If you need to file a disability claim for degenerative disc disease (DDD), you may have already applied and been denied. Degenerative disc is one of the most common causes of back and neck pain resulting in disability. Today we share important tips about how the Social Security Administration, disability insurance companies, and the Department of Veterans Affairs evaluate these claims.
A form of arthritis, degenerative disc disease involves the progressive loss of normal structure and function in the spine. Arthritis refers to joint pain and disorders affecting joints and surrounding tissues, and this includes the spine.
The spine consists of boney structures called vertebrae that support the body and form the corridor through which the spinal cord passes. Separating the vertebrae are gel-filled, cushiony discs, which serve as shock-absorbing spacers.
Causes of degenerative disc disease can vary. Wear and tear of aging may affect the facet joints causing the discs to degenerate or break down. Spinal discs dehydrate with age and become thin and rigid. This brings stress to the spine, which can lead to the formation of bone spurs and pinched nerves.
Degeneration also promotes tears or cracks in the discs’ outer layers, causing bulging or ruptured discs and other serious physical limitations. Degenerative spine conditions may arise due to a person’s history of musculoskeletal disorders or arthritis, a strenuous occupation or lifestyle, or an injury that sets off the degenerative process.
Localized or radiating pain, numbness, weakness, and immobility associated with degenerative disc disease can range from mild to severe, with the severity of symptoms increasing over time. Severe cases of degenerative disc disease can make the simplest tasks difficult or even impossible to perform.
Why Proving a Disability Claim for Degenerative Disc Disease Can Be a Challenge
Claimants often work in an impaired state for years until they no longer can, before they seek help from a disability attorney. In the meantime, claimants may lose valuable medical evidence if they have not kept a documented treatment regimen or other necessary proof of disability.DDD is a complex medical condition, and claim examiners will require you to medically back up your claim that you are disabled. Winning a disability claim for degenerative disc disease always calls for submitting thorough medical evidence, proof of ongoing treatment from qualified doctors, and often undergoing a functional capacity evaluation.
An experienced disability attorney will ensure your condition is properly diagnosed and medically documented, including continuous treatment under a qualified physician.
Winning your Social Security Disability Claim for Degenerative Disc Disease
When deciding disability cases, the Social Security Administration (SSA) uses a process called the 5-Step Sequential Evaluation Process. The first two eligibility requirements are:
- Step 1 – You are not gainfully employed, and
- Step 2 – Your condition is severe.
If you pass these requirements, the next hurdle of the 5-Step Evaluation is Step 3 – Does your disability meet or equal a medical listing?
The SSA maintains a Listing of Impairments that are so severe that, if you satisfy the criteria of any listed condition, you are automatically considered disabled. The medical evidence to support all the criteria of the list can be massive – and our attorneys will help you secure and assemble the materials needed to meet the requirements.
Degenerative disc disease is found in the SSA Listing 1.00 Musculoskeletal Disorders.
Recent Changes to the Musculoskeletal Listings
Effective April 2, 2021, SSA changed its rules for people with musculoskeletal back disorders, including degenerative disc disease. If your new disability claim for degenerative disc disease is filed on or after April 2, or your claim is still pending approval as of April 2, 2021, the new rules will apply to you. All previously approved claims will remain under the past rules.
It’s vital to understand the new listing for degenerative disc disease, so the information that you provide in your claim to SSA is correct.
Under the new SSA listing, degenerative disc disease is categorized under 1.15, – Disorders of the skeletal spine resulting in compromise of a nerve root(s). The medical criteria that must be met are now different from the old SSA listing, which was 1.04 – Disorder of the spine.
SSA now classifies degenerative disc as an infirmity of the skeletal spine that results in compromise of a nerve root. SSA will consider disability claims for degenerative disc disease that are supported by medical evidence such as:
- Physical examination for type and location of pain, range of motion, nerve function, sensation, and muscle strength, with a full review of the entirety of symptoms
- Diagnostic imaging tests (such as MRI, CT scans, and x-rays)
- Records of treatment regimens
- Medical history
Similar deteriorating spinal impairments that impinge on or irritate a nerve root include:
- herniated disc
- spinal osteoarthritis
- vertebral slippage
- facet arthritis, and
- vertebral fracture or dislocation.
SSA listing criteria specifies that degenerative disc disease can cause cervical spine (neck region) or lumbar spine (lower back) dysfunction when abnormalities of the skeletal spine compromise:
- nerve roots of the cervical spine,
- a nerve root of the lumbar spine, or
- a nerve root of both cervical and lumbar spines.
Sometimes physicians will not document a claimant’s ability to bend, stoop or crouch during a physical examination. We know the SSA is looking for these limitations and will ensure your disability claim for degenerative disc disease contains these and other key pieces of medical evidence.
What if you do not “meet” the new SSA listing 1.15?
