Back pain is one of the leading reasons people apply for disability benefits. But qualifying isn't automatic—SSA has specific criteria. Here's what you need to know.
In this article, we'll cover:
- When back conditions qualify
- SSA's musculoskeletal listing
- Proving you can't work
- Strengthening your claim
1. When Back Conditions Qualify
Common back conditions:
- Herniated discs
- Degenerative disc disease
- Spinal stenosis
- Spondylolisthesis
- Arachnoiditis
- Nerve root compression
- Failed back surgery syndrome
What makes them qualifying:
- Severe, documented condition
- Significantly limits physical activity
- Expected to last 12+ months
- Prevents substantial gainful activity
What's NOT enough:
- Having a diagnosis alone
- Occasional pain
- Minor limitations
- Conditions manageable with treatment
The challenge:
- Back pain is common
- Many people work with back pain
- Must show yours is severe enough
- Documentation is critical
2. SSA's Musculoskeletal Listing
Listing 1.15 (Disorders of the Skeletal Spine):
- Compression of nerve root or spinal cord
- With specific findings:
- Motor function limitation
- Sensory findings
- Reflex findings
- Imaging showing specific abnormalities
What you need to show:
- Nerve root compression with:
- Limited range of motion, AND
- Motor loss with muscle weakness, AND
- Sensory changes, AND
- Imaging abnormality at affected level
If you don't meet the listing:
- SSA evaluates your RFC
- What can you still do?
- Can you do sedentary work?
- What are all your limitations?
Residual Functional Capacity (RFC):
- How much can you lift?
- How long can you sit/stand/walk?
- Can you bend, stoop, crouch?
- Need to alternate positions?
Important: Most back pain claims are decided based on RFC, not by meeting a listing. Document all your limitations.
3. Proving You Can't Work
Physical limitations to document:
- Can't sit for more than X minutes
- Can't stand for more than X minutes
- Can't lift more than X pounds
- Need to lie down during day
- Must alternate positions frequently
What prevents work:
- Can't maintain consistent schedule
- Need unscheduled breaks
- Would miss too many days
- Side effects of medication
Sedentary work:
- SSA will consider if you can do desk work
- If over 50, rules are more favorable
- If under 50, harder to show can't do any work
- Other limitations help (hands, mental)
Combined impairments:
- Back pain + other conditions
- Total impact on functioning
- Don't just report back issues
- Everything matters
4. Strengthening Your Claim
Medical evidence:
- MRI or CT scan results
- Nerve conduction studies
- Physical therapy records
- Pain management records
- Surgical records if applicable
Treatment history:
- Consistent treatment
- Multiple approaches tried
- Surgery (if applicable)
- Pain management
- Physical therapy
Doctor's statements:
- Specific limitations
- Objective findings
- Functional restrictions
- Prognosis
Your descriptions:
- Daily activities affected
- What you can't do
- How you manage pain
- Good days vs. bad days
Activity limitations:
- Describe a typical day
- What household tasks you can't do
- How often you need to rest
- Sleep problems from pain
Employment history:
- Past jobs and why you left
- Attempts to continue working
- Accommodations tried
- Why work isn't possible
Common Mistakes
Not getting treatment:
- SSA expects you to seek treatment
- Gaps in treatment hurt your case
- Financial barriers can be explained
- But try to get some treatment
Inconsistent statements:
- Tell the same story to all providers
- Activities should match limitations
- Don't minimize or exaggerate
- Be honest and consistent
Focusing only on pain:
- SSA needs objective findings
- Not just your description of pain
- Document measurable limitations
- Get testing done
How Purple Helps
Purple supports you during the process:
- Manage finances while awaiting decision
- Track medical expenses
- Prepare for life on benefits
- Simple, supportive banking
- Reduced financial stress