earning the SGA amount determined for that year.
- Inability to adapt to other work – The individual cannot adjust to other work, and this inability is determined based on their age, work experience, or condition.
- Enough work history –The person must have earned enough work credits by paying into Social Security through payroll taxes. Typically, 40 credits are required, but this may sometimes be lower.
- Medical evidence –The person must provide enough medical evidence to justify their claim.
- Adhering to treatment – The person must adhere to the prescribed treatment or have a valid reason not to.
Chronic Back Pain as a Disability
Medical evidence is necessary to prove that the chronic back pain you’re experiencing is enough to support a claim of disability. Usual pieces of evidence include:
- Medical documentation – Evidence of diagnosis, treatment plans, and the impact on your daily living.
- Test results – X-rays, MRIs, or CT scans showing spinal issues or nerve damage.
- Treatment records – Evidence of ongoing efforts to manage back pain, such as physical therapy, medication, or surgery.
Common qualifying conditions include disorders and injuries that affect the musculoskeletal system, especially the spinal cord [3]. They may include:
- Spinal injuries
- Ankylosing spondylitis
- Certain soft tissue injuries
- Spinal stenosis
- Degenerative conditions such as degenerative disc disease
- Nerve root compression
However, while these back conditions qualify you for disability, they do not guarantee that you will receive it. Your medical documentation must prove that the issue limits your ability to work or perform daily activities.
Factors Affecting Disability Benefits Eligibility
The main factors that influence whether people qualify for SSDI claims include the severity of pain, possible treatment options, and how the condition affects your ability to work.
Severity of Pain
The severity and frequency of the back pain primarily determine eligibility for disability benefits. It must be severe enough to limit basic tasks and frequent enough to require medical treatment, rest, or medication.
The Social Security Administration (SSA) requires the pain to be severe and persistent, and those who have mild or moderate pain with periods of respite do not typically qualify for disability. Documentation must prove that you’re in pain, as your own account isn’t enough for the SSA.
Treatment Options
Another significant factor in qualifying for benefits is the effectiveness of treatment options, including physical therapy, medications, or surgical intervention. If the treatment options prove to be ineffective, it demonstrates that the condition is more likely permanent and disabling, which increases the likelihood of qualifying for disability.
Work Limitations
Chronic back pain is usually highly uncomfortable and requires rest to improve. It affects people in jobs that require movement, as well as people with sedentary jobs.
Chronic back pain can cause several types of work limitations:
- Physical limitations – Back pain limits the range of motion and the ability to sit, walk, stand, lift, bend, extend one’s arms and reach overhead.
- Cognitive limitations – Chronic pain leads to mental fatigue, creating concentration issues that can affect decision-making abilities. Fatigue, drowsiness, and brain fog are also common side effects of pain medication. The pain can also lead to depression or anxiety.
- Attendance issues – Frequent rehabilitation and other medical appointments can affect attendance. Frequent flare-ups can also require unexpected PTO and affect productivity and reliability.
Obtaining a Disability Determination
If you want to obtain a disability determination and apply for a Social Security Disability or Supplemental Security Income, you must go through the program’s application process. Once you determine eligibility, you will need to submit your medical record, demonstrate your limited ability to work, and, if necessary, appeal a denial.
Medical Record
To support the disability claim, you must provide comprehensive medical records confirming your medical condition and verifying the diagnosis. You must also provide documentation proving your illness’s severity, including limitations, symptoms, treatment history, and proof that you’re complying with the doctor’s orders.
Functional Assessments
Functional assessments measure your physical and mental capabilities and how they relate to job demands. They use standardized tests to evaluate your range of motion, strength, endurance, and mobility, quantifying the pain’s impact on your life and work.
While medical records prove you have the condition, functional assessment results demonstrate that it prevents you from working.
Appealing a Denial
Appealing a denial gives you the chance to contest the SSA’s decision and try again. If you understand the grounds on which the SSA denied your application and you have a way to contest them, you can start the appeal process by following these steps:
- Filing a Request for reconsideration
- Submitting evidence that supports your claim
- Waiting for the decision
If your appeal is denied again, you still have ways to fight this decision:
- Contact a disability attorney;
- Request a hearing before an Administrative Law Judge within 60 days of the decision;
- Attend the hearing and state your case, possibly including medical specialists as witnesses.
The Role of a Personal Injury Lawyer
An experienced personal injury attorney can increase your chances of receiving a disability claim, guide you through the legal process, and negotiate with insurance companies and government agencies in your name, letting you preserve your strength for more important things.
Legal Expertise
Chronic back pain is exhausting, even more so when you’re fighting to prove you have it. A disability lawyer can help you by providing legal expertise and guidance through the disability claims process, including:
- A free consultation
- Gathering documentation
- Consulting medical experts
- Navigating the appeals process
- Representing you at hearings
Advocacy
Not all people with disabling pain get benefits, which leaves them in precarious situations. Workers’ compensation attorneys ensure that all aspects of your claim are considered, potentially identifying additional benefits or programs for which you may qualify. They can also help you with future claims or benefits as circumstances change.
Negotiation Skills
If you’re trying to get SSDI or SSI benefits or need to negotiate with an insurance company or government agency, a disability lawyer with years of negotiation experience will advocate for your best interests.
Your disability lawyers will know how to reject lowball offers, protect you from discrimination, and advocate for better terms.
Secure Expert Legal Representation
At Rosenfeld Injury Lawyers, we specialize in personal on-the-job injuries. Our Chicago workers’ comp lawyers know the toll pain takes on our clients, and we will fight to get you the best conditions so you can continue your life with more comfort and security.
Call (888) 424-5757 for a free consultation, or fill out our contact form.
References: [1] Statista, [2] ssa.gov, [3] ssa.gov