Living with chronic back pain can range from mildly annoying to fully debilitating. In some cases, chronic back pain can prevent a patient from carrying out typical daily activities, including being able to work. Many jobs include sitting, standing, or walking for long periods, all of which can be irritating to back conditions.

By some estimates, as many as 80% of Americans will struggle with back pain at some point, and many Americans live with long-lasting and chronic back pain. If you are struggling with chronic back pain, it’s important to understand how your situation may be evaluated by the Social Security Administration when it comes to qualifying for benefits through the Social Security Disability Insurance program.

5 Causes of Back Pain

Though the causes of back pain are many and varied, there are a few usual suspects when it comes to the root causes of back pain – we’ve outlined some of the most common below.

  • Bulging or Ruptured Discs
  • Injury or Accident
  • Arthritis
  • Effects of Aging
  • Improper Posture

The Social Security Disability Insurance program exists to help American adults who are unable to work due to a disability. According to the American Chiropractic Association, chronic back pain accounts for more than 265 million lost hours of work every year, and it is the leading cause of disability in the United States. In addition, back pain is the most common disability for which people apply for Social Security disability benefits.

While chronic back pain claims are incredibly common, these claims often are difficult to prove since pain is such a subjective measure. It can be challenging to provide objective medical evidence that quantifies a patient’s pain intensity, along with the functional limitations the pain causes.

If you’re preparing to apply for disability benefits related to your chronic back pain, you should know the details about the process the Social Security Administration will use to make a determination on your disability claim.

1. Bulging or Ruptured Discs

Spinal discs serve as individual cushions between our vertebrae. When they bulge out of place or rupture, they can press on nerves, causing pain that is often intense and long-lasting. In some cases, chronically bulging or ruptured discs may be caused by degenerative disc disease.

2. Injury or Accident

It’s easy for muscles and ligaments to become strained as a result of injury or accident. Even repeated heavy lifting or an awkward sudden move can strain ligaments and muscles, causing temporary pain. Injuries and accidents that are especially severe and long-lasting, such as car accidents, falls on ice, or other high-impact injuries can cause long-term chronic pain.

3. Arthritis

Arthritis, particularly Osteoarthritis, often affects the lumbar region of the spine, causing intense and chronic low back pain. In some cases, osteoarthritis can even lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis. In addition, rheumatoid arthritis can lead to ankylosing spondylitis, a spinal disorder that involves fixation of the spine, usually of at least 45 degrees.

4. Effects of Aging

The natural muscle atrophy associated with the aging process is a common culprit for causing back pain. If the back muscles atrophy to the point that they no longer have healthy strength and stability to offer support, they can begin to ache and easily become irritated, inflamed, or strained. It’s common as we age not only for muscles to atrophy but also for disc space between our vertebrae to decrease.

5. Improper Posture

Poor posture and/or body mechanics can lead to chronic back pain, along with stressing the spine and straining the soft tissue surrounding it. This is where your work environment can play a key role – in particular, sitting for long periods, or hunching over a keyboard can lead to posture or body mechanics habits that eventually cause chronic back pain.

Disability Benefits for Chronic Back Pain

Whether the Social Security Administration will classify your chronic back pain as an eligible disability depends on the specific details of your situation. The SSA will examine the severity of your symptoms, the effectiveness of your current treatment and pain medication, your age and education level, the type of work you do, and anything else within your medical record that can help provide a clear picture of how your chronic back pain affects both your quality of life and your ability to work.

In order to effectively evaluate your claim, the SSA will employ a five-step process. It’s important to note that the full evaluation process can be lengthy, and getting a final decision may take several months or more, especially if you enter the appeals process. In many cases, though, the SSA will grant SSDI back pay that covers the time between submitting your application and gaining final approval.

Non-Medical Criteria

In the first stage of review, Non-Medical Criteria, the adjudicator will determine whether you meet Social Security qualifications outside of your medical condition. This includes having an income level that falls below $1090 pre-tax. Keep in mind that no matter the nature of your medical condition, if you do not meet the non-medical criteria SSA has stipulated, your claim automatically will be denied.

