An estimated 5.4 million Americans are currently living with some form of paralysis. Approximately 47% people are considered quadriplegic, or paralyzed from the shoulders down. Many different conditions and injuries can lead to quadriplegia.
Due to the severity of quadriplegia, many individuals are permanently disabled. If you have been impacted by quadriplegia and are unable to work to your full capacity, there could be financial help available to you.
The Social Security Disability Insurance (SSDI) program was created to assist those who have become disabled due to a health issue such as quadriplegia.
What Exactly is Quadriplegia?
Quadriplegia, also called tetraplegia, is the loss of muscle function to the arms, legs, and torso. More often than not, it is accompanied by loss of sensation to these areas as well. The paralysis can be temporary or permanent. It can also be partial or complete.
With partial paralysis, you may be able to have some control over the muscles.
The primary cause of quadriplegia is a spinal cord injury, although other conditions such as a stroke or cerebral palsy can also cause quadriplegia.
The severity of quadriplegia depends on the location of the injury. In addition to being unable to use their limbs, people with quadriplegia may also suffer from difficulty breathing, bowel and bladder problems, blood clots, and pressure sores.
While there is no cure for permanent quadriplegia, some people may regain limited function over time.
What Symptoms Do I Need to Qualify?
Individuals with quadriplegia may face a broad range of symptoms which may affect one’s ability to work differently. The Social Security Administration (SSA) lists the criteria for disability benefits in the Social Security Blue Book. Section 1.04 addresses disorders of the spine.
Additionally, if your quadriplegia has a neurological cause, you might be evaluated under Section 11.08, spinal cord disorders. Here are some signs that you might qualify for financial assistance from the SSA for your paralysis:
- Complete loss of function of any part of your body may make it difficult to work. The SSA requires that your loss of function last for at least three months before considering your application because paralysis may sometimes be temporary.
- If you have had a complete loss of function of any part of your body, you will qualify for social security benefits.
- Some people with quadriplegia have challenges moving from a seated position to standing, but most are unable to stand at all. Some may experience difficulty with balance when walking or standing. Again, walking and standing are not possible for most individuals. If your job demands that you stand or walk, you will be eligible for benefits from the SSA.
- Neurological disorders, which cause paralysis, may lead to mental impairments as well. Some individuals may experience difficulty interacting with others, understanding information, or concentrating. As most jobs require communication and focus, work may prove difficult for you.
- Paralysis can cause anxiety and depression, which may impact your ability to work. If you experience emotional difficulty as a result of your illness, this may be considered in your application.
- Quadriplegia often affects other body systems. If you suffer from respiratory, cardiac, gastrointestinal, or urinary problems, you will also be evaluated under those body systems.
- If you do not meet the qualifying criteria in the Blue Book, you still may be assessed by the SSA for your “Residual Functioning Capacity” or RFC. The SSA will determine your abilities and make recommendations for you. For example, if you are unable to walk, but you can perform sedentary work, the SSA will determine your eligibility for benefits.
Do I Qualify for Social Security Benefits?
To be eligible for Social Security benefits, your medical records will need to show that the symptoms of your paralysis have been present for at least three months and that they are severe enough to prevent you from working at a level which would support you.
Additionally, your paralysis needs to be expected to last for at least 12 months. For the majority of people with quadriplegia, this will be the case.
What Information Will I Need to Provide?
When applying for Social Security for your quadriplegia, you may be asked to provide the following proof of your condition:
- Confirmation of your diagnosis from your doctor, including notes addressing your function and mobility.
- X-rays, MRIs, CT scans, or other imaging results.
- Electromyography (EMG) or Somatosensory Evoked Potential (SSEP) results, if performed.
- Blood and urine tests, especially if you are experiencing other health problems secondary to your paralysis.
- Hospitalization records
- Progress notes from your doctor, physical therapist, or other health care specialists involved in your care, describing your symptoms and prognosis.
If you are missing any of the above information, contact your doctor or hospital immediately. The more medical evidence that you have on your side, the better your chances of receiving SSDI benefits for your quadriplegia.
What’s Next?
If you have quadriplegia and believe that you may qualify for Social Security benefits, you should contact a disability advocate or lawyer in your area. Losing function or feeling in any part of your body is life-changing.
When your health is suffering, it can be difficult to know where to turn or what to do next. A qualified attorney can help you navigate the Social Security application process, leaving you time to focus on what’s most important: your health.
What Kind Of Spinal Conditions Qualify For Disability Benefits?
