WHAT IS DEGENERATIVE DISC DISEASE?
Degenerative disc disease (DDD) refers to dehydration and shrinkage of the spinal discs that cushion the vertebral bodies of the spine. Spinal discs are soft, spongy discs that separate the thirty-three vertebrae that make up your spine. Spinal discs act as shock absorbers for your spine and allow your spine to move with comfort and ease. The outer portion of a spinal disc is a tough elastic cartilage called the capsule. It surrounds and protects an interior jelly-like material called the nucleus. Spinal discs change naturally as you age or they may change as a result of an injury. This process is called DDD. Degenerative disc disease can lead to chronic pain and seriously impact your ability to function daily.
DDD is not technically a disease but rather a condition that describes changes to the spinal discs located between the 33 vertebrae of your spine. DDD can be seen on X-rays, MRI, and CT scans of the spine. It appears as narrowing of the space between vertebral bodies. Symptomatic DDD usually occurs between the 5th lumbar vertebra and the 1st sacral vertebra (L5-S1).
CAUSES OF DEGENERATIVE DISC DISEASE
As you age, your spinal discs will naturally degenerate and change. Aside from the aging process, an injury from something like an auto accident or from playing sports may also impact one or more spinal discs and start the degeneration process. The changes and the type of degeneration typically include one or both of the following:
Reduction in Spinal Disc Thickness: A spinal disc gradually becomes thinner as a result of fluid loss in the jelly-like interior of the disc. When spinal discs do become thinner, it narrows the distance between vertebrae and reduces shock absorption and flexibility of the spine.
Tears or Cracks in Spinal Discs: Small tears or cracks may develop in the outer portion of spinal discs. When this happens, the jelly-like interior may leak into these tiny tears or cracks causing them to bulge or rupture.
The development of DDD can put pressure on the spinal cord and nerves causing pain and abnormal function.
SYMPTOMS AND TYPES OF DEGENERATIVE DISC DISEASE
The symptoms of degenerative disc disease vary depending on the location of the spinal disc degeneration. If a spinal disc or multiple spinal discs in the neck region of the spine become degenerated, it may cause neck or arm pain. This is commonly referred to as Cervical Degenerative Disc Disease.
If a spinal disc or several spinal discs in the low back area of the spine become degenerated, it may cause low back pain or pain in the hips, buttocks, and legs. This is commonly referred to as Lumbar Degenerative Disc Disease.
The degree of pain may also vary from numbness or tingling to intense pain that increases with movement.
Initial treatments may range from medication to physical therapy or epidural injections. Sometimes DDD may become severe enough to require surgery. Surgery is performed with hopes of stabilizing the spine and decreasing pain.
CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS FOR DEGENERATIVE DISC DISEASE?
Degenerative Disc Disease pain and associated symptoms can impact your ability to work. Social Security Disability benefits may be available to you.
If you are not engaging in gainful activity due to Degenerative Disc Disease, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.)
Generally, to establish Degenerative Disc Disease as a medically determinable severe impairment, you must show:
- Objective medical imaging establishing degenerative disc disease;
- Consistent complaints of pain or other symptoms for a period of time and which is not controlled through conservative treatment modalities
At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. For DDD, SSA will determine if your condition meets any of the Listing 1.04 – Disorders of the Spine. There are three parts to this listing that you may meet. They are as follows:
- 1.04A can be met if your DDD
- Results in compromise of a nerve root (including the cauda equina) or the spinal cord
- Causes lumbar spinal stenosis resulting in pseudoclaudiction established by findings on appropriate medically acceptable imaging,
- Is manifested by chronic nonradicular pain and weakness,
- Results in inability to ambulate effectively, which is defined as
- The inability to walk without the use of a walker, two crutches or two canes,
- The inability to walk a block at a reasonable pace on rough or uneven surfaces,
- The inability to use standard public transportation,
- The inability to carry out routine ambulatory activities, such as shopping and banking, and
- The inability to climb a few steps at a reasonable pace with the use of a single handrail.
- There is evidence of nerve root compression characterized by–
- neuro-anatomic distribution of pain,
- limitation of motion of the spine,
- motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss, and
- if there is involvement of the lower back, positive straight-leg raising test (sitting and supine).
- 1.04B can be met if your DDD
- Causes spinal arachnoiditis confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, and
- Is manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours.
- 1.04C can be met if your DDD
The key to meeting the listing is to have the appropriate objective medical testing and a longitudinal medical history that addresses each of the requirements. In most cases, in my experience, the medical listing will not be met, but having a good knowledge of what you have to prove can help you discuss your case with your doctor.
If your related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your DDD and pain), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.
TIPS FOR SSDI APPLICATION FOR DEGENERATIVE DISC DISEASE
- Make sure an imaging report (MRI, CT, X-ray) diagnosing Degenerative Disc Disease is in your medical records. It is important that you “know your medical records.”
- Make sure your medical records document ALL of your symptoms and limitations. Your medical records should not just document your pain. Let your doctor how often you feel the symptoms, how severe each symptom is and how long each episode lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
- See a specialist. Treatment of DDD by an orthopedist or neurologist or a chronic pain specialist will carry more weight than the same diagnosis from a family physician or internist professional.
- Comply with your doctor’s orders and try various modes of conservative or less invasive treatment, if recommended.
- See a mental health professional. If you are suffering from depression or anxiety as a result of the chronic pain and inability to participate in life, see a mental health professional to diagnose, treat, and document these conditions. Pain is often accompanied by or is the cause of mental health conditions. Treatment of the depression can help with the pain.
- See your doctor regularly and keep your appointments.
- If you can, provide evidence of a long work history.
- Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity.
- Include information from nonmedical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
- Keep a journal. Make regular notes about your impairment, level of function, and treatments.
- If you need assistance with your claim, call disability attorney Loyd Bourgeois at 985-240-9773. At Louisiana Disability Law, we have experience obtaining disability benefits for clients with degenerative joint disease.