Musculoskeletal problems are the leading cause of missed workdays in the United States. It is commonly believed that musculoskeletal problems afflict the older, non-working population, but research has shown an increasing number of musculoskeletal problems are appearing among the working-age population.1
If you are afflicted by a musculoskeletal problem, you are probably familiar with the incessant pain that can make most everyday activities, especially job-related undertakings, difficult to sustain. The Social Security Administration’s (SSA’s) Social Security Disability Insurance (SSDI) can provide you with the financial support you need during this time of impairment.
What Criteria Does the SSA Use to Evaluate a Musculoskeletal Problem?
The SSA recognizes musculoskeletal disorders and impairments stemming from hereditary factors, traumatic events, congenital reasons, degenerative processes, and other causes. Whatever the cause, there are some criteria that the SSA takes into consideration when evaluating a condition:
- Inability to engage in any gainful activity for a minimum of 12 months.
- Inability to walk a sufficient distance and carry out tasks as a result of this limitation.
- Inability to perform fine and gross movements effectively due to a loss of function of both upper extremities.
- Pain or other symptoms which severely limit ability to perform basic activities.
- Claimants using orthotic, assistive or prosthetic devices are examined with and without them.
These are the general criteria for listings in this section. Apart from these, your musculoskeletal problem could need other specific criteria to be considered eligible.
What Kind of Documentation Is Required?
The documentation required includes, but is limited to:
- CAT scan
- MRI scan
- Radio nuclear bone scan
It is important to remember musculoskeletal disorders can improve with time or get better with treatment, so maintain long-term records to prove severity and duration of the problem. A record of your response to treatment can also strengthen your disability case.
What Happens When Your Musculoskeletal Problem Does Not Meet a Blue Book Listing?
Section 1.00 of the SSA’s Blue Book has listings for musculoskeletal problems. It’s possible that your problem may not be specifically listed. In this case, the SSA will determine if your medical condition meets the requirements of a listing, or if you have a combination of impairments that meet the requirements.
If you do not meet the requirements, then the SSA will check your Residual Functional Capacity (RFC) to see if you have the capacity to perform physical activities required by a job, like walking, standing or sitting for periods of time, pulling, lifting and so on. If they find that you don’t have RFC, then you could be eligible for SSDI benefits through a medical vocational allowance.
What Kind of Musculoskeletal Problems Qualify for SSDI Benefits?
Section 1.00 separates musculoskeletal problems into the following categories:
- Joints: Disorders in the hips, knees, ankles, shoulders, wrists, elbow, wrists, and hands are considered if there is chronic pain, deformity and inability to perform a range of movements. Some examples of joint disorders are:a)
- Degenerative joint disease: occurs when joints like hands, shoulders, neck, hips, knees, and lower back get inflamed. You can qualify for disability benefits under the ‘major dysfunction of a joint’ or ‘spine’ category, and you need to show deformity in the joint, narrowing of the joint, damage to bone or joint, or fusion of the joint.
- Osteoarthritis: is the painful stiffening of joints that increases with age. Qualifying for SSDI benefits based on only pain and stiffness is not likely, but you can qualify under the ‘spine’ and ‘major dysfunction of joint’ categories if you meet a listing requirement.Other diseases such as carpal tunnel syndrome and fibromyalgia are not specifically listed in the Blue Book in this section, but you can still apply for benefits if the severity of your problem prevents you from working. Inflammatory arthritis, however, has a separate listing under Section 14 of the Blue Book.
- Spine: Disorders of the spine coupled with nerve-root compression, spinal arachnoiditis or lumbar spinal stenosis is considered. The following are some of the spinal disorders mentioned in Section 1.00:
- Osteoarthritis: Neck-related disorders as a result of osteoarthritis are considered under this section. Nerve root compression and spinal arachnoiditis are listed. If you meet the requirements, you could be approved for benefits right away.
- Herniated nucleus pulposus: A herniated, ruptured, or prolapsed intervertebral disk is also considered for SSDI benefits.
- Facet arthritis: This refers to disabling low back and neck problems which are caused due to inflammation of lumbar or cervical facet joints, and so are eligible for benefits if it meets the criteria in this section.
- Vertebral fracture: These can result from osteoporosis, and must result in a compromised nerve root to qualify for benefits.
- Amputation: Whatever the cause, amputation of two limbs is necessary to qualify; however, in some cases amputation of one limb can be considered. Additionally, a claimant needs to show that a prosthetic device cannot help him/her to walk effectively.
- Fractures: Fractures of the femur, tibia, pelvis, tarsal bones, and other bones are considered eligible as long as the claimant is able to show that the fracture will not allow him/her to return to work for a minimum of 12 months.
- Surgeries like hip replacement can often be eligible for benefits under the category of ‘Reconstructive surgery or surgical arthrodesis of a major weight- bearing joint’ if their surgery leaves them unable to work for one year or more.
Is There a Faster Way Get Approval?
The disorders listed in Section 1.00 of the Blue Book do not generally qualify for Compassionate Allowance (CAL) which is a fast-track way to get disability benefits under SSDI. However, inherited musculoskeletal disorders such as Fibrodysplasia Ossificans Progressiva or Osteogenesis Imperfecta which appear in the ‘Childhood Listings’ under relevant sections are eligible for CAL.
The best way to ensure faster approval of benefits is to submit the required documentation completely and fill in the forms carefully. A good disability lawyer can help you make sure your claim gets quicker approval.
Apply for SSDI Benefits Today
Pain on a daily basis is a reality for many suffering from musculoskeletal problems. Stealing your physical mobility, it just one issue, but financial burdens can also be quite painful. You may be under treatment to help you cope with the pain, and have friends and relatives who support you during this time. However, financial support is critical too. This is especially true if you can no longer work because of your problem.
Our advocates at Disability United can help you with application process, and make your disability case stronger. Fill out our form to get a free disability evaluation of your eligibility and take one step closer to getting the benefits you deserve.