Criteria to Qualify for a Cervical Spine Fusion

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Criteria to Qualify for a Cervical Spine Fusion

Cervical spine fusion can offer significant relief from neck pain and other limitations. The fusing of two or more vertebrae can stabilize the neck and relieve pain caused by pressure on the nerves. Cervical spine fusion is a procedure that is intended to be a solution and to relieve pain and decrease disability caused by an injury or a condition such as arthritis. However, the surgery doesn’t always achieve its goals, and even successful spinal fusion can leave the patient with limitations. 

Whether or not someone who has undergone cervical spine fusion qualifies for Social Security disability benefits depends on the success or failure of the surgery, the limitations the patient is left with, and how long those limitations are expected to last. Recovery time varies, and the patient typically has restrictions during that time that may impact the patient’s ability to work. This recovery period typically lasts for a few to several months, which is not sufficient to qualify for SSDI benefits. However, if your condition lasts or is expected to last for 12 months or more, you may be eligible for disability benefits.

Some of the many symptoms people who have undergone cervical spinal fusion surgery may experience include: 

  • Chronic pain
  • Limited range of motion
  • Neurological symptoms
  • Numbness, tingling, and weakness
  • Disk degeneration
  • Spinal muscle injury

Qualifying for SSDI after Cervical Spine Fusion

To establish a claim for Social Security disability benefits, you’ll have to: 

  • Have sufficient work credits to qualify for disability benefits–the number required depends on the age at which you become disabled
  • Show that you are not currently engaging in substantial gainful activity (SGA)
  • Show the Social Security Administration (SSA) that your medical condition prevents you from engaging in substantial gainful activity 

One way to establish that your disability and the associated limitations are severe enough for the SSA to consider you disabled is to meet the criteria for a condition listed in the Social Security Blue Book. 

Cervical Spinal Fusion and the Social Security Blue Book

The Social Security Blue Book is a listing of medical conditions that may qualify a person for SSDI benefits, along with the criteria each condition must meet in order to be eligible. But, the listing is not comprehensive. That is, you can qualify for SSDI benefits even if your condition is not listed. Instead, you may qualify by meeting the requirements for a listed condition or by “equalling” a qualifying condition. 

Cervical spine fusion is not listed in the Blue Book, as it is not in itself a disabling condition. But, there are several musculoskeletal conditions, including spinal disorders, that provide an indication of the type and severity of symptoms and limitations that might be sufficient to establish your disability. 

Receiving Disability Benefits for a Non-Listed Condition

When your condition isn’t listed in the Blue Book and you don’t equal a listed condition, or your limitations stem from a combination of conditions that do not independently meet or equal a listing, the process for determining your eligibility is longer and more complex. One key step is for the SSA to determine your residual functional capacity (RFC). Your RFC is what you are still able to do in spite of your medical limitations.

Residual functional capacity is determined based on a variety of factors, including your own reports about what you can and cannot do, reports from others who observe your abilities and limitations in day-to-day life, and medical documentation. The analysis considers not just your physical limitations, but your ability to meet mental, sensory, and other requirements for work. 

The first step after determining your RFC is to consider whether you are able to return to the type of work you were doing before. If the SSA determines that you are able to return to your prior work, your claim will be denied. If you are unable to return to your prior work, the next step is to determine whether you can adjust to other work

At this point in the process, the assessment moves beyond your medical condition and residual functional capacity to consider factors such as your age, educational level, and past work experience. That’s because the SSA recognizes that all of these factors will impact your ability to adapt to a different type of work. 

The Social Security Grid Rules in a Cervical Spine Fusion Claim

When you’re applying for SSDI benefits for cervical spine fusion, another unlisted condition, or a listed condition for which you don’t meet the Blue Book criteria and you’re unable to return to your previous work, the SSA consults a grid to determine whether there is work you can adapt to. 

One key factor in the grid analysis is your age. If you are 55 or older, you will be found disabled unless you have skilled or semi-skilled experience that will transfer to other work. That changes significantly below the age of 55. If you’re aged 50-54, you may be found not disabled even with limited education and only unskilled work experience. A younger worker (meaning any adult under the age of 50) may be found fit to adjust to other work even if illiterate and lacking work experience. 

However, someone who appears able to adjust to other work based on the grid may still be determined to be disabled based on specific limitations. For example, someone who by age and education level should be able to adjust to sedentary work may be unable to do so due to an inability to sit for long periods of time or a mental health challenge that precludes many such jobs. In that case, a vocational expert will be asked to assess whether there are jobs you would be able to perform with your medical limitations.

A Note For Veterans Seeking Disability after Cervical Spinal Fusion

The VA assesses disability differently since veterans disability benefits are available even if you are only partially disabled and may still be able to work. While there is no guarantee, a disability rating for cervical spine fusion will be considered as evidence in your Social Security disability benefits case. And, if you are rated 100% permanently and totally disabled by the VA, the SSA will expedite your claim

Get Help with Your SSDI Claim for Cervical Spine Fusion

The process of receiving SSDI benefits for cervical spine fusion can be long and frustrating. Most applications are denied in the first round, and one or more appeals may be required to receive a determination of disability and become eligible for benefits. This is especially true when dealing with unlisted conditions that require the SSA to consider residual functional capacity.

The sooner you get assistance from an experienced Social Security disability benefits advocate, the better you will be able to ensure that you have completely, accurately, and clearly provided the information necessary to establish your claim. To learn more about how Disability Help Group can help you after your cervical spine fusion, call (800) 800-3332 right now, or contact us here.

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