Many cases of disability involve some kind of muscle and bone disorder, and often this kind of disorder is the primary factor in making someone unable to work. This is a broad category of impairments, and different muscle and bone disorders may be evaluated quite differently, depending on the extent to which they can evaluated with objective evidence.
Social Security for Spinal & Muscular Disorders
Spinal disorders are often disabling. The medical records of disability claimants very frequently show degenerative disc disease, which involves deterioration of the discs which cushion the vertebrae in the spine. While this deterioration may be hastened by strenuous work activity, deterioration also occurs naturally as people age. Because so many disability cases involve degenerative disc disease, Social Security has a well-established framework for evaluating it.
Recent changes to the “listings,” or medical criteria, for spinal disorders have created a situation in which almost all evaluations of spinal disorders will default to a vocational analysis. If someone’s impairment meets a listing (meaning it satisfies all medical criteria), that person is presumed to be disabled, without any vocational analysis taking place. However, Social Security’s recent changes to the listings for spinal disorders (1.15 and 1.16) create a situation where—absent significant difficulty with one or both upper extremities—someone will only meet a listing if they need a wheelchair, a walker, two crutches, or two canes. So the vast majority of cases involving spinal impairments are going to come down to a vocational analysis.
How "Vocational Analysis" Affects Your Claim for Disability Benefits
To perform this analysis, Social Security will consider objective evidence to assess someone’s limitations. This includes the reports of any imaging that was done, such as x-rays or MRIs. Social Security will also consider the results of an electromyelogram (EMG) or nerve conduction study which would indicate neurological compromise caused by the spinal impairment. Clinical findings – such as loss of strength or reflexes, diminished sensation, reduced range of motion, or a positive straight leg raising test – could also demonstrate the severity of a spinal impairment.
Social Security will then assign a claimant with limitations and then consider whether the person is still capable of working with these limitations. If the limitations do not allow for work, the person should be considered disabled. When making the finding about limitations, Social Security will assign someone with an exertional level at which they are found to be capable of working, such as sedentary, light, or medium. If someone is under 50 years old, that person will be found not to be disabled if they are capable of performing sedentary work which exists in significant numbers in the national economy. This creates somewhat of a frustrating situation because sedentary is the lowest exertional level someone will be assigned and the vocational “experts” Social Security pays to testify will always say there are sedentary unskilled jobs.
However, a skilled Social Security attorney can show the judge additional information that make someone unable to perform sedentary work on a regular and continuing basis (which constitutes disability) or cross-examine the vocational experts who cite a reference manual that hasn’t been updated in decades and claim there are full-time jobs preparing documents for microfilming or routing mail through pneumatic tubes all day long. (As ridiculous as this sounds, the vocational “experts” regularly provide this kind of testimony in disability hearings, and busy administrative law judges show no interest in thinking critically about it.)
Under this decision making framework, judges can deny even the most seriously debilitated claimants under 50 years old, especially when they do not have a skilled attorney challenging the findings and opinions of the medical and vocational consultants paid by Social Security. However, claimants aged 50 and over can take advantage of Social Security’s grid rules. Under these rules, someone first needs to prove that they cannot do their past work or utilize skills from their past work to do other work. Then, someone aged 50 to 54 can be considered disabled if they are capable of no more than sedentary work. Someone 55 or over can be considered disabled if they are capable of no more than light work.
Well-Documented Medical Evidence Is Critical to Your Claim for Disability Benefits
Social Security’s medical consultants make findings about someone’s exertional limitations so the grid rules can be considered. If objective medical evidence is readily available, it may be sufficient for these findings to be made. However, objective medical evidence does not always tell the whole story. Fibromyalgia is an example of this. Fibromyalgia always involves widespread pain and is generally associated with myofascial pain, or pain which affects the body’s muscles and fascia (connective tissue holding the body’s other components in place). Fibromyalgia does not show up on an x-ray or MRI. There is no blood test for it. In fact, it is not diagnosed with any objective finding.
To diagnose fibromyalgia in someone with widespread pain, doctors may evaluate tender points or fibromyalgia’s co-occurring signs and symptoms, such as fatigue, cognitive or memory problems (“fibro fog”), depression and/or anxiety, IBS, headaches, dizziness, insomnia, or easy bruising. (This is not an exhaustive list.) If someone with widespread pain exhibits the requisite number of tender points or co-occurring signs, a doctor can make a valid fibromyalgia diagnosis after the doctor has ruled out other disorders which could cause the symptoms. The doctor would likely order imaging studies to rule out spinal or joint etiology, and could also order blood work to make sure inflammatory markers do not indicate an autoimmune disease. Even after a fibromyalgia diagnosis is made, however, objective medical findings do not demonstrate the severity of it. It’s best to have a skilled representative who can present claimant testimony about the limitations caused by the fibromyalgia and how it affects daily life.
Our Social Security Disability Attorneys Are Here to Help with Your Claim
While there are all kinds of muscle and bone disorders, we handle all kinds of disabling claims at Keller & Keller. We can listen to you describe your diagnoses and advise if you if you should see doctors to generate additional objective medical evidence, such as an x-ray, MRI, or EMG report. Alternatively, we could work with you to seek opinions from medical professionals about the extent of your limitations when they may not be readily apparent from a review of objective medical evidence. You are welcome to contact us for a free consultation.