Can I Get Social Security Disability Benefits for Back Pain and Spine Immobility?

Residual Functional Capacity Assessment for Back Pain

What Is RFC?

If your back injury is not severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process, the Social Security Administration will need to determine your residual functional capacity (RFC) to decide whether you are disabled at Step 4 and Step 5 of the Sequential Evaluation Process. RFC is a claimant’s ability to perform work-related activities. In other words, it is what you can still do despite your limitations. An RFC for physical impairments is expressed in terms of whether the Social Security Administration believes you can do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.

Neck Abnormalities

Individuals with spine abnormalities involving the cervical spine (neck) are not as limited as those involving the lumbar spine (lower back). The ability to perform overhead work is often limited and can be an important consideration. However, the overhead work restriction is not limited to cervical fusions. An fusion of the cervical spine caused by arthritis would have the same effect, as would any condition of the cervical spine that results in painful movement and stiffness, like the inflammatory spondyloarthropathies (e.g., ankylosing spondylitis), or simply advanced osteoarthritis.

The Social Security Administration is liable to overlook rotational movement ability in the neck as an important work-related limitation. Even less regard is given to rotational ability in the lower spine. While these functions are not as important as bending and the ability to look upward, they could be a critical in some claims—especially the ability to look right and left without having to turn the whole body.

Spondylolisthesis

Grade I spondylolisthesis is rarely symptomatic and often found incidentally on X-ray. Grade I patients generally do not receive any restrictions from orthopedic surgeons. As a generalization, symptomatic grade II spondylolisthesis can result in restriction to medium work; grade III restriction to light work; and grade IV can sometimes be limited to sedentary work. However, this degree of functional severity is unusual and refers only to those rare cases with significant symptoms.

Spondylolisthesis is an anatomical abnormality that does not, by its mere appearance on imaging studies, imply symptoms or functional limitation. For example, some studies over a period of years showed no symptoms in over a third of patients followed with grades III and IV spondylolisthesis, and only mild symptoms in over half of the cases with grade IV slippage.

Of course, all cases must be evaluated in light of the individual claimant’s symptoms. Persistent, significant back pain related to spondylolisthesis and not responding to conservative treatment is likely to be treated with lumbar fusion.

Laminectomies

In uncomplicated cases of an HNP (herniated disc) and treatment with a surgical discectomy (see Figure 11 below) and laminectomy, the Social Security Administration will generally tend toward giving a medium RFC with occasional bending. If there are additional problems, such as associated arthritis elsewhere in the spine, surgery at multiple levels, or persistent pain, then the RFC should be lower. The important point is that the Social Security Administration should give no higher than a medium RFC (lifting up to 50 lbs) if modest pain persists. The most appropriate RFC for an individual claimant may be lower. A completely asymptomatic claimant after a simple laminectomy might receive no restriction in regard to back impairment.

Generally speaking, the Social Security Administration considers a 3 to 4 month recovery period sufficient for cases involving post-operative laminectomy or spinal fusion. This is true only in the absence of complications.