How to Get Disability Benefits for Spinal Arachnoiditis

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Spinal arachnoiditis is a painful condition caused by the inflammation of the arachnoid (a membrane that surrounds and protects the spinal cord) and involves nerve roots around the spine. The arachnoid membrane can become inflamed after spinal surgery, infection from bacteria or viruses, injection of dyes or steroids, compression of spinal nerves, or from a traumatic injury to the spine. When arachnoiditis interferes with the spinal nerves, it can cause persistent stinging and burning pain in the lower back and legs and numbness and tingling in the hands or feet. It can also affect bladder and bowel control, sexual function, and the ability to sit.

Arachnoiditis is not curable; patients are treated for chronic pain. Many patients who suffer from arachnoiditis are unable to work because of the pain, the impairment to bodily functions and the ability to sit for more than a few minutes. Fortunately, arachnoiditis is one of the few back conditions recognized by the Social Security Administration (SSA) as an official impairment listing, meaning that those with documented cases of severe arachnoiditis are automatically granted disability benefits – if you can meet the SSA’s requirements.

Arachnoiditis can occur on its own or in conjunction with another back condition such as degenerative disc disease, nerve root compression from arthritis or herniated disc, failed back syndrome (also known as failed back surgery syndrome), fracture of vertabrae, or spinal cord injury.

Qualifying for Social Security Disability for Arachnoiditis

There are three requirements to qualify for disability because of arachnoiditis. In addition to a diagnosis by a medical doctor, you must have all three of the following:

  • objective evidence of the condition (as discussed below)
  • severe burning pain or other abnormal painful sensation, and
  • the need to change your position or posture more than once every two hours to reduce pain.

Medical Evidence Required for Arachnoiditis Disability

The SSA will request your medical records from your treating doctor. The SSA wants to see objective evidence that you have arachnoiditis, rather than just a diagnosis by a doctor based on your pain symptoms and medical history. The SSA requires one of the three following objective forms of evidence to confirm the doctor's diagnosis:

  • an operative note (a note a surgeon writes about what was seen during surgery)
  • a pathology report of a biopsy, or
  • an imaging test (MRI, myelography, and/or CT scan).

The above evidence should show the thickening and swelling of nerve roots, and if adhesive arachnoiditis has occurred, the clumping together of nerve roots.

Your records should also include a detailed physical exam, including testing your sensation, reflexes, and range of motion, as well as your ability to walk, bend, squat and rise. Your records should include the various treatments you have tried, such as pain medication, physical therapy, or nerve or spinal cord stimulation, and the side effects of the pain medication. You should ask your doctor to record how your pain, medication side effects, and other symptoms limit your ability to work, and what functional restrictions your doctor has placed on you (for example, no heavy lifting or sitting for longer than two hours at a time). If your doctor does not maintain that you need to change your position or posture more than once ever two hours, you won’t qualify for disability benefits under the arachnoiditis listing.

If you have been diagnosed with arachnoiditis but you don’t fulfill the three requirements above (say you don’t have the proper objective evidence, or your treating doctor refuses to give you a functional restriction of needing to change your position or posture more than once every two hours), you may still be able to qualify for disability benefits under what’s called a medical-vocational allowance. For more information, see our article on Disability Benefits for Reduced Capacity Caused by Back Problems.

Starting a Disability Claim for Arachnoiditis

Call the SSA at 800-772-1213 to set up an appointment to fill out an application for disability benefits (SSDI and SSI). When you fill out your application, include both how your back pain affects your life outside of work and how it impairs your ability to work. If you have both arachnoiditis and a mental impairment, such as depression (as many people with back problems do), be sure to include symptoms and documentation of the mental impairment as well.

If your condition fulfills the SSA’s three requirements above, you have a good chance of getting disability benefits on your first try, and it might not make sense to pay a lawyer for help. If, on the other hand, your case is borderline, or you are initially denied benefits, consider contacting a disability lawyer for help. (The attorney fee should come out of your award of back pay from your disability benefits; if you don’t win, the lawyer shouldn’t get paid.) When you interview the lawyer, ask if he or she has experience with spinal cases, and in particular arachnoiditis. Your lawyer can help you appeal a denial by the SSA or file an initial clam for arachnoiditis.

by: , J.D.

This article is provided for informational purposes only. If you need legal advice or representation,
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