Why Was My Cpp Disability Application Denied
More often than not, denial is due to a lack of information about your condition, so you will need to rebuild your claim, covering anything you may have missed before appealing the decision.
Throughout this section, we will cover some of the most common reasons CPP Disability applications are denied, so you know what to avoid when navigating the application process.
Extraschedular Va Disability Ratings
There are times when VA can rate veterans outside of what is included in the rating schedule. Extraschedular ratings are assigned when the rating criteria for a veterans disability does not accurately reflect their level of disability. Usually this happens when a veteran experiences symptoms or limitations that are not considered by the rating schedule. Therefore, VA must determine if the veteran is eligible for a higher rating than the schedule sets forth. This might be the case for a veterans degenerative disc disease, as the highest schedular rating under Diagnostic Code 5003 is only 20 percent.
To receive an extraschedular disability rating under 38 CFR § 3.321 for degenerative disc disease, the following requirements must be met:
- A veteran must show, and VA must find, that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that make it impractical for VA to assign a schedular rating
- The final determination on whether an extraschedular rating is warranted must be made by VA Undersecretary for Benefits or Director of Compensation Service
Extraschedular disability ratings are granted on a case-by-case basis and are very specific to each veteran and his or her disability picture.
What Is ‘medically Determinable’ Back Pain
The first thing you need to know about qualifying for disability based on back pain is that the Social Security Administration does not typically grant benefits to those with mild, moderate, or intermittent back pain. Despite the fact that the SSA receives millions of applications for back pain-more applications for any other type of illness or injury, in fact-it only grants benefits to individuals with ‘medically determinable’ back impairments. This means that, in order to qualify for Social Security disability benefits, you’ll need to show that you have an impairment that can be detected and affirmed by a medical professional.
The Social Security Administration has a section on ‘Disorders of the Spine’ in its Listing of Impairments, which is typically used to determine whether back pain is compensable.
In order to be considered a ‘disability,’ your back pain must involve, among others, one of the following:
- Herniated discs
- Difficulty walking
- Chronic pain associated with compression of the lumbar spine
This list is not exhaustive you may be required to meet additional criteria in order to qualify for disability for your back pain or spinal condition.
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Symptom Of Degenerative Disc Disease
Symptoms are consistent with those suffering from lower back pain or neck pain. These symptoms include pain caused by flare ups, severe episodes of back or neck pain, and difficulty bending, lifting, and twisting. The amount of chronic pain a patient experiences varies between individuals and can range from minimal pain to severe and disabling pain. Back and neck pain can last anywhere between a few days to a few months, depending on the severity of the condition.
Certain positions make pain worse, such as when sitting in comparison to standing. Patients tend to feel better when they change positions on a frequent basis. It also helps when they are lying down or in a reclining position as these positions relieve stress on their lumbar disc space.
Employment And Disability Rights For Back Pain
Many people worry about losing their jobs when they take sick leave. As a general rule, employers can fire anyone as long as they give proper notice. But, they cant let you go for a discriminatory reason.
Most employers wont fire workers on sick leave. Under Canadas human rights laws, employers must help employees if their medical condition affects their work. Allowing sick leave is a reasonable accommodation that employers should give.
To take sick leave, youll need to give your employer a doctors note. The note should confirm that you cant work and need time off. If you need to stay off for a longer time, youll need to regularly provide these notes. Usually, you can submit them every three to six months to show that youre still unable to work.
If you apply for disability benefits and get denied, you can stay on sick leave while you appeal. Most employers wont question this as long as you continue to provide doctors notes.
If your employer tries to fire you while on sick leave, you may have legal rights to severance pay. You can even have the termination overturned if it was because of your condition. These situations are complicated, however. You should always get legal advice.
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Does Back Pain Qualify As A Disability In Canada
Heres the good news: All Canadian insurers see back pain as a cause of disability. While most people with back pain recover quickly, it can also be chronic. Often, it interferes with work and daily life.
Following is a list of back problems that can qualify for disability:
- Degenerative disc disease refers to pain that originates from a degenerated disc in the spine. Pain from this type of disorder decreases over time.
- A bulging disc, or a slipped disc, is when an intervertebral disc expands beyond its normal bounds. Pain happens when the disc presses on a nearby nerve root.
- Lumbar radiculopathy is nerve irritation caused by damage to vertebrae discs. Pain increases with hip movements, coughing, and sneezing.
- Sacroiliac joint disease is the inflammation of the firm joint between the spine and the pelvis.
- Sciatica is when the sciatic nerve gets pinched. This disorder can cause back pain, numbness, weakness, and tingling that radiates down the body.