Severity of the Disability

Next, the SSA will determine the severity of your condition by reviewing all medical documentation related to your disability claim. You will likely need to complete an Activities of Daily Living and Vocational questionnaire, which gives you the opportunity to share with SSA reviewers how your symptoms have impacted your ability to function on a day-to-day basis. If you are working with a Social Security disability lawyer, she likely will be heavily involved in this stage of the process and can help you navigate the steps involved.

You may be asked to participate in a consultative examination if the SSA determines additional medical documentation is needed. Through this process, you will be examined by a physician contracted by the SSA to gather any missing medical evidence or answer specific questions posed by reviewers about your current medical condition.

The strength of your medical documentation is key to the SSA’s ultimate decision – the SSA will need to see that your chronic back pain is attributable to a specific medical condition. You may include medical evidence such as MRI and X-ray results that show a connection between your medical condition and your level of chronic pain. This is the most objective portion of your claim and will carry great weight with reviewers. You also may supplement this objective medical documentation with statements from treating physicians, friends, and family who observe how your medical condition has affected your quality of life and ability to work.

Blue Book Listing of Impairments

In the third step, reviewers will determine whether your current condition meets the criteria for a pre-existing medical listing. The Social Security Administration keeps a running list of medical conditions called the Listing of Impairments – or sometimes Blue Book. This list serves as a general reference for SSA reviewers to help them understand various medical conditions and how they are viewed in terms of compensation.

Although back pain does not have its own specific listing, the Blue Book does include listings of specific medical conditions that can lead to back pain. For example, back pain claims typically are reviewed under Listing 1.04 – Disorders of the Spine. This is a subset of Listing 1.00 – Musculoskeletal System Impairments.

Generally, to be approved under Listing 1.04, a disability claim must show documentation of at least one of the following: herniated disc, spinal pain radiating throughout the body, nerve compression, osteoarthritis, degenerative disc disease, arthritis in spinal joints, or a fractured vertebra which results in compression of either a nerve root or the spinal cord.

If medical evidence shows a clear disability that aligns with listing criteria, your application may be approved for SSDI benefits at step three and will not need to continue with additional steps.

Past Relevant Work

If your medical evidence does not support a clear condition in the Listing of Impairments, the next step is for reviewers to consider the type of work you previously performed. SSA staff will determine whether your current medical condition allows you to continue working. At this stage, a reviewer will determine your Residual Functional Capacity (RFC), which represents your ability to perform various work-related physical functions, ranging from sitting and standing to crouching, lifting, and carrying – plus mental functions such as comprehension and decision-making.

Adjudicators will consider the level of exertion associated with your past work and make a determination on whether your current medical condition prevents you from being able to perform that type of work. If the answer is, “yes,” then your claim will move to the final step in the review process.

Common functional limitations that may lead to an approved claim include things like needing to lie down at several points throughout the day, an inability to bend or stoop down to pick up something, or the need to keep one or both legs elevated throughout the day. If reviewers determine that your medical condition is not severe enough to prevent you from performing the type of work you’ve performed in the past, then your claim will be denied at this point in the process.

Performing Similar Work

The final step in the review process is to determine whether your medical condition is severe enough to prevent you from completing any type of work for which you are qualified. This expands the pool of possible jobs beyond just the type of work you’ve done in the past.

Using the same Residual Functional Capacity results from the previous step, along with your age, education, and skill level, reviewers will determine whether your disability prevents you from doing any type of work that otherwise would be feasible for someone with your age and experience. If an adjudicator finds that your disability keeps you from doing any type of work you might otherwise be qualified for, then your claim for disability insurance benefits may be approved. However, if an adjudicator determines that you are able to perform other types of work, then your Social Security disability claim will be denied.

Help for Chronic Back Pain

SSDI benefits claims related to back pain often are complex and may be difficult to win – back problems stem from a wide variety of causes, some of which are challenging to document with sufficient medical evidence.

It’s important to have help along the way. If chronic back pain keeps you from working and you believe you may qualify for disability benefits, don’t hesitate to reach out to a qualified and knowledgeable Social Security attorney. The information presented here can help you begin an informed and productive conversation with an advocate who can help you navigate the process.