Spinal Stenosis Symptoms and Treatment Options

Posted on November 16, 2010 by Editorial Board

Spinal stenosis refers to a condition characterized by narrowing of the spaces within the spine or the backbone. The spinal cord and the spinal nerves lie in the space within the spine and narrowing of this space leads to compression of the spinal cord or the spinal nerves. Numbness, pain, or weakening of the lower back, thighs, legs, arms or shoulders are some of the common features of spinal stenosis.

Noted in about 250,000-500,000 people in the US, spinal stenosis commonly affects adults above the age of 50 years. It may occur due to disorders such as arthritis, slipped disk, spinal injury, tumors, or Paget’s disease. Younger individuals with narrowing of the spine since birth or injuries to the spine may also suffer from spinal stenosis.

Symptoms and signs

A wide variety of symptoms and signs are noted in individuals suffering from spinal stenosis. The symptoms may vary with the region of the compression. The most common symptom of spinal stenosis is numbness, cramping or pain in the involved regions. The lower back, buttocks, thighs, calves, shoulders, neck or the arm are the regions that can experience these symptoms based on the area of spinal compression. Affected individuals may also feel weakness in the lower leg or the arms. Most often these symptoms are noted only on one side of the body and are relieved when the individual sits or flexes the lower back.

In severe cases, affected individuals may have difficulty balancing themselves while walking, and also have difficulty in controlling  bowel movements or urination. Loss of sexual function and loss of sensation or weakness in the legs may also be noted. Such severe symptoms require immediate medical attention.

Treatment options

The treatment options vary with the severity of the condition. In cases of mild to moderate symptoms, spinal stenosis can be managed with home care and administration of medications and using medical aids (like a brace).

Adequate rest and simple activities such as walking are advised to relieve the stiffness. Medications commonly advised include non-steroidal anti-inflammatory drugs (NSAIDs), and pain killers. Corticosteroid injections to the outer coverings of the spinal cord can also relieve the symptoms. Stretching and strengthening exercises may be advised, and sometimes even prescribed through physical therapy, to strengthen the muscles of the back that would in turn help stabilize the spine. Medical aids such as a lumbar brace or corset are advised in individuals with weak abdominal muscles or multiple areas of involvement.

Surgery which involves procedures such as foraminotomy, laminectomy or spinal fusion may be advised if the symptoms are not relieved with the more conservative measures addressed above.

Individuals with spinal stenosis are generally capable of resuming normal activities with proper care. In certain cases, alterations in the activities or work performed by the affected individuals may need to be done. Although spinal surgery can completely or partially relieve the symptoms, it may be associated with other related problems in future, and surgery is never a risk free proposition.

Posted in Bone & Joint Problems | Comments Off on Spinal Stenosis Symptoms and Treatment Options

Social Security Disability Appeals Council Review

Posted on November 15, 2010 by Editorial Board

The Appeals Council is the last level of disability decision making in the Social Security Administration.  If your disability claim is denied by a judge after a hearing you can appeal your case to the Appeals Council (AC) for a review of the hearing decision.  Most AC reviews occur because the person seeking benefits asked the AC for the review.  For more on appeals to the AC read our other article about appealing to AC.

The Appeals Council can review a hearing decision even if no appeal was made.  This is referred to as a review “on its own motion” since no request for review was submitted by the person seeking benefits.  The Appeals Council has 60 days after the date of a disability hearing decision to determine whether it will review a case on its own motion.  However, the Appeals Council can get around the 60 day deadline by using regulations that provide for the reopening of cases that meet certain criteria.  These criteria are described in sections 404.988, 404.989, 416.1488, and 416.1489 of Title 20 of the Code of Federal Regulations.

If the Appeals Council decides to review a case on its own motion it mails a notice of this action to the disability claimant and their attorney if they have one.  The Appeals Council should issue a final determination within 110 days after the date of its decision to review the case.  If the Appeals Council does not issue a final determination within 110 days the disability claimant can receive temporary benefits until the final determination is made.  The temporary benefits do not have to be repaid even if the Appeals Council ultimately makes an unfavorable decision.

Posted in Appealing a SS Decision, Basics of SSD, Legal Concepts in SSD, Why People Are Denied | Comments Off on Social Security Disability Appeals Council Review

If You Can Not Return to Past Work Are You Disabled?

