Monday, October 10, 2005

A few thoughts on Back Pain and Social Security Disability

It is now a little over a week since I injured my back and, fortunately, I am on the mend; that is, with the help of many doses of flexeril, percocet, a back brace, ice packs (the freezeable gel kind) to keep the inflammation down, and a spouse who didn't mind helping me put my socks on.

This, of course, is not the first time that my lower back has completely "gone out". But this has been the longest episode I've had yet to endure. The last major one was 8 years ago and I was "on my back" in bed for three days then. I guess this may point to what eight years of added age can do to one's recuperative abilities.

I couldn't help but think (each time I broke out into a sweat as I got to my feet and each time I had to adjust my position in a chair because sitting was uncomfortable) how horrible it would be to be saddled with nagging lumbar back pain indefinitely as is the case with many disability claimants.

It would be awful without a doubt. But here are some specific things my spouse (also a former DDS examiner and a current D.O. CR) and I discussed: light jobs would be difficult because handling any amount of weight, let alone, say, 20 pounds, would aggravate a back problem. I rediscovered this reality yesterday as I, in a limited fashion, tried to help my wife with groceries. The simple weight of a gallon jug of milk was enough to make me wince. How about a sedentary job? Well, the problem with sedentary jobs is...being sedentary. As many claimants with chronic lower back pain will attest, being in a seated position can become very uncomfortable even after a few minutes. But even "sedentary jobs" are not entirely sedentary. Most sedentary work still involves having to get up and down from a seated position dozens of times during the course of a day. And this can obviously present a problem for someone with lower lumbar pain. And, of course, there are the psychological aspects of having continuous pain and discomfort; chief among these is the effect that continuous pain has on one's ability to maintain attention and concentration. And, of course, pain does have a nasty effect on one's disposition.

Now, in the context of disability claims adjudication, why do I even bother mentioning this kind of stuff? Simply for this reason: Disability examiners, their supervisors, and the medical consultants with whom disability examiners work all too often slap decisions on cases without allowing claimants reasonable consideration with respect to their pain. This is not a trivial issue as the social security administration has been sued a number of times over its failure to recognize claimants' limitations due to pain.

Why do the "functionaries", or cogs of the disability system, fail to recognize the role that pain plays in a claimant's functional limitations?

Well, in the case of examiners, it may have a little to do with age. Most disability examiners tend to be younger individuals (twenties and thirties), i.e. people who have never had to deal with a disabling illness, such as degenerative disc disease. It's an unfortunate reality of human existence that people are often unable to empathize with someone else's pain if we have not experienced something similar ourselves.

In the case of the disability docs, that is the physicians who serve as unit medical consultants in a state's DDS (disability determination services), the blinders they wear may have more to do with the nature of their work. Basically, "disability docs" sit in an office all day long, reading files and writeups that have been written by disability examiners. After a disability doc has finished perusing a file, he or she will write an RFC (residual functional capacity form) that may or may not agree with what an examiner has "conjured". At any one time, a DDS medical consultant may have dozens of cases in his office which need reviewing. But in NONE, ABSOLUTELY NONE, of that time will one of these doctors ever see, touch, or feel one of the claimants that they are writing an RFC for. Can you make out the picture that I'm drawing. These doctors render VERDICTS on cases, in a way that is very impersonal, removed, bureaucratic, and even automated. And with the number of cases that come across their desks, it's hardly a wonder that MOST cases are given a medium RFC.

What is a medium RFC? It means several things, but in terms of exertional limitations, it means that a claimant is still expected to be able to, in the course of a workday, lifte 50 lbs occasionally and 25 lbs frequently. As an examiner, I saw medium RFCs given to claimants who, doubtless, would have difficulty lifting even 20 lbs once, let alone 50 lbs occasionally.

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