Degenerative disc disease can prevent you from working and earning a wage. If you have applied for SSDI or SSI benefits through the Social Security Administration (SSA) but your application has been denied, you may be able to have the decision reversed.
It is not unusual for an application for disability benefits to be denied at the first instance. In fact, up to 70% of initial applications for benefits are refused.
The appeal procedure is well established and goes through several successive stages. Your original application may be granted at any of these stages of appeal if you have prepared your ground work carefully. It is sensible to get a disability attorney to help you with an appeal.
How to Appeal the Decision
Following a rejection of your application for SSDI or SSI benefits, the first step of an appeal is to request a “reconsideration” of the decision. This is basically a re-run of the original assessment.
All the same documentation and evidence you supplied in the first assessment is examined again, but the medical consultant and examiner used in the first assessment are barred from the review. The review is done by the Disability Determination Services (DDS). About 10% of original rejections are reversed by reconsiderations.
If your application is again denied, the next stage is to request a hearing overseen by an Administrative Law Judge (ALJ). A request for a hearing must be submitted within 60 days of receipt of a denial of your review. At the hearing, the ALJ considers whether the denial of your disability application was justified. About 50% of appeals at this stage are upheld.
Failing approval of your application by the ALJ, there are further stages of appeal which are possible. This is a request to be heard by the Appeals Council and further to that, apply for a federal review. Neither of these later stages of an appeal is often successful.
Blue Book for Condition
The Blue Book is the SSA’s definitive list of criteria for defining whether a person’s condition is eligible for SSDI or SSI benefits. Many, but not all disabilities are listed in the Blue Book.
The main criteria for degenerative disc disease are assessed as follows:
- Detailed description of the state of your spine;
- Range of motion possible in the spine;
- State of the muscles attached to the spine;
- Test results from a lying/sitting leg raise test;
- History of the condition;
- Results of a physical exam;
- Need for assistive devices such as a wheelchair or crutches;
- Test results such as X-rays, CT scans, MRI scans etc.
Consider an RFC
If you find that your disability doesn’t quite match the exacting specifications listed in the Blue Book, this doesn’t mean you cannot appeal the decision against you. You can request a RFC (residual functional capacity) test by your physician.
You can use the RFC assessment to present as part of the evidence submitted at one or another stages of the appeal. The RFC is a measure of what you are able to do or not do as far as work is concerned. The RFC assessment may allow the SSA to grant you a medical vocational allowance, which is in effect confirmation of eligibility for disability benefits.
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You will need to have a good working relationship with your regular physician throughout the process of applying for disability benefits, especially if an appeal is necessary. The evidence and documentation that your physician should be able to provide about your condition is basic to assessment and comparison to the criteria listed in the Blue Book by a DDS or ALJ review.
If your application must go to the appeal stage, you are strongly advised to use a disability attorney.
