A herniated disc occurs when the soft, gel-like center of a spinal disc pushes through a tear in the tougher outer layer, often causing pressure on nearby nerves. This condition is most common in the lower back but can happen anywhere along the spine. Whether it qualifies as a disability is determined not by the diagnosis alone, but by the severity of the functional limitations it imposes on a person’s ability to work. The determination depends entirely on specific medical evidence and the legal criteria established by governmental agencies for long-term impairment.
The Medical Basis for Impairment
A herniated disc becomes an impairment when the displaced material compresses a nerve root, leading to a condition known as radiculopathy. This nerve compression results in a specific set of symptoms that extend beyond simple back pain, including pain that radiates down the arm or leg, often called sciatica in the lower back. The severity of the impairment is directly linked to the neurological deficits that follow, such as muscle weakness, numbness, and the loss of deep tendon reflexes in the affected limb.
These functional limitations must be objectively documented to support a claim of disability. Physicians rely on diagnostic imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, to confirm the presence and location of the disc herniation. Furthermore, nerve conduction studies and electromyography (EMG) can provide measurable evidence of nerve damage and motor loss.
Legal Criteria for Disability Status
The Social Security Administration (SSA) is the primary federal agency that determines disability status, requiring that the condition prevent the applicant from engaging in Substantial Gainful Activity (SGA). This means an applicant’s monthly earnings must fall below a specific federal threshold, which is adjusted annually. Additionally, the impairment must be expected to last for a continuous period of at least twelve months or result in death.
For a herniated disc to automatically qualify as a disability, it must meet the specific criteria outlined in the SSA’s Listing of Impairments, specifically Listing 1.04 for Disorders of the Spine. Simply having a diagnosis of a herniated disc is not enough to satisfy this listing. The applicant must demonstrate compromise of a nerve root or the spinal cord, confirmed by medically acceptable imaging.
The most common way to meet this listing is by showing evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of spinal motion, and measurable motor loss. This motor loss must include either muscle atrophy with associated weakness or significant muscle weakness accompanied by sensory or reflex loss. If the lower back is involved, a positive straight-leg raising test is typically also required to satisfy the listing’s criteria.
Assessing Work Limitations and Residual Capacity
If an applicant’s condition does not meet the severity of a Listing, the SSA moves to the next step of the sequential evaluation process by assessing their Residual Functional Capacity (RFC). RFC represents the maximum amount of work-related physical and mental activity a person can still perform despite their limitations. For a spinal impairment, this assessment focuses heavily on exertional factors, such as the ability to lift, carry, stand, walk, push, and pull.
The SSA uses a five-step process to determine eligibility, with the RFC determination factoring into the final two steps. Once the RFC is established, the SSA first determines at Step 4 whether the person can still perform any of their Past Relevant Work (PRW), which is any job held in the last fifteen years. If the claimant cannot return to their PRW, the SSA proceeds to Step 5 to consider if they can adjust to any other work existing in the national economy.
The RFC assessment classifies a person into an exertional work category, such as sedentary, light, or medium work. For instance, a person limited to sedentary work can lift no more than ten pounds occasionally and must be able to sit for approximately six hours of an eight-hour workday, with standing and walking limited to two hours. If the herniated disc limits a person to standing or walking for less than six hours a day, the RFC is automatically restricted to sedentary work.
The Disability Application Process
The application process for disability benefits is extensive and requires meticulous documentation to succeed. Applicants must provide all relevant medical records, including imaging reports, surgical notes, and physical therapy records. Continuous medical treatment is important, as it demonstrates that the condition is ongoing and that the applicant is complying with prescribed care.
A crucial piece of evidence is a detailed statement from the treating physician, often called a Medical Source Statement (MSS), which quantifies the patient’s functional limitations. This document should specify the maximum amount of time the person can sit, stand, and walk, along with any manipulative or postural restrictions like bending or stooping. Without the physician’s documented opinion on specific functional limits, the SSA must rely on its own medical consultants who have not treated the patient.
Applicants should be prepared for a long process, as the initial application stage is frequently denied, with denial rates often exceeding sixty percent. If denied, the applicant must file a request for Reconsideration, the first level of appeal. If that is also unsuccessful, the next step is to request a hearing before an Administrative Law Judge (ALJ), which is the stage where approval rates significantly increase.