Degenerative Disc Disease and ERISA Long Term Disability Claims


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San Diego, California ERISA LTD Attorney Discusses Degenerative Disc Disease

Degenerative disc disease (DDD) is one of the most common disability for which people apply for long term disability benefits. Despite the sheer number of claimants listing DDD as the cause of their disability, insurance companies do not easily approve disability benefits.

What is Degenerative Disc Disease

DDD is the most common cause of back pain and neck pain. It is also very misunderstood. Simply put, degenerative disc disease are the symptoms of pain and possibly radiating weakness or numbness stemming from a degenerated disc in the spine. When the usually rubbery, pliable disc between your vertebrae loses integrity as a normal process of aging, it is described as a degenerative disc.

In a healthy back, these discs provide height between your spinal vertebrae. This allows easy bending, flexion, and torsion of the spine. As the discs deteriorate, they lose this cushioning ability.

DDD is common and affects everyone, but it usually gets worse with age.

Symptoms of Degenerative Disc Disease

DDD can occur up and down your entire spine, but usually occurs in the lower back (lumbar) and your neck (cervical).  Common symptoms include:

  • Chronic back and neck pain that can flare up, or be constant in severity and duration.
  • Herniated disc – an abnormal bulge or breaking open of your spinal disc
  • Limited range of motion.
  • Osteoarthritis – cartilage or cushion between joints breaks down leading to pain, stiffness and swelling. .
  • Spinal stenosis – narrowing of the spinal canal, which is channel in your spine that your spinal cord runs down.

Diagnosis of Degenerative Disc Disease

Usually diagnosis of DDD starts with a physical exam, where you describe to your doctor the symptoms you are experiencing. These symptoms will include pain in your neck and back, limited range of motion, weakness, loss of reflexes, loss of sensation. Next your doctor will probably perform one or more of the following diagnostic tests:

  • X-Rays. Usually x-rays will be used to rule out other causes of your symptoms. Other causes include scoliosis, spondylolisthesis (one bone slips out of place), fractures, and gross instability.
  • CT-Scan. A computed tomography scan is basically a fancy collage of individual x-rays combined to create a “slice” of your body. The same limitations of X-Rays apply here. CT-Scans are more useful in eliminating causes rather than diagnosing you. CT-Scans are great at eliminating other possible causes such as pars defect or spondylolisthesis.
  • MRI. Magnetic Response Imaging. Probably the most useful test for diagnosing DDD. An MRI can evaluate the spinal canal and space available for neural structures. It can directly evaluate neural and disc structures, which is not possible by a CT-Scan. It can even evaluate the hydration of your discs.
  • Discography/Discogram. The most controversial of the tests. This one involves injecting your spine with a dye to see if it invokes pain. Some doctors question the effectiveness of this test and the utility of its results.

How Do Disability Insurance Companies Evaluate Disability Claims for Degenerative Disc Disease?

DDD is the most common cause for back pain. Long Term Disability insurance companies know this. For most people, the pain is intermittent and can be managed while the suffering employee keeps working.

For those who can no longer work, the pain doesn’t go away, and doesn’t allow you to work. This brings us to the biggest issue with DDD. Only the person experiencing the pain really knows how bad the pain is, and the degree in which the pain inhibits your ability to work.

For this reason, disability claims handlers do not give much weight, if at all, to complaints of pain. They need proof. And the proof is contained in the medical records, which is why those records are so integral to your case.

LTD companies typically grant disability benefits to those whose medical records strongly and compellingly illustrate the DDD progressed to the point it severely impacts their day to day life and ability to work.

What Do Long Term Disability Insurance Companies Look for in Degenerative Disc Disease Cases?

When a disability claims examiner opens a newly assigned application and they see degenerative disc disease, neck pain, back pain, spinal stenosis, or degenerative joint disease the examiner will immediately look for the following evidence to support the claim:

  • Medical records – consisting of treatment notes, physical examination results showing restriction in your range of motion when you bend over, lift, twist, walk, stand, sit. The records should show a consistent history and reports of pain and limitations. Any inconsistency will be used by the examiner to deny your claim.
  • Doctor’s narrative – a narrative from your doctor detailing your medical history, treatment thus far, test results, and their medical opinions on diagnosis, prognosis, recommended treatment, and limitations caused by the condition.
  • Objective evidence of disc degeneration – This can include x-ray reports, CT scans, MRI studies.
  • Functional capacity evaluation – this can be used to show you are unable to sit, stand, or walk for an extended period of time, or any other physical requirements needed to perform your job.
  • Vocational rehab expert’s evaluation – A vocational rehab expert evaluates why you can or cannot perform your job duties. Either your previous job, or any other job.

The Significance of Medical Evidence in DDD Disability Cases

I cannot overstate how significant medical evidence is for your long term disability case. The most important pieces of evidence are probably your imaging studies. These are your x-rays, cat scans (CT scan), MRI’s. These are the objective findings that show spinal problems in the neck and back.

A doctor can diagnose DDD based on your reports of symptoms (subjective), and then the doctor performs a physical examination. Once a possible diagnosis is made, imaging studies can confirm (or deny) the diagnosis. The imaging studies will provide support of a medical condition that is likely to cause pain.

It will be extremely difficult to get the disability insurance company to willingly pay you benefits without having objective imaging studies with compelling evidence of degenerative disc disease.

In addition to imaging studies, your treatment notes are also very important. The examiner will want to see decreased range of motion, decreased strength, and other objective physician findings. Also very important is consistent reports. If you report wildly different levels of pain and complaints each time, or the doctor has inconsistent findings, this will give the examiner ammunition to deny your claim.

In other words, in order to receive benefits from your long term disability insurance policy for degenerative disc disease, you will need a mountain of compelling medical evidence.

Seek a skilled San Diego, California ERISA Long Term Disability Attorney

Do not wait to contact an attorney to help you with your claim. Get support from a skilled LTD lawyer for your claim for benefits. You need to submit the strongest possible evidence from the start. Because if you have to sue for your benefits, your lawsuit will be limited to the documents you provided in your appeal.

You cannot afford to get this wrong. If your application for benefits has been denied or terminated, get it right the first time by contacting the Disability Legal Center at (888) 320-2058.