The Role of a Social Security Disability Lawyer

The role of a Social Security disability lawyer is to make filing your disability claim as painless as possible while ensuring that you receive the full amount of benefits to which you are entitled.

It’s hard for the average person to deal with the mountain of paperwork that comes with filing a Social Security disability claim. The Social Security Administration is diligently working to prevent fraud in disability claims (they suffer almost one hundred million dollars worth of fraud every year) and as a result their rules and regulations on how to properly file a disability claim have grown increasingly strict.

It’s unfortunately not uncommon for someone with a genuinely legitimate disability claim to be denied because of some minor clerical error in preparing their paperwork. A misplaced form or improperly filled out paperwork can make the Social Security Administration incorrectly flag your disability claim as fraudulent and that means you get denied the benefits that you are entitled to.

It’s not your fault; you don’t deal with this sort of bureaucratic red tap everyday. That is why you should always consult with an experienced social security disability professional when you need help getting your disability benefits!

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Proving a Lumbar Spine Disability

What it Takes to Prove a Lumbar Spine Disability Case

Degenerative disc disease is one of the most likely causes of low back pain, effecting approximately 65 million Americans a year. However, it is also one of the most misunderstood conditions and often people are left unsure on what the diagnosis actually means. Much of the confusion centers around the idea that because it’s called “degenerative,” the condition will progress and get worse over time. But actually, while disc degeneration is likely to progress over time, the resulting lower back pain usually gets better over time. Disc degeneration is a natural part of aging so everyone will have changes in their discs; however, not all people will develop symptoms because degenerative disc disease is quite variable in its severity. Therefore, when assessing an alleged back condition, Social Security looks for certain markers that indicate an individual’s condition is truly disabling. This article will explore these markers and provide tips on how to strengthen a disability case which involves degenerative disc disease of the lumbar spine.

What Social Security is Looking For?

MRI’s are a great way to prove the severity of a disc disease. Most doctors will order this imaging test when a patient consistently complains of low back pain. The MRI offers a more detailed image of the spine than an x-ray, and can tell the doctor how much degeneration exists and whether the disease is affecting a nerve or the spinal cord. A procedure that offers an even more detailed image of the spine is called a discography. A patient’s disc is injected with a special contrast dye which outlines the damaged areas on x-rays taken following the injection. This procedure is often suggested for patients who are considering lumbar surgery.

After a patient undergoes an MRI imaging exam, a one to two page report is generated. On the bottom of this report, a doctor who has analyzed the MRI lists the diagnoses in the “impressions” section. Words like “mild, moderate, or severe” are used to describe the severity of the disease. Social Security often looks for moderate to severe degeneration described on the imaging study. Additionally, Social Security looks for nerve root or spinal cord implication. When a disc is displaced or degenerating to a significant degree, it may “abut, efface, irritate or compress” a nerve root or cord. When a nerve is involved, there is significant pain not only in the lower back, but radiating pain down one or both legs. Lastly, Social Security looks for how the disc disease affects an individual’s ability to ambulate. Specifically, the Administration checks to see if the disease results in “ineffective ambulation,” which is defined by an inability to walk without the use of 2 canes, crutches or a walker.

Though not all the markers need to be present to win a Social Security case, having these markers makes the case strong because the medical evidence points to a severely disabling condition. An individual with an MRI showing severe degeneration of disc L4-5, with nerve root compression and a prescribed walker will probably meet one of Social Security’s Listings, resulting in an automatic win. However, an individual with a mild degeneration at L4-5, no nerve root or spinal cord implication, and no assistive devices for ambulation will have a more difficult time proving their disability.

What Various Types of Medical Treatment Says About Your Case


Other than tests, Social Security looks for medical treatment. Much in the way of treatment can be offered to individuals suffering from low back pain. Medications are the most common form of treatment, but they can range from over the counter pain relievers to serious narcotic pain management medications such as vicodin, morphine and valium. The stronger medications suggest more severe, unmanageable pain conditions and they are likely to cause debilitating side effects.

Other forms of treatment are physical therapy, pain injections, TENS units and pain patches. These conservative treatments are often exhausted before more invasive procedures are considered. Social Security looks to see if conservative medical management has been tried and inevitably failed to provide relief from the pain. If an individual has found total relief from pain after using medications and undergoing physical therapy, their condition is no longer disabling. However, if despite medications, physical therapy trials and pain injections, an individual’s pain persists, then the case appears much stronger.

