Social Security recently updated its rules for evaluating musculoskeletal conditions including conditions affecting spine, joints, and soft tissues. These changes will make it more difficult to meet Social Security specific criteria of disability known as the “listings.” However, these changes are not likely to have a major impact on disability decisions.
What Are “Listings”
Social Security has a list of criteria for disability for specific conditions known as The Listings. The purpose of the listings is to set criteria for disability “severe enough to prevent an individual from doing any gainful activity, regardless of his or her age, education, or work experience.” 20 C.F.R. 404.1525(a) This standard is more stringent than the usual disability standard, which requires that an individual be unable to perform substantial gainful activity. If your condition meets the listing, the disability evaluation process stops and your team to be disabled.
What Changes Were Made
The new musculoskeletal listings set a basic functional standard of disability that is consistent between all the rules. Basically, to meet these listings an individual must be unable to walk or get around without using both upper extremities. For example, an individual claiming disability due to back problems would likely need to be using two canes, to crutches, a walker, or a wheelchair to meet the rules. However, the rules do account for situations where a person may have one upper extremity that cannot aid in getting around. For example, someone with a non-dominant upper extremity amputation and a medical necessity for use of a cane would also meet the functional limitations of the new listings because both upper extremities cannot be used for activities other than walking or getting around.
Before these changes, Social Security’s rules were similar but not as clear. The prior listings focused on a person’s ability to walk, and provided several examples that would qualify as ineffective walking. These examples included an inability to walk a block over rough or uneven surfaces at a reasonable pace without mention of any requirement for an assistive device. However, another example did specifically refer to an inability to walk without two crutches, two canes, or a walker. This left decision-making inconsistent and many people frustrated because some decision-makers would rely primarily on the uneven surfaces example while others used the two crutches, two canes, or walker example. By shifting focus to the criteria that both upper extremities be medically required for walking, Social Security has solved this inconsistency, but eliminated a less stringent requirement for disability.
How To Prove Disability for Musculoskeletal Problems
The other requirements of the listings have not changed significantly. So, when an individual is claiming disability for musculoskeletal problems like spine problems, joint problems caused by arthritis or something else, burns or other soft tissue injuries, or amputations documentation of certain physical findings on exam is essential.
First and foremost, these listings require imaging studies or physical exams that document the deformity. In the spine the deformity may be a herniated disc or arthritis known as spondylosis. In a joint, the deformity may be a loss of cartilage or arthritis. Sometimes the deformities are obvious on physical exam. If this is the case, the medical provider needs to provide a detailed statement of the observed deformity. Imaging studies help establish the existence of the condition, but don’t provide much information about how limiting the condition is, so more information is needed.
Physical exams should also document other musculoskeletal dysfunction such as weakness measured on a five-point scale, sensory loss, reflex loss, paresthesia (abnormal nerve sensations such as pins and needles, burning, and stabbing), pain, and bowel or bladder dysfunction. These sorts of problems should be documented in as many visits as possible, doing it once is simply not sufficient. A medical record that contains multiple statements of problems in these areas over time can be powerful evidence of disabling musculoskeletal problems. However, imaging studies and physical exams are often not enough on their own.To further document your physical impairments it is essential that you share examples of how your conditions limit your physical activities on a day-to-day basis with your doctor. For example, someone who has back pain could describe a visit to the grocery store that required use of the electric cart, help loading a gallon of milk into the cart, and help loading the groceries into the car. A person with knee problems might describe a similar trip to the store but with a need to sit and rest throughout the shopping trip, demonstrating an inability to walk more than a few hundred feet without stopping to rest. Of course, examples should include an assistive device like a single cane or single crutch if one is used. Again, multiple detailed examples of limitations in daily activities over time in the medical record are very powerful evidence supporting disability.
Conclusion
While the new musculoskeletal listing criteria are more stringent than the previous version, the basic types of evidence and the basic ways of documenting an individual disability have not changed. The key to winning a case for musculoskeletal conditions is to accurately and completely document the extent to which that condition interferes with daily activities.
Dealing with a disability and getting appropriate compensation can be complicated and frustrating. While many people imagine that disabilities are something you are born with, in most cases disabilities usually occur later in life or develop over time. Disabilities can result from accidents or injuries, or even from acute or chronic illnesses. Understanding what qualifies as a long-term or permanent disability can help you to navigate disability coverage options and make the best choices for your future.
