To win your disability claim for degenerative disc disease, you must prove two things with solid medical evidence: that you have the condition and that it keeps you from working. This means you’ll need a clear diagnosis backed by imaging, a record of ongoing treatment from qualified doctors, and proof of how your symptoms limit what you can do day to day.
A Social Security Disability lawyer can help you gather this evidence, file a strong claim, and fight to get the benefits you’re owed. Let’s take a closer look at how to win a degenerative disc disease disability claim and how a lawyer can help you succeed.
If you need to file a disability claim for degenerative disc disease (DDD), you may have already applied and been denied. Degenerative disc disease is one of the most common causes of back and neck pain resulting in disability.
Why Proving a Disability Claim for Degenerative Disc Disease Can Be a Challenge
Claimants often work in an impaired state for years 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 complicated 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 requires thorough medical evidence, proof of ongoing treatment from qualified doctors, and, in many cases, undergoing a functional capacity exam.
An experienced disability attorney will ensure your condition is properly diagnosed and medically documented, including continuous treatment under a qualified physician.
For a free legal consultation, call (800) 562-9830
Winning Your Social Security Disability Claim for Degenerative Disc Disease
When deciding disability cases, the Social Security Administration (SSA) uses what’s called the 5-Step Sequential Evaluation Process. The first two eligibility requirements are that you are not gainfully employed and that 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. A lawyer can help you secure and assemble the materials needed to meet the requirements. Your attorney will explain how to win a disability claim for a degenerative disc disease and work hard to get the best outcome possible.
Recent Changes to the Musculoskeletal Listings
Effective April 2, 2021, the 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 important to understand the new listing for degenerative disc disease to ensure that the information 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. Understanding these new criteria is important if you want to win your disability claim for degenerative disc disease.
New Classification Details
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
- Vertebral fracture or dislocation
SSA listing criteria specify 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
- 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. You must hire an attorney who can include these important pieces of medical evidence in your claim to win your degenerative disc disease disability case.
What if You Do Not “Meet” the New SSA Listing 1.15?
Most people’s initial SSDI applications are denied. The SSA’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.
The 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.
The organization will measure what is called your residual functional capacity to determine whether you are not able to do your past relevant work, or you are not able to do any other work that you may have the education or experience to do.
SSA Q&A: What Percent of Decisions do Adjudicators Make Using These Revised Rules?
You can gain more insight straight from the SSA’s Q&A on the revised Musculoskeletal Listings. When asked what percent of decisions adjudicators make using these revised rules, the SSA answers by saying it decides claims involving musculoskeletal impairments primarily at step 5 of the sequential evaluation process.
It is at this point that the SSA considers a claimant’s residual functional capacity (RFC), age, education, and work experience. Specifically, the SSA makes 90% 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% 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.
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, you can 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, an attorney will handle your appeal and assist throughout your case with strong legal representation. Having a dedicated lawyer by your side will give you the best chance possible at winning your degenerative disc disease disability claim.
If you have not yet submitted your claim to SSA, your lawyer can manage your initial application every step of the way.
Long Term Disability (LTD) Insurance Claim for Degenerative Disc Disease
With an experienced disability attorney, you may be able to win a Long Term Disability claim for back pain and immobility caused by degenerative disc disease, osteoarthritis, and other disorders of the skeletal spine. Major carriers like AETNA, The Hartford, and Unum routinely deny these claims, and a lawyer can file suit when they do.
You may hold an individual disability policy you bought to protect your income, which is governed by state contract and insurance laws. You also may be covered by an employer’s group plan under the Employee Retirement Income Security Act of 1974, or ERISA, a federal law that often overrides consumer protections and works in favor of insurers.
Either way, you must prove to the insurer that you cannot work under the terms of your policy. Insurers often deny credible claims for degenerative disc disease and other back and neck disorders by asserting:
- You are able to work in sedentary occupations
- There is no basis for the restrictions your doctor imposed
- There is no objective evidence of the condition, since pain and radiculopathy are hard to measure
A skilled attorney can counter these tactics, evaluate your case, and hold insurers accountable for unfair or bad faith practices. If you have not yet filed, a lawyer can handle your initial LTD application from start to finish.
