Helping Your Customers: Applying for Disability Benefits after a Spinal Cord Injury

Published in Complex Rehab on January 30, 2020

A representative from the United States Social Security Administration provided U.S. Rehab with an article on how to qualify for Social Security benefits after a spinal cord injury. The following information can be shared with any customer or patient that plans to apply for disability benefits after a spinal cord injury:

Living with a spinal cord injury can be a major challenge. Activities you used to consider routine are now difficult or impossible, and your independence may be compromised if your condition is severe enough to cause partial paraplegia or quadriplegia. You are also likely experiencing symptoms like the following:

  • Pain
  • Decreased or eliminated mobility
  • Loss of motor control

On top of all that, your financial security is also jeopardized. Medical bills for rehabilitation, hospital stays, and assistive devices are expensive, and if your spinal cord injury leaves you unable to work, the outlook may seem overwhelming.

Fortunately, the Social Security Administration (SSA) will pay monthly cash benefits to those who meet its definition of disability, which is a condition that:

  • Leaves you unable to do any work that you are trained and qualified for
  • Has rendered you physically or mentally incapable of training for new employment
  • Is expected to last at least one year or end in death

If your spinal cord injury has caused you to meet these criteria, you should apply for SSA benefits to help meet your daily needs and pay down your medical bills.

Disability Benefits Programs

There are two types of SSA disability benefits. The medical criteria for approval is the same for both, but each one has its own eligibility requirements.

  • Social Security Disability Insurance (SSDI): This program pays monthly benefits to you and your dependents if you were employed for a certain length of time and paid Social Security taxes.
  • Supplemental Security Income (SSI): SSI pays monthly benefits to disabled children and those who have limited income and resources. To qualify, you must have an individual or household (for children) income beneath a certain amount and agree to be interviewed by a SSA representative.

Medical Eligibility with a Spinal Injury

The SSA determines the medical eligibility of all applicants by consulting the Blue Book, which is its official catalog of disabling conditions and the criteria for each one. Spinal cord injury is specifically referenced under Listing 1.04: Disorders of the Spine, which states that you will be considered disabled if you suffer an illness or injury that compromises the spinal cord. The following conditions / symptoms must also be present.

  • Compression of a nerve root, creating pain, limited spinal mobility, and loss of motor function OR
  • Spinal arachnoiditis (severe pain caused by the inflammation of a membrane that protects the nerves of the spinal cord) OR
  • Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)

When you apply for SSA benefits, you must also submit medical documentation that confirms the existence of your spinal cord injury and records treatments you have received, as well as your response to them. Examples include:

  • X-rays
  • MRIs
  • Surgeon’s reports
  • Reports from rehabilitative specialists

Your treating physician will also have to fill out a residual functional capacity (RFC) form, which will detail the ways that your spinal injury has affected your ability to work and function. The SSA uses this document to decide if your disability stops you from doing the type of work you did prior to the injury.

Receiving Benefits Without Meeting a Listing

If you don’t meet the criteria for any of the SSA’s Blue Book listings, you may still qualify for disability benefits under a medical vocational allowance. Your application and medical documentation must demonstrate clearly that your functional capacity has been diminished by a spinal injury symptom such as paralysis, and that you are unable to do the essential tasks required for your previous job or any other for which you’re qualified. Medical vocational allowances are essentially an acknowledgement that you are disabled and entitled to benefits even if you do not meet a Blue Book listing.

For more information about qualifying for SSA disability benefits when you have experienced a spinal cord injury, please visit the SSA ‘s website, or go to your nearest SSA office, or call 1-800-772-1213. 

Resources:


comments powered by Disqus

From Our Experts

U.S. Rehab Tech Training at Heartland Addresses All Levels of Experience thumbnail U.S. Rehab Tech Training at Heartland Addresses All Levels of Experience Complex rehab providers attending VGM's 20th Heartland Conference will have the opportunity to increase their expertise in repairing and programming complex rehab wheelchairs as part of U.S. Rehab's Tech Training. CMS Announces 90-Day Extension For CRT Manual Wheelchair Accessories thumbnail CMS Announces 90-Day Extension For CRT Manual Wheelchair Accessories CMS announced a 90-day extension of the suspension of the application of Medicare Competitive Bidding Program pricing to CRT manual wheelchair accessories. The current policy will stay in place through October 1 and there will not be any payment cuts or claims processing changes. Don't Allow Medicare Advantage Plans and MCOs Take Advantage of YOU! thumbnail Don't Allow Medicare Advantage Plans and MCOs Take Advantage of YOU! The HME supplier has always had challenges in getting paid timely and accurately for the items and services they provide to their customers. This is an assumed cost of doing business but the HME supplier still does this because of the reward of taking care of their customers. But nothing has challenged the supplier as much as when a customer has a Medicare Advantage Plan or an MCO. Right to Repair Legislation: Just Say No thumbnail Right to Repair Legislation: Just Say No Over the past few months there have been several bills introduced at the state level titled "Right to Repair." The purpose of these bills is to give the consumer the right to purchase parts from manufacturers directly in order to repair their own products. This may be fine for some consumer goods, but it could have devastating consequences to consumers attempting to repair their own medical equipment for several reasons. The Q2 Buyer's Guide is Available Now thumbnail The Q2 Buyer's Guide is Available Now VGM & Associates is excited to announce that the second quarter Digital Buyer's Guide has been released. The latest edition can be downloaded now. Complex Rehab Legislative Update thumbnail Complex Rehab Legislative Update Legislation is always a hot topic in CRT and this year is no different. We have 5 major issues that we are working: Stopping June 30 Cuts to CRT Manual Wheelchair Accessories, Establishing Coverage for Power Seat Elevation and Power Standing System, Securing Permanent Remote Service and Telehealth Options for CRT, Establishing a Medicare Separate Benefit Category for CRT, State Medicaid Cuts, and the Right to Repair legislation that is currently being introduced in several states. Telehealth for Complex Rehab Technology: Is It Effective? thumbnail Telehealth for Complex Rehab Technology: Is It Effective? This report analyzes telehealth in the complex rehab technology (CRT) industry. In this report, we define telehealth in the current environment of CRT and how we see it moving forward post-pandemic. Then, we will summarize our feelings of how we see the industry moving forward and utilizing the tools that are available to better the industry and patient care. We also have a list of studies on this subject provided at the end of this report. U.S. Rehab Releases Whitepaper on Telehealth in CRT thumbnail U.S. Rehab Releases Whitepaper on Telehealth in CRT U.S. Rehab has released a whitepaper on the use of telehealth in the CRT industry, “Telehealth for Complex Rehab Technology: Is It Effective?”