How the Social Security Administration Evaluates Back Injury Claims

The impairment most commonly cited by applicants for Social Security disability in Philadelphia and nationally is a back injury.

Unfortunately, the Social Security Administration is in the dark ages in its approach to evaluating the most common back problem — disability from low back pain. Part of the problem lies in the Social Security Administration’s approach to the evaluation of pain. The way the Social Security Administration deals with osteoarthritis and degenerative joint disease also contributes. The Social Security Administration does not treat these impairments as disabling, at least in the early stages when claimants may be suffering pain, muscle spasms and some limitation of motion but may not have significant neurological findings.

X-rays and symptoms

Doctors will tell you that x-ray findings for osteoarthritis and degenerative joint disease do not correlate well with symptoms. Some people with x-ray evidence of severe osteoarthritis or degenerative joint disease may have no symptoms whatsoever. Others, who have x-ray findings characterized as mild, suffer excruciating pain. For those people who are symptomatic, x-ray findings often seem to lag far behind symptoms. The Social Security Administration acknowledged that “there is a relative lack of correlation between findings on imaging and function of the joint” in the introductory comments to the musculoskeletal listings.

Indeed, there is little or no correlation between lumbar range of motion and residual functional capacity (RFC). Studies have found a large variation in lumbar range of motion of those who have no back impairment whatsoever. Age, gender and time of day of testing also influence lumbar range of motion. Spinal stability has been found to be more important for the performance of everyday activities than is the ability to touch one’s toes.

The Social Security Administration’s administrative law judges frequently explain denial decisions in low back pain cases on the grounds that the “mild” x-ray findings or lack of significant limitation of lumbar range of motion do not support the claimant’s allegation of pain and reduced residual functional capacity. This is despite the fact that the record contains a report from the treating physician reciting findings and describing a significantly limited RFC. In order to avoid this problem, it is necessary that your disability attorney have the treating physician provide maximum detail and explanation. Your attorney must ask the treating physician to explain why the findings support the diagnosis, and why the medical signs and findings caused the physician to conclude your RFC was so limited.

Emotional overlay

There may be additional factors that help explain your symptoms. For example, if the treating physician concludes that you have a back problem but that your symptoms are out of proportion to the findings and that an “emotional” or “psychogenic” overlay accounts for your increased symptoms, your disability attorney should develop evidence concerning this “overlay.” He or she should have the treating physician explain what this means. An emotional overlay is defined as “the emotionally determined increment to an existing organic symptom or disability.” Dorland’s Illustrated Medical Dictionary, 29th ed., p. 1295.

If the treating physician suggests that you have an emotional overlay, corroboration may be obtained through a psychological evaluation. Most often the combination of the underlying back problem and the emotional overlay will explain your symptoms.

Assistance available

Back injury claims can be challenging. If you have a back injury and are not already represented by a Philadelphia Social Security disability attorney and want our evaluation, give us a brief description of your claim using the form to the right.

Or you may e-mail us. More information on back injury claims is also available here on our website.

Silver & Silver
Philadelphia Social Security disability attorneys
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Representing disabled individuals seeking Pennsylvania, Delaware, and New Jersey Social Security disability benefits for over 30 years.