Social Security Disability Benefits for Musculoskeletal Disorders

Applicants with painful musculoskeletal impairments may qualify for social security disability benefits on the basis of a detailed medical record review. This type of impairment is a physical problem that affects the spinal cord, arms, joints and legs. Candidates with severe symptoms that prevent them from engaging in gainful employment can apply for disability benefits.

Musculoskeletal Disorders That May Qualify for Benefits

• Major dysfunction of a joint: According to the SSA website, this condition may qualify if it is characterized by chronic joint pain, severe anatomical deformity, and abnormal motion or limitation of motion. In this case appropriate imaging studies would be reviewed for findings of body destruction, joint space narrowing, or ankylosis of the joint. One major peripheral weight bearing joint, namely hip, ankle or knee; or one major peripheral joint in each upper extremity (shoulder, elbow, wrist) must be involved, which makes effective movement impossible.
• Spinal disorders: The SSA lists osteoarthritis, herniated disks, spinal stenosis, degenerative disc disease, facet arthritis and vertebral fracture among the conditions that may qualify. However, they would review the medical records to find evidence of nerve root compression characterized by motor loss, sensory/reflex loss and so on; or evidence of spinal arachnoiditis or lumbar spinal stenosis. Operative notes, pathology reports of tissue biopsy, and medical imaging records are among the medical records that would be needed.
• Amputation: Applicants with an amputated limb may or may not qualify for total, permanent disability as per SSA’s definition. Medical documentation should show complications that make it medically impossible to use prosthetic devices. The condition must have lasted or expected to last for at least 12 months. The education level of the applicant and prior work experience may also be considered because there may be jobs he/she can do with sufficient education and experience.
• Fractures: Fractures that heal in less than a year do not come under the SSA’s list of impairments. However, applicants with pelvic bone fractures, fractures of the tarsal bones, femur, tibia and pelvis that typically take a long time to heal may qualify for the benefits.
• Soft tissue injury such as burns: This type of injury of an upper or lower extremity that is under continuing surgical management, with major function not restored or not expected to be restored within 12 months of onset is considered an impairment that may qualify for benefits.

Medical Documentation Necessary

• The SSA would be looking for medical signs/lab findings that show the existence of a medically determinable impairment that could be causing the pain and other symptoms.
• The medical records should clearly document descriptions of the affected joints including ranges of motion, whether there is muscular weakness and atrophy, or circulatory problems.
• Acceptable medical imaging studies include X-rays, CAT scans, and MRI.
• Documentation regarding electrodiagnostic procedures that may help to establish the clinical diagnosis.
• Physical examination records containing details of the orthopedic, neurological, and rheumatological findings related to the specific impairment.
• Documentation regarding alternative testing methods used to verify the abnormal findings.
• Ongoing management and evaluation records establishing the presence of abnormal physical findings over a period of time.
• Documentation of medically prescribed treatment, medications administered and the patient’s response to it.

Medical Review Services to Determine Merit of the Case

Many disability applicants approach social security disability lawyers to help submit their claim and handle the processing. Before taking up a case, lawyers can utilize medical review services to evaluate whether it is meritorious. Expert medical reviewers including licensed physicians and legal nurse consultants can carry out a medical record analysis and review to find evidence that could establish the disability claim. Their review would help determine if the applicant’s condition affects his/her daily life to the extent that he/she can no longer do the kind of work they were doing. With a reliable medical case summary and chronology, lawyers can plan the best ways to present the case both in the initial application and throughout the appeals process.

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