- Fractures of the spine happen when vertebrae break or collapse. If left untreated, this can lead to more severe problems.
- Osteoarthritis of the lower spine is when the cartilage in the joints and discs of the back break down.
- Ankylosing spondylitis is a type of arthritis that affects the spine.
- Spinal stenosis is when the bone channel the spinal nerve goes through gets narrower.
Recent Changes To The Musculoskeletal Listings
Effective April 2, 2021, SSA changed its rules for people with musculoskeletal back disorders, including degenerative disc disease. If your new disability claim for degenerative disc disease is filed on or after April 2, or your claim is still pending approval as of April 2, 2021, the new rules will apply to you. All previously approved claims will remain under the past rules.
Its vital to understand the new listing for degenerative disc disease, so the information that you provide in your claim to SSA is correct.
Under the new SSA listing, degenerative disc disease is categorized under 1.15, Disorders of the skeletal spine resulting in compromise of a nerve root. The medical criteria that must be met are now different from the old SSA listing, which was 1.04 Disorder of the spine.
SSA now classifies degenerative disc as an infirmity of the skeletal spine that results in compromise of a nerve root. SSA will consider disability claims for degenerative disc disease that are supported by medical evidence such as:
- Physical examination for type and location of pain, range of motion, nerve function, sensation, and muscle strength, with a full review of the entirety of symptoms
- Diagnostic imaging tests
- Records of treatment regimens
Similar deteriorating spinal impairments that impinge on or irritate a nerve root include:
- herniated disc
- facet arthritis, and
- vertebral fracture or dislocation.
- nerve roots of the cervical spine,
- a nerve root of the lumbar spine, or
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Whiplash Associated Disorder / Chronic Whiplash Syndrome:
A whiplash injury can affect the soft tissues in the neck and/or the cervical vertebrae, joints of the spinal column and the intervertebral discs. This can lead to a variety of clinical presentations.
A whiplash injury which primarily affects the soft tissues of the neck will have signs and symptoms similar to a sprain or strain.
A whiplash injury which affects the structural elements will have signs and symptoms of similar to Cervical Spondylosis e.g., radicular symptoms.
A whiplash injury can result in the clinical onset of Cervical Spondylosis at the time of the injury or in the onset of Cervical Spondylosis many years later.
Starting A Disability Claim For Back Pain
Call the SSA at 800-772-1213 to set up an appointment to fill out an application for disability If you don’t know whether you are eligible for Social Security disability insurance or Supplemental Security Income , you can apply for both. 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 severe back problems and a mental impairment, such as depression , be sure to include symptoms and documentation of the mental impairment as well.
|Take our disability quiz to help you determine whether you qualify for benefits.|
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Your Diagnosis Is Essential
The first thing your insurance company will require is proof of your degenerative disc disease diagnosis.
There may not be any outward symptoms of degenerative disc disease until you start developing pain. At that point, the level of degeneration can be quite advanced.
A doctor will be able to diagnose your degenerative disc disease through spinal imaging tests such as X-rays, MRIs, and CT scans. These scans can determine the degree of degeneration that you are suffering from. By comparing the thickness of your weakened disc to other normally functioning discs in your spine, your doctor can measure the progression of degeneration.
The degeneration of a disc is usually quite apparent because the disk’s thickness will not match the thickness of other normally functioning disks in your spine. The doctor may perform other tests to determine whether or not you have associated problems such as osteoarthritis or osteoporosis.
Can I Get Disability Benefits For Degenerative Disc Disease
To be found disabled, you must have a medically determinable physical or mental impairment that is severe and has lasted or is expected last one year or end in death. If your medical condition is not that severe, you will not be found to meet the requirements for Social Security disability benefits. If your condition is that severe, the SSA goes to Step 3.
Step 3. Does your disease meet or equal the severity of a Listing?
The SSA maintains a listing of medical criteria that are considered to be so severe that you will be found disabled if your medically determinable physical or mental impairment matches them. The Adult Listing for degenerative disk disease can be found here.
If you do not have an impairment that meets or equals one of the listings or the duration requirement is not met, SSA determines your Residual Functional Capacity that is, what youre capable of doing despite your impairments and will proceed to Step 4.
RFC is a function-by-function assessment of your maximum ability to do sustained work-related physical and mental activities on a regular and continuing basis despite the limitations and restrictions resulting from your medically determinable impairments. In short, it is an evaluation of your capacity for full-time work.
Step 4. Are you still able to do any job youve had in the past fifteen years?