If you suffer from a spinal condition that keeps you from working and earning a living, you may qualify for disability benefits from the Social Security Administration (SSA). The SSA uses a medical guide, which is called the Blue Book, to determine if an individual is disabled. There are listings for several different spinal disorders. Among those spine disorders that have specific listings in the Blue Book are the following:
- Osteoarthritis
- Facet arthritis
- Spinal arachnoiditis
- Vertebra fracture
- Degenerative disc disease
- Spinal stenosis
Each of those has a listing with specific criteria that must be met for a claimant to qualify for disability benefits. However, you may still qualify for disability benefits if you have a different spinal condition. A medical vocational allowance can be used in conjunction with a residual functional capacity (RFC) form. For example, to qualify with the listing for spinal stenosis, you must meet several criteria as specified in the Blue Book. Here are the criteria that must apply to your condition:
- The stenosis must be in your lumbar region
- You must have a positive imaging test showing proof of lumbar spinal stenosis
- You must have pseudoclaudication – which includes pain and weakness
- You must experience chronic nonradicular pain
- You must not be able to walk effectively
The last requirement is to rule out those who suffer severe pain, but who can effectively walk without assistance.
Each spinal condition has its own specific criteria that must be met, and if you don’t meet those criteria and provide supporting medical evidence for those criteria, then your claim will not be approved. If your condition doesn’t meet the listing criteria, then you will need to show that you are disabled through a medical vocational allowance with the help of an RFC.
Using An RFC or Medical Vocational Allowance
Your physician should complete the RFC, and it will explain any restrictions or limitations in detail, so you will be able to show Disability Determination Services what you can and cannot do. It will explain how long you can stand, how far you can walk, if you can reach and grasp, if you can squat or bend, how much you can carry, and how much you can lift.
As an example, you may suffer from a herniated disc or a bulging disc, or you may have a lipoma or some other problem. Disability Determination Services may argue that you can still do sedentary work, which involves sitting in one spot for an extended timeframe. To perform sedentary work, you must be able to concentrate on complex tasks or utilize manual dexterity to a high degree. Some spinal conditions could disrupt that. You may not be able to sit in the same position for long time periods, and the pain and discomfort could affect your ability to concentrate and stay focused.
You must provide supporting documentation that explains the severity of your back problem and how it affects you. Make sure it is understood that the problem exists even when you are sitting and not just when you are standing, walking, lifting, or bending. If you have ongoing pain even after treatment, indicate that. If you are prescribed painkillers that affect your ability to concentrate or that cause drowsiness, that should also be indicated.
An RFC should be very detailed, painting a clear image of your capabilities, limitations, and restrictions. When a disability examiner reviews the RFC and your medical records, then he or she should be able to determine what kind of work – if you can work – you can do. An accurate and well-written RFC can be the key to having a disability claim for a spinal disorder approved.
When a medical vocational allowance is used, your age, educational background, work history, and transferrable skills are all taken into consideration and used to determine if you can train for another job or perform some other kind of work.
Tips For A Better Chance Of Claims Approval
The key to a successful disability claim for your spinal condition is hard medical evidence. You will need to provide supporting documentation including exam notes, test results, imaging reports, surgical notes, treatment records, and so forth. Most claims are denied because they don’t have enough supporting documentation to back up the claim, so making sure you prepare a detailed list of your medical providers along with their contact details and the dates of service.
If you can gather your own medical records that would be beneficial and that way you can make sure that your file is there for them to review. Including an RFC from your primary care physician as well as any specialists, such as an orthopedic surgeon and/or neurosurgeon or neurologist can be very beneficial to the outcome of your claim. You will need to provide as much supporting evidence as possible to ensure your claim has all the details that you can provide so it can be fairly and properly reviewed.
While most claims are denied initially and an appeal must be filed, many advance all the way to the hearing level. At the hearing level, your claim has a better chance of being approved and you being awarded disability benefits. Claimants that are represented by a disability lawyer are much more likely to be awarded disability benefits as well.
Disability attorneys work on a contingency basis, which means that your attorney will not require payment upfront. Instead, your lawyer will not be paid until you win your claim and you are awarded benefits. To make sure your claim gets on track as quickly as possible, you should consult with a Social Security Disability attorney who represents disabled workers in your area.
To ensure that your disability claim for quadriplegia or a spinal disorder is underway properly and that you have all the hard medical evidence needed to support your claim, complete the Free Case Evaluation Form on this page. The details of your claim will be shared with a disability attorney’s office so you can get a free case review.
