Lumbar stenosis is regarded by the SSA as a recognized disability as more severe manifestations of it can prevent a person from working due to the pain experienced. Unfortunately, convincing the SSA that your own disability matches the criteria in the SSA’s Blue Book can be difficult and many initial applications are rejected.
If you have received a letter from the SSA denying your application for SSI or SSI benefits, it doesn’t mean you will never receive benefits as you can appeal the decision. There are several stages of the appeal process.
Most benefit application denials are due to insufficient documentation or a lack of confirmation of your condition from medical personnel. You may need to get advice from a disability attorney about improving your submission of proof of your disability when going through an appeal.
How to Appeal the Decision
There are four stages of the appeal process. The first stage is to request a “reconsideration” of the SSA’s decision. A reconsideration is basically a review by the Disability Determination Services (DDS) made by different people than when your initial application was reviewed by them.
If this review again ends in a denial, the next stage is to request a hearing which is overseen by an Administrative Law Judge (ALJ). This needs to be requested within 60 days of your application being denied.
The judge will review the decisions made up to that stage to see whether there have been any errors in the process. Appeals that have got to this stage are often successful in reversing the original denial of benefits. About 50 % of hearings result in a successful outcome.
There are two further stages of the appeal which can be pursued. The first is to ask for a review of the decision by the Appeals Council and if this is unsuccessful, a Federal review can be requested. Few appeals are successful at this stage.
Blue Book for Condition
Lumbar stenosis is listed in the SSA’s Blue Book under Disorders of the Spine, section 1.04.
While there are few tests that definitively demonstrate the condition exists, the Blue Book criteria include an examination of the following;
- complete medical history of your condition;
- records from any surgery or specialists such as neurologists, or orthopedists;
- pain in your legs;
- difficulty walking;
- difficulty in getting into or out of a car;
- results of a straight leg raise test;
- description of any assistance required for improving mobility.
- results of a full medical examination.
Consider an RFC
Despite the Blue Book listing for Disorders of the Spine, under which lumbar stenosis is described, it may be determined by the SSA that the condition you are experiencing fails to match the criteria in the listing. One of the things you can do to be pro-active, or when considering an appeal, is to ask your doctor to perform a residual functional capacity assessment (RFC).
This is a series of tests that determines just what you can and cannot do in terms of physical activity. If the appeal is successful, benefits can be granted through a medical vocational allowance.
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Confirmation of the status of your lumbar stenosis is very much determined by the details provided by your physician and any other medical professionals who have treated your condition.
You will need to liaise with all these people throughout your appeal process so that supporting documentation convinces either the DDS or the ALJ that you deserve to be recognized for SSDI or SSI disability benefit. As there is a lot of stake when you are contemplating an appeal, you are strongly advised to use the services of an experienced disability attorney throughout.