Do not give up! It is fact that most people’s initial SSDI applications are denied. Social Security’s own statistics show that most claimants who persevere with the help of an experienced attorney are found to be disabled at the next stages of the process—when proof of disability is based on a combination of medical and vocational factors at Step 4 and Step 5.SSA will next base its determination of disability on your capacity for full-time work, despite your limitations and restrictions resulting from your degenerative disc disease and any other physical or mental impairments. SSA will measure what is called your residual functional capacity to determine whether:
- Step 4: You are not able to do your past relevant work, or
- Step 5: You are not able to do any other work that you may have the education or
experience to do.
We gain more insight straight from the SSA’s Q & A on the revised Musculoskeletal Listings, in the excerpt below:
Q4: What percent of decisions do adjudicators make using these revised rules?
A4: We decide claims involving musculoskeletal impairments primarily at step 5 of the sequential evaluation process where we consider a claimant’s residual functional capacity (RFC), age, education, and work experience. Specifically, we make 90 percent of allowances due to a musculoskeletal impairment using the medical-vocational rules at step 5 of the sequential evaluation process, which have not changed. The remaining 10 percent of the people who apply for disability benefits, and are found disabled after an initial review due to a musculoskeletal impairment, meet (or medically equal) a musculoskeletal disorders listing. We do not expect this to change because of these final rules.
At every stage, there are specific ways to strengthen your SSDI case for degenerative disc disease.
By understanding what medical and vocational evidence the claims examiner or administrative law judge is looking for, we can help you demonstrate the medical severity of your condition, and how your degenerative disc has reduced your productivity and your ability to perform even sedentary tasks.
Remember, if you are still trying to prove a disability claim for degenerative disc disease that was initiated before April 2, 2021, the SSA listing for Musculoskeletal Disorders including all back disorders has changed. Be careful that you do not use a prior version of the Listing.
If your claim has been denied, we will handle your appeal and assist throughout your case with strong legal representation.
If you have not yet submitted your claim to SSA, we can manage your initial application every step of the way. Take a behind-the-scenes look at what we do to win your Social Security Disability Claim.
Long Term Disability (LTD) Insurance Claim for Degenerative Disc Disease
Our law firm has extensive experience with long-term disability claims for back pain and immobility due to degenerative disc disease, osteoarthritis, and various disorders of the skeletal spine. We have filed suit on behalf of disabled clients whose disability claims for degenerative disc disease were denied by major carriers including AETNA, The Hartford, and Unum.
You may have purchased an individual disability policy to protect against loss of income should disability strike. These policies are controlled by state contract laws and insurance laws.
Or, you may be covered by your employer’s group disability benefit plan. Group LTD benefits are controlled by the Employee Retirement Income Security Act of 1974, a.k.a. ERISA. For claimants fighting insurance companies who refuse to pay, this cumbersome federal law actually overrides state laws that protect consumers and work more in favor of insurance companies.
In either case, you need to prove to the insurer you are unable to work under the terms of your insurance policy. Insurance providers often deny credible disability claims for degenerative disc disease and other back and neck disorders, by asserting various reasons including:
- You are able to work in sedentary occupations
- There is no basis for the restrictions and limitations imposed on you by your doctor
- There is no objective evidence of the condition (because pain and radiculopathy are too hard to objectively gauge)
Marc Whitehead & Associates are ready to help you. We are skilled litigators who represent disabled individuals across the United States against insurers who handle claims unfairly and deal in bad faith insurance practices.Let’s schedule a consultation to discuss your case and discuss your legal options. We will thoroughly evaluate your case and get you the answers you need. If you have not yet filed with your insurer, we will handle your initial LTD application from start to finish.
Veteran’s Disability Claim for Degenerative Disc Disease
Disorders of the back and spine are all too common for veterans. Degenerative disc disease can cause soldiers of every age to lose their ability to work. If you’ve served in the armed forces and have been diagnosed with degenerative disc disease or other severe spine or back injury, talk to us.Degenerative disc disease is evaluated under diagnostic code 5242 – Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome. The VA typically rates DDD between 10% and 20% with alternate rating options under diagnostic codes 5003 (Degenerative arthritis, other than post-traumatic) or 5010 (Post-traumatic arthritis).
Can a veteran increase his or her rating for degenerative disc disease?
It’s important to look into worsening symptoms and secondary conditions that may have surfaced as a result of the degenerative disc disease. DDD can trigger other conditions including radiculopathy, herniated discs, neurological impairments, spinal stenosis, and more. Claiming secondary or different conditions and combining ratings can result in considerably higher ratings.If the VA has denied your claim or if you have received an unsatisfactory rating decision, you may need someone by your side. An accredited Veterans claims attorney at our firm is an excellent place to start.
We’re here for you throughout the disability process.
Don’t let a delay or denial stop you from winning your disability claim for degenerative disc disease. We provide significant help, and your initial consultation is always free. If you need help with a disability claim concerning Social Security, an insurance company, or the Department of Veterans Affairs, please contact us.