A doctor’s recommendation for surgery on the spine reflects a serious condition. Although an individual’s choice to follow through with surgery or not does not effect a disability determination, the fact that it’s even recommended shows that the condition is very serious.

Multiple failed surgeries or other invasive procedures such as surgically inserted pain stimulators, tend to show that the condition is very severe and has probably totally disabled the individual.

What You Can Do to Strengthen Your Case

Though the presence or absence of the markers mentioned above are beyond an individual’s control, there are certain things that claimant’s can personally do to strengthen their case. Social Security looks for consistent pain complaints in order to assess the validity of a disability claim. An individual who never complains about back pain to their doctor, but then alleges it is preventing him/her from working will not be found very credible. Therefore, if your condition causes severe pain, be sure to see your doctor regularly and check that progress notes are being taken which reflect your pain complaints. Also, doctors can perform certain tests on their patients other than medical imaging which can help determine how severe a low back condition is.

For example, a straight leg-raising test can be performed on a patient to determine whether there is disc herniation. Additionally, testing can be performed on range of motion to check how much a patient can bend and move. Muscle strength tests will show whether the disease is causing weakness. Atrophy can be tested to check if the back condition is causing muscle wasting and foot drop. Gait tests can tell how the disease affects a patient’s ability to walk and stand. Make sure you explore these testing procedures with your doctor so that a supportive medical record will be available for Social Security to review.

APPEALING THE SOCIAL SECURITY ADMINISTRATION DECISION

You should not become discouraged if your claim is initially denied. In a recent year roughly 60% of claims were denied. An SSDI attorney will be able to determine what documentation and evidence will strengthen your claim.

LEVEL 1: RECONSIDERATION OF YOUR INITIAL CLAIM
You must request a reconsideration of your claim within sixty days of receipt of the denial letter. Reconsideration is a complete review of your claim by someone who did not take part in the first decision. They will look at all the evidence submitted when the original decision was made, plus any new evidence.
After approximately four to six months a decision will be reached on the reconsideration request. The case will either be granted benefits or denied again. In some states, this process may vary.

LEVEL 2: HEARING BY AN ADMINISTRATIVE LAW JUDGE
If your claim is denied after reconsideration, you have 60 days to request an informal hearing. This will be in front of an administrative law judge who had no part in the first decision or the reconsideration of your case. The judge will listen to witnesses, review medical evidence, and decide your case. An SSDI appeal lawyer will help you prepare for the hearing and represent you at the hearing.
The Judge will not announce a decision at the administrative hearing. It usually takes at least two to three months after the hearing to receive the decision, if not longer. If the decision is favorable, you should receive your first check about eight to twelve weeks after the decision.

LEVEL 3: REVIEW BY THE APPEALS COUNCIL
If the Judge's decision is not in your favor, the next step is to request a review by The Appeals Council. This must be done within sixty days after you have received the hearing decision. You should be represented by an experienced SSI/SSDI lawyer to ensure you have the best chance of winning the appeal.
A failure to appeal by the deadline will result in having to start an entirely new claim unless you can demonstrate good cause for not filing the appeal prior to the deadline. Good cause includes illness, hospitalization, comprehension problems due to mental infirmity, or other circumstances beyond your control.
The Council looks at all requests for review, but it may deny a request if it believes the hearing decision was correct. If the Appeals Council decides to review your case, it will either decide your case itself or return it to an administrative law judge for further review.
If the Appeals Council denies your request for review, you will receive a letter explaining the denial. If the Appeals Council reviews your case and makes a decision itself, you will receive a copy of the decision. If the Appeals Council returns your case to an administrative law judge, you will receive a letter and a copy of the order.

LEVEL 4: FEDERAL COURT
If the Appeals Council denies your appeal and/or refuses to review your case, you have 60 days to file a lawsuit in a federal district court. After reviewing the record from your hearing, the Federal judge can (1) award disability benefits, (2) deny disability benefits, or (3) send your case back to a lower court for an additional hearing. It is critical to have good legal representation to give you the best chance of winning the appeal.

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