Nancy Withers, Michelle Parsons, and Maureen Nowak
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General Issues

How to meet Listing 1.04A Disorders of the spine

The information below explains listing 1.04 “A” disorders of the spine. Many people have spine pain listing 1.04 “A” address pain from the spinal cord being pinched or compressed.

“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:
“A. 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).”
You will meet listing 1.04A if you have:
• A disorder of the spine (examples, herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis, degenerative disc disease, facet arthritis, vertebral fracture);
• Resulting in compression of a nerve root or spinal cord;
• With evidence of nerve root compression;
• Characterized by–
o neuro-anatomic distribution of pain,
o limited range of motion in the spine,
o loss of motor function from atrophy with muscle weakness or muscle and loss of reflexes, and
o if there is involvement of the lower back, positive straight-leg raising test.
Many problems can occur causing compression in the spine, such as herniated disks, bone spurs, arachnoiditis, cancer, and benign tumors. Objective evidence (CT or MRI scans) of the diagnosis is necessary to meet the listing. The result of testing does not necessarily explain the symptoms a person feels. When Social Security evaluates back pain consideration must be given to the pain the individual feels. Generally, when the spinal cord is pinched there is radiating pain or neuro-anatomic distribution of pain. Neuro-anatomic pain refers to nerve pain.
When Social Security reviews medical evidence for motor loss (muscle weakness with or without associated atrophy) they are looking for muscle size of the impaired limb compared to the unimpaired limb. For example, a patient may have pain radiating from the low back down the right leg with atrophy of the right leg. A measurement documenting the right leg is smaller in diameter than the left would support a diagnosis of atrophy in the right leg. Atrophy of a limb is very convincing evidence of severe nerve root compression.
Sensory reflex loss means a change in reflexes. In other words when the doctor taps on the knee of the impaired leg the leg does not jump. When the leg does not jump it could mean there is pressure on a nerve root. Changes in leg reflexes are a sign of nerve compression. For example, low back pain with right leg pain and a change in the reflex of the right leg would be a sign of nerve root compression in the low back. Another sign of nerve root compression is numbness in the right leg.
Representative Services frequently receives calls concerning the inability to work due to low back pain. However, very few claimants meet the listing. Most claims for low back pain with radiating pain to a limb are approved because of the person’s limitation in the ability to walk more than very short distances, stand, sit, lift and carry.
For more information feel free to send us an email or call us at 515-271-8186.

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