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What If I Am Denied For Cpp Disability For Chronic Back Pain
It is important to note that around 60% of all new CPP Disability applications get denied and that there are limited opportunities to appeal Service Canadas decision therefore it is imperative that you approach the appeal process carefully.
In this section, we will briefly cover the denial and appeal process but if you were denied, we encourage you to check out our CPP Disability Denial and Appeal Overview article covering each step of the appeal process.
The CPP Disability appeal process has three steps, those being:
How Do I Prove My Degenerative Disc Disease As A Disability
Degenerative disc disease can be a challenging condition to prove as disabling to insurance companies. While the debilitating pain of degenerative disc disease is very real, pain is considered a subjective symptom. Your insurance company will want objective medical evidence to back up your disability claim.
Winning Your Social Security Disability Claim For Degenerative Disc Disease
When deciding disability cases, the Social Security Administration uses a process called the 5-Step Sequential Evaluation Process. The first two eligibility requirements are:
- Step 1 You are not gainfully employed, and
- Step 2 Your condition is severe.
If you pass these requirements, the next hurdle of the 5-Step Evaluation is Step 3 Does your disability meet or equal a medical listing?
The SSA maintains a Listing of Impairments that are so severe that, if you satisfy the criteria of any listed condition, you are automatically considered disabled. The medical evidence to support all the criteria of the list can be massive and our attorneys will help you secure and assemble the materials needed to meet the requirements.
Degenerative disc disease is found in the SSA Listing 1.00 Musculoskeletal Disorders.
How To Apply For Disability Tax Credit For Degenerative Disc Disease
To apply, our experts will assist you in filling out form T2201 where you will need to get your medical practitioner to complete this form. This will ask your doctor to describe how you are impaired by your disability. It is important to be descriptive in this section as a patient can be affected in a variety of ways by degenerative disc disease.
Disability Tax Credit Consultants at DCC can help to +claim this tax credit and collect up to $40,000 in disability tax credits.
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Were Here For You Throughout The Disability Process
Dont let a delay or denial stop you from winning your disability claim for degenerative disc disease. We provide significant help, and your initial consultation is always free. If you need help with a disability claim concerning Social Security, an insurance company, or the Department of Veterans Affairs, please contact us.
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Types Of Back Pain That Qualify For Ssd Benefits
According to the SSA, back pain is considered disabling if it meets one of three criteria:
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Common Medical Terms Associated With Degenerative Disc Disease
Bone spurs Bone spurs represent an enlargement of the bony structure and are a sign of spinal degeneration . Spine bone spurs can cause intense pain.
Herniated nucleus pulposus A herniated disc is a rupture of the outer casing of the disc.
MRI Magnetic resonance imaging is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. MRI is often used to help diagnosis disorders of the spine.
Neck pain Neck pain can be caused by a variety of factors, including injury, stress or some other health problem.
Neck problems and injuries Most people will have a minor neck problem at one time or another. Our body movements usually do not cause problems, but its not surprising that symptoms develop from everyday wear and tear, overuse, or injury.
Nerve root compression A pinched nerve causes pain or impaired function when a nerve is under so much pressure that its ability to carry signals is hindered.
Osteoarthritis Osteoarthritis is a joint disease caused by cartilage loss in a joint. Pain and stiffness are symptoms.
Radiculopathy Radiculopathy refers to a set of conditions in which one or more nerves in the spine is affected and does not work properly .
Spinal arachnoiditis Arachnoiditis is a debilitating chronic pain condition characterized by severe stinging, burning pain, and neurologic problems.
Determining The Level Of Functional Impact
As in the other Tables, the descriptors in Table 4 are interlinked in that they follow a consistent incremental hierarchy, which in this Table is expressed, among other things, by the use of terms indicating increasing levels of difficulty in performing certain activities .
Consequently, as is the case in applying any other Table, in establishing which descriptor in Table 4 is appropriate to a person’s circumstances, that is whether the impairment has no , mild , moderate , severe or extreme functional impact, an assessment process under this Table should follow the same incremental path.
The structure of the Tables requires that, in assessing the level of functional impact, a comparison must be made of all the descriptors for each level of impairment. An assessment starts by considering the descriptors for 0 points, and if a person has more than ‘no functional impact’, the descriptors for 5 points are then considered, and so on for the descriptors for higher impairment levels. When it is determined that the person meets all the required descriptors for a certain impairment rating level, but does not meet all the required descriptors for the next impairment rating level, the appropriate impairment rating applicable to the person’s circumstances will be the lower of those 2 impairment ratings .
Note: Individual descriptors or their parts must not be applied in isolation from one another.
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