Posted on November 12, 2010 by Editorial Board

In most cases Social Security must decide that you cannot do your past work or other work before awarding you disability benefits.  However, depending on your age, you might qualify just by showing you cannot perform your past work.

If you are age 49 or younger you will have to show you cannot do your past work or other work to win your case.  Individuals who are illiterate or unable to communicate in English might be found disabled if they cannot do their past work and are age 45.

At step four of the five step disability evaluation process, Social Security determines your ability to perform your “past relevant work”, which is the work you have done in the past 15 years.  They consider work you did over 15 years ago only if you have an expired Date Last Insured [hyperlink].  The key question is whether you can perform that past work as you performed it or as it is usually performed.  A jobs expert, called a “vocational expert” in disability hearings, often gives testimony about how jobs are usually performed.  For example, if you worked as a warehouse manager you might have done heavy lifting even though most warehouse managers do not.

Social Security might deny your case even if your past work no longer exists.  If you worked for a company that has shut down and that type of work is no longer available in your area, Social Security will still deny your case if they believe you could still do the job if you could somehow get it again.  This is true even if the job no longer exists anywhere in the country.  For example, if there are no more elevator operators, but if it was part of someone’s past relevant work then Social Security could deny the case by finding they could return to that job.  This is clearly an unfair rule, but it is part of Social Security disability law and must not be ignored.

If you are older than age 50 you might still have to convince Social Security that you cannot do other work.  This depends on several factors, including your education, job skills, and limitations from your medical conditions.  As you age, the disability standard becomes easier to meet.  Disability claimants who are age 55 or older are evaluated under an easier standard, and another favorable rule applies at age 60.

Posted in Past Relevant Work (Step 4), Questions & Answers, Vocational or Work Issues, Winning Disability Benefits | Comments Off on If You Can Not Return to Past Work Are You Disabled?

Is Advanced Congestive Heart Failure a Disabling Condition or Not?

Posted on November 11, 2010 by Editorial Board

The Social Security Administration (SSA) has a strict definition of disability; in order to qualify for Social Security benefits a condition must meet this definition plus the SSA criteria for the specific condition or be able to show they cannot sustain employment. The SSA usually requires three months of detailed medical records to evaluate disability claims for congestive heart failure.

About Congestive Heart Failure

Congestive heart failure (CHF), also called chronic heart failure or heart failure, occurs when the heart fails and is not able to pump enough blood to the rest of the body. As a result, blood collects in the vessels leading to the heart and fluids accumulate in various organs. The locations of fluid accumulation depend on which chambers of the heart fail.

Symptoms of CHF include shortness of breath, fatigue, waking up during the night with a feeling of suffocation, chest pain, heart palpitations, dizziness, lightheartedness, and fainting. Medication may control some symptoms.

CHF is a progressive and potentially fatal condition that usually develops over months or years. Treatment typically involves rest, moderate activity, dietary restrictions, and prescription medications.

CHF and Disability Benefits

The SSA often looks at CHF conditions over time (typically three months) to see if functioning stays the same, gets worse, or improves with treatment.  To do this SSA requires medical records that include hospital and medical visit information, date of CHF diagnosis, cause of CHF, medications prescribed and their effectiveness, the patients compliance with treatment, and a statement of the patients residual functional ability.

To qualify for SSA disability benefits under the CHG listing, medical records must show clinical heart failure plus significant limitations in the ability to perform activities of daily living. The New York Heart Association (NYHA) Functional Classification for CHF is one way to evaluate such limitations. A higher classification indicates more serious limitations; a patient in a higher class is more likely to qualify for Social Security disability benefits.

NYHA classifications:

Class I: Patient has symptoms with more than ordinary activity.

Class II: Patient has symptoms with ordinary activity.

Class III: Patient has symptoms with minimal activity.

Class IV: Patient has symptoms when resting.

A CHF patient can support his or her disability claims with a letter from the treating physician and or cardiologist. In the letter the doctor should summarize the diagnosis, testing, and treatment. The letter should give a NYHA classification and describe the patient’s ability to function in terms of lifting, carrying, sitting, walking, etc. It would be helpful, although it is not always necessary, if the physician includes a statement that the patient cannot work on a regular basis due to the limitations of CHF, or that the patient could only work part time.

Posted in Heart & Circulation | Comments Off on Is Advanced Congestive Heart Failure a Disabling Condition or Not?