Social Security has proposed changing to its listings for musculoskeletal disorders. Social Security’s listings are impairments used by Social Security in making disability determinations by judging the severity of impairments. We will be presenting a series on the proposed changes, first looking at the current listing Social Security considers, followed by the proposed new listing. Next up is 1.04 Disorders of the spine, which is the current listing, but proposed to be replaced by two different new listings. In a previous blog we identified listing 1.15, but 1.04 would also partially be replaced by listing 1.16 Lumbar spinal stenosis resulting in compromise of the cauda equina.
1.04 Disorders of the spine (Current Listing)
1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise of a nerve root (including the cauda equina) or the spinal cord. With:
- Evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine);
OR
- Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours;
or
- Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.
1.16 Lumbar spinal stenosis resulting in compromise of the cauda equina (proposed) 101.16 Lumbar spinal stenosis resulting in compromise of the cauda equina (see
101.00G), documented by A, B, C, and D:
- Symptoms of neurological compromise, such as pain, manifested as:
- Nonradicular distribution of pain in one or both lower extremities; or
- Nonradicular distribution of sensory loss in one or both extremities; or
- Neurogenic claudication.
AND
- Nonradicular neurological signs present
during physical examination or testing and evidenced by 1 and 2, or 1 and 3, below:
- Muscle weakness; and
- Sensory changes evidenced by:
- Decreased sensation; or
- Sensory nerve deficit (abnormal sensory nerve latency) on electrodiagnostic testing; or
- Areflexia, trophic ulceration, or bladder or bowel incontinence.
- Decreased deep tendon reflexes in one or both lower extremities.
AND
- Findings on imaging or in an operative report consistent with compromise of the cauda equina with lumbar spinal stenosis.
AND
- D. Impairment-related physical limitation of musculoskeletal functioning that has lasted, or can be expected to last, for a continuous period of at least 12 months, and medical documentation of at least one of the following (see 101.00E):
- A documented medical need for a walker, bilateral canes, or bilateral crutches;
or
2. An inability to use one upper extremity to independently initiate, sustain, and complete age-appropriate activities involving fine and gross movements, and a documented medical need for a one-handed assistive device that requires the use of the other upper extremity
