Social Security Disability Benefits for Arthritis

By / April 19, 2017 / Applying for Social Security Disability & SSI Benefits / 22 Comments

How to get Social Security disability benefits for arthritis. We’ll show you the guidelines, what documents you need, and what will help prove that arthritis impairs your ability to work.

The Social Security Administration (SSA) has developed a set of guidelines to determine when disability benefits would be appropriate for arthritis claims. Arthritis is an inflammatory disease that can range from mild to moderate to severe and debilitating, Depending on how severe your arthritis, you may be able to collect Social Security Disability (SSD) benefits. We will explain what you need to document and prove to qualify for benefits.

Causes and Symptoms of Arthritis
There are more than 100 types of arthritis, but osteoarthritis (also known as degenerative arthritis) is the most common one. It can occur in any joint in the body but is commonly found in the hands, knees, hips, and spine. This happens when the cartilage on two adjoining bones wears away and the ends of the bones begin to grate against one another. This causes an inflammation of the joints and pain.

There are many causes of this disease including obesity, age, excessive wearing of the joint, an injury, hereditary predisposition, or even an infection caused by bacteria or viruses. As people age, this disease becomes more of a problem. This is when hip and knee replacements are called for in hopes of regaining some lost mobility. Osteoarthritis in the joints of the hands is a difficult issue because treatment options are limited due to the small size of the bones and joints involved

Rheumatoid arthritis (an autoimmune disease) occurs when the body’s immune system attacks a membrane around the joint. The tissues swell and may deform the joint. The hands and fingers are typical locations for this, but it can spread to other joints and organs as well. Depending on the severity of the arthritis, this disease could hinder your ability to work or even make it impossible to do many daily tasks.

The progressive loss of the functional use of the hands and fingers can really impact a person’s daily life.

Documentation Needed
Proper medical records are essential in filing a successful disability claim with the Social Security Administration (SSA). Some of these needed records are:

  • Test results showing your functional and mobility limitations.
  • Imaging tests, such as MRIs, CAT scans, x-rays, or PET scans.
  • Laboratory results for inflammatory arthritis.
  • Blood work showing inflammatory arthritis or autoimmune disease markers.

Standards Needed For Claim Approval
Unfortunately, the Social Security Administration (SSA) does not approve most initial claims for arthritis. To be approved, it is important to submit all the supporting evidence you have. During an initial assessment, the Disability Examiner will determine:

  • Does your disease prevent you from working?
  • Is your condition expected to last for at least one year from when it caused you to either stop working or reduce your work so that after payment of impairment-related work expenses (IRWEs), your gross wages or net self-employment is not at the level of substantial gainful activity (SGA)? ($1,170 in 2017)
  • Have you been getting treatment for at least 3 months? And if so, how are you responding to treatment?
  • If you are currently working, did you earn $1,170 gross wages or net self-employment per month? If so, did you have IRWE’s that dropped your earnings below that amount.
  • Is the disease causing chronic pain and swelling and joint motion that makes it painful or restricted to a degree that based on your age, skills, previous jobs, mental capacity, and education are you incapable of working at a Heavy, Medium, Light, or Sedentary level?
  • Are you incapable of performing work

If all those questions show you have severe arthritis by Social Security’s standards and that you cannot work in any occupations that you could do if you didn’t have medical limitation, you should be approved for benefits.

Blue Book to Assess Impairments
SSA has prepared a list of impairments and gathered them in the Blue Book, for their disability examiners as a