Is Paraplegia Eligible For Social Security Disability Benefits?

by | Published on Jun 27, 2022 | Social Security Disability

Paraplegia is a severe disabling condition wherein the lower half of the body is paralyzed, making it difficult or impossible for you to do gainful activity. Usually caused by a spinal cord injury or by certain diseases, paraplegia prevents affected people from standing or walking. Social security disability benefits (SSDI) or supplemental security income (SSI) may be available to individuals with this disability. The claimant’s medical records will be reviewed to find evidence that supports a paraplegia diagnosis. This makes the service of a medical record review company useful for disability attorneys. They can have a clear outline of the medical history of the claimant and his/her health concern as well as the extent of impairment caused by this condition.

Paraplegia may be complete or incomplete. In the former case, the patient has no feeling or sensation in the lower half of the body and no movement. In the latter case, the patient will have limited movement and sensation in the lower body, though that is typically not enough to have normal function and mobility. Disability benefits may be available in both instances, whether the paraplegia is complete or incomplete. What the Social Security Administration (SSA) considers is whether the condition is severe enough to prevent the claimant from working and earning a living.

Medical Records Analysis to Determine Disability

Medical record review for social security disability firms handling spinal cord injuries and paraplegia would focus on extracting from the claimant’s medical chart, the medical facts that support the diagnosis. To get approved for benefits, the claimant must meet the specific diagnostic criteria established by the SSA and described in their Blue Book. Typically, the listing used to evaluate a spinal cord injury is Section 1.04, Disorders of the Spine. If the claimant’s paraplegia has a neurological cause, he/she may be evaluated under Section 11, Neurological Disorders. A medical records analysis should show evidence of the following.

  • The claimant suffered a spinal injury/damage that has affected the nerves of the spinal cord, and this injury has resulted in nerve root compression leading to pain and/or loss of motion.
  • Total loss of function of any part of the body that makes it difficult for the patient to work. This loss of function must have lasted for at least three months before the SSA would consider the disability application. This is because sometimes paralysis may be temporary.
  • The paraplegia must last for at least 12 months, which is the case for most patients.
  • Difficulty moving from a seated position to a standing one, and difficulty with balance when walking or standing.
  • Signs of mental impairment following the neurological disorder that caused the paralysis, difficulty to interact with others, difficulty in comprehending things, and difficulty in concentrating.
  • Anxiety or depression caused by paraplegia, which has a negative impact on the claimant’s ability to work.

The SSA would want the claimant to provide the following along with the application.

  • A complete medical history of the claimant.
  • Physical examination records that describe the claimant’s condition.
  • A confirmation of the paraplegia diagnosis from the claimant’s doctor, which also includes documentation regarding the claimant’s function and mobility.
  • EMG (Electromyography) or Somatosensory Evoked Potential (SSEP) results, if performed.
  • MRIs, CT scans, X-rays, and other imaging results.
  • Blood and urine tests.
  • Medical records from the treating physicians, physical therapists, surgeons, and other healthcare providers that describe the claimant’s symptoms and prognosis.
  • List of medications administered.

Medical Vocational Allowance for Paraplegia

Following a medical record review, if the claimant fails to meet the specific criteria listed in the Blue Book, the SSA may evaluate him/her for their Residual Functioning Capacity or RFC. To determine whether the claimant is eligible for disability benefits under the Medical Vocational Allowance, the SSA would review the medical records to find out how the paraplegia impairs the claimant’s ability to perform daily activities and work. If the SSA determines that the claimant is unable to perform gainful activity because of the paraplegia, he/she may be approved for SSD benefits under a medical vocational allowance.

A medical record review company reviewing medical records for disability evaluation would help disability attorneys assess whether the claim is a valid one. Since spinal cord injuries can be complex, proving that a claimant is eligible for SSDI benefits due to such an injury can be complicated. Therefore, an accurate analysis of the medical records and proper evaluation of the case is crucial from the very beginning. With the correct information and supporting medical evidence, disability attorneys can develop the case well and ensure that their clients receive the due benefits.

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