A common cause of people being unable to continue to work is back pain. When applying for Social Security Disability for back pain, it can be difficult to prove you are entitled to benefits based on your medical condition.
The Social Security Administration (SSA) does not approve claims based on a diagnosis alone. Instead, they look for clear medical evidence showing how your symptoms limit your ability to engage in everyday activities, including the types of activities you’d be expected to do when working.
If you’re thinking about applying for back pain disability benefits, understanding what the SSA looks for could make the difference between your claim being approved or having it denied. Relying on the disability benefits team at Clauson Law ensures you of representation by a knowledgeable and skilled representative with years of experience handling all types of claims, including those related to back pain.
Back pain affects people differently. Two people with the same MRI results may function very differently, and SSA knows this. That’s why the review of your application for Social Security Disability benefits focuses on functional limitations, not only a medical diagnosis.
Whether your condition involves a herniated disc, degenerative disc disease, chronic muscle spasms, or other pain-generating back condition, the claims examiners at the SSA need documentation of how the condition affects your ability to continue working at a substantial and gainful level. The SSA evaluates Social Security back pain claims by reviewing your medical records, including:
· Diagnostic imaging
· Physical exams
· Treatment history
· Testing results
Equally as important is that your records show that you followed medical advice by taking prescribed medication, following treatment recommendations, and not missing appointments with your healthcare providers. They also consider how long your symptoms have lasted and whether they’re expected to continue for at least 12 months, a basic requirement for Social Security benefits for back pain.
Social Security uses a definition of “disability” found in federal regulations to evaluate claims for Social Security Disability Insurance and Supplemental Security Income benefits. According to the definition, a determination that a person is disabled requires evidence of an inability to do substantial gainful activity due to a physical or mental impairment that is expected to result in the death of the claimant or that has lasted or is expected to last for a continuous period of 12 months or longer.
Substantial gainful activity (SGA) describes work activity involving significant mental or physical activity that a person performs for pay or profit. Social Security relies on the amount of a person’s monthly earnings to determine whether they are doing activities that are gainful and substantial.
The SGA earnings threshold for 2026 is $1,690 per month. If a person claiming disability benefits works and earns more than $1,690 during a month, they are considered to be doing work that is substantial and gainful. For an individual whose inability to work is due to being blind, the monthly SGA threshold amount is $2,830.
Applications for SSD back pain disability benefits undergo a five-step sequential evaluation process to determine whether the applicant meets the definition of disability. The questions to be answered at each step of the evaluation process include:
· Step One: Is the claimant doing substantial gainful activity? If they are, the process stops, and they are not disabled.
· Step Two: Does the individual have a severe medically determinable physical or mental impairment expected to last for at least 12 months or result in death? If they do not, they are not disabled according to the definition.
· Step Three: Does the impairment or impairments meet or equal a listed impairment? If yes, they have a severe condition satisfying the definition of disability.
· Step Four: Does their residual functional capacity allow the person to do past relevant work? If it does, they are not disabled.
· Step Five: Does a person’s residual functional capacity and their age, education, and work experience allow them to adjust to do other types of work? If it does not, then they are disabled.
The second step in the evaluation process can be crucial to your claim because back pain that meets or equals a condition in the listing of impairments could be approved for benefits without going through the remaining steps.
The listing of impairments, commonly referred to as the “Blue Book” because it was an actual book at one time, contains impairments the SSA considers to be severe enough meet the standard
of the federal definition of a disability. It includes medical criteria, such as symptoms and diagnostic testing standards, that must be met for each condition.
Generalized back pain may be severe and debilitating to the point that it limits activities that you can participate in, but it may not, on its own, allow you to be approved for disability back pain using the listings of impairments. You will not find back pain in Listing 1.00, musculoskeletal disorders. You will, however, find it as a symptom with other conditions, including:
· Scoliosis
· Spinal stenosis
· Spondylitis
· Degenerative disc disorder
· Arachnoiditis
· Osteoarthritis
· Rheumatoid arthritis
· Herniated discs
· Nerve root compression
The listing of impairments includes the medical criteria for use by physicians and other healthcare professionals when evaluating conditions to determine their effect on an individual's ability to perform work activities.
Back pain would have to be associated with a listed impairment to be approved for benefits through the listing of impairments, such as section 1.16, lumbar spinal stenosis. However, the inability to meet or equal a listing does not mean denial of the claim.
You may be approved for SSDI benefits based on the functional limitations of your medical condition. Your disability attorney at Clauson Law would have to prove that the function limitations prevent you from engaging in physical or mental activities.
The fourth and fifth steps in the evaluation process rely on RFC, which is your functional capacity remaining with the limitations caused by a physical or mental impairment. The SSA evaluates medical and other documentation to assess your ability to do physical, mental, sensory, and other work activities. The result is your residual functional capacity.
RFC will be used in step four of the evaluation process to determine whether you can do past relevant work. RFC is again used in step five with your age, education, work, and vocational background to determine whether you have the ability to adjust to another type of work available in the national economy.
The disability attorneys at Clauson Law have years of experience representing people nationwide with all types of Social Security Disability claims. They know the evidence needed to build a strong claim for Social Security back pain benefits.
Whether filing an initial application or appealing a denial of benefits, the team of Clauson Law disability professionals lets you focus on your medical care while we concentrate on getting you the disability benefits that you need and deserve. Learn what our clients already know: At Clauson Law, we fight for our clients. Get your free case evaluation by reaching out to us today.