Veteran’s Disability Claim for Degenerative Disc Disease
Back and spine disorders are all too common for veterans, and degenerative disc disease can cost soldiers of any age their ability to work. If you served and have been diagnosed with degenerative disc disease or another severe spine or back injury, you have options worth exploring.
DDD is evaluated under diagnostic code 5242, degenerative arthritis and degenerative disc disease other than intervertebral disc syndrome. The VA typically rates it between 10% and 20%, with alternate options under codes 5003 (degenerative arthritis, other than post-traumatic arthritis) or 5010 (post-traumatic arthritis).
Can a Veteran Increase Their Rating for Degenerative Disc Disease?
It is worth looking into worsening symptoms and secondary conditions caused by the DDD. The condition can trigger radiculopathy, herniated discs, neurological impairments, spinal stenosis, and more. Claiming these secondary conditions and combining ratings can lead to considerably higher ratings.
If the VA has denied your claim or given you an unsatisfactory rating decision, you may need someone by your side. An accredited veterans claims attorney is an excellent place to start. They’ll handle every aspect of your case and offer insight into how to win a disability claim for a degenerative disc disease.
How Severe Does Degenerative Disc Disease Have to Be to Qualify?
Not every case of degenerative disc disease qualifies for benefits. Because it is an age-related condition, nearly everyone’s discs move through some stages of degradation over time. A healthy disc simply cushions the spinal bones, and mild disc damage on its own will not win a claim. What matters is the worsening of symptoms to the point that you can no longer work.
Decision makers look for objective severity, not just discomfort. Common symptoms that signal a qualifying level of impairment include severe pain, a limited range of motion, muscle weakness, and nerve root compression or nerve damage that radiates into your limbs and restricts everyday physical activity.
In its most serious form, degenerative disc disease can lead to conditions like spinal arachnoiditis, an inflammation and scarring around the spinal nerves that is sometimes confirmed by a tissue biopsy or operative report. Conditions this severe make it far easier for a disability examiner to find a medically determinable impairment.
How to Win Your Claim
Winning your disability claim for degenerative disc disease starts with proving your condition keeps you from earning above Substantial Gainful Activity. That standard applies whether you are pursuing Social Security Disability Insurance through Social Security or Long Term Disability benefits from a private insurer, and it is the foundation of any Disability Benefits claim.
Understanding Degenerative Disc Diseases
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 the joints and surrounding tissues, and that includes the spine.
The spine is made of bony structures called vertebrae that support the body and form the corridor through which the spinal cord passes. Between the vertebrae sit gel-filled, cushiony discs that act as shock-absorbing spacers.
Aging wear and tear can affect the facet joints and cause the discs to break down, while the discs also dehydrate and grow thin and rigid. This stresses the spine and can bring on bone spurs, pinched nerves, and tears that cause bulging or ruptured discs. It may also stem from a history of musculoskeletal disorders, a strenuous occupation or lifestyle, or an injury.
Symptoms such as localized or radiating pain, numbness, weakness, and immobility can range from mild to severe and tend to worsen over time. Because severe cases can make even the simplest tasks impossible, knowing how to win your disability claim for degenerative disc disease starts with recognizing how disabling this condition can become.
We’re Here for You Throughout the Disability Process
At Marc Whitehead & Associates, disability is all we do. Marc Whitehead is double board certified in disability and litigation; our attorneys have earned more than 2,500 five-star reviews, and we have spent over 30 years fighting for the benefits our clients paid for. We quite literally wrote the book on the subject.
We know how to win your disability claim for degenerative disc disease, whether your claim involves Social Security, an insurance company, or the Department of Veterans Affairs. Don’t let a delay or denial stop you. Contact us today to schedule a free consultation and get started on your case.
Call or text (800) 562-9830 or complete a Free Case Evaluation form