Failed Back Surgery Syndrome (FBSS) is a generalized term describing persistent or newly developed chronic pain following spinal surgery. It is not a formal diagnosis but rather a description of a post-operative state where the desired outcome of pain relief was not achieved. For individuals dealing with this ongoing pain, qualifying for Social Security disability benefits is complex. The determination hinges not on the diagnosis of FBSS alone, but on the severity of the functional limitations the chronic pain imposes on a person’s ability to work.
Understanding Failed Back Surgery Syndrome
Failed Back Surgery Syndrome is a broad label applied to patients who continue to experience pain in the lower back, legs, or both, after one or more spinal operations. Estimates suggest that between 7% and 27% of all spinal surgeries may result in this outcome. The persistent discomfort is often described as chronic back or leg pain, which may be similar to the pre-surgical pain or feel entirely new.
Symptoms leading to functional decline include chronic pain, numbness, tingling, and weakness in the legs or feet. More severe cases involve limited mobility, difficulty walking, or problems with bladder or bowel control. Underlying causes vary, ranging from scar tissue formation around nerve roots to nerve damage sustained during the procedure. Other causes include the original surgery failing to address the true source of pain, or the development of a new issue, such as adjacent segment disease.
How Disability Status is Determined
The process for determining disability relies on a structured, five-step sequential evaluation to assess a claimant’s ability to work. The first step determines if the applicant is currently engaging in Substantial Gainful Activity (SGA), defined as earning above a certain monthly income level. If an individual is working at or above the SGA threshold, they are generally not considered disabled.
If the claimant is not working at the SGA level, the evaluation assesses the severity of the medically determinable impairment, which must be expected to last for at least 12 continuous months. FBSS is not specifically listed in the Social Security Administration’s “Blue Book” of impairments. However, the underlying spinal disorders and nerve damage are evaluated under appropriate medical listings. Approval at this stage requires the condition to meet or equal the specific medical criteria for disorders of the skeletal spine.
Most FBSS claims do not meet the stringent criteria of a listing and are evaluated based on the individual’s functional capacity. This involves determining the Residual Functional Capacity (RFC), which assesses the most work they can still do despite their limitations. The RFC evaluates physical abilities, such as how long a person can sit, stand, walk, lift, or carry. If the RFC determines the individual cannot perform their Past Relevant Work (PRW), the final step considers the claimant’s RFC, age, education, and prior work experience to determine if they can adjust to any other work existing in the national economy.
Essential Medical Evidence for an Application
Securing a disability finding for FBSS requires objective medical evidence demonstrating the severity of the impairment and resulting functional restrictions. Documentation must establish a medically determinable impairment, meaning the pain is rooted in a physical abnormality of the spine or spinal canal. Objective evidence includes diagnostic imaging (MRIs, CT scans, and X-rays) that documents underlying spinal pathology like nerve root compression, degenerative changes, or failed fusion.
The complete medical record must include operative reports from the initial spinal surgery and subsequent treatment notes. These records should detail conservative treatments attempted (physical therapy and medication) and the patient’s response to pain management. Continuity of care, shown through regular visits to treating physicians, confirms the long-term nature of the chronic pain.
The most persuasive evidence comes from a treating physician’s opinion, documented on a Residual Functional Capacity (RFC) form. This form provides a detailed, work-related assessment of the patient’s limitations. It specifies restrictions on sitting, standing, walking, lifting, and non-exertional limitations like the need for positional changes. The RFC form translates medical findings into vocational terms used by the SSA to decide if the claimant cannot perform sustained work activity.
Navigating the Application Process
The initial application for disability benefits is often a lengthy and complex administrative process. The claim begins with submitting the application and the comprehensive medical evidence gathered. Claims examiners then review the evidence and apply the sequential evaluation process.
Initial applications for conditions like FBSS have a high rate of denial, making the subsequent appeals process important. If the claim is denied, the first step is Reconsideration, where a different examiner reviews the case and considers any new evidence. If denied again, the claimant may request a hearing before an Administrative Law Judge (ALJ).
The ALJ hearing often provides the best opportunity for approval, as the claimant and their representative can present testimony and cross-examine vocational or medical experts. Given the complexity of the medical evidence and administrative law, securing legal representation from a disability attorney is beneficial. A lawyer helps ensure all necessary medical evidence is present, argues the case effectively under the RFC framework, and manages the procedural steps of the appeal stages.