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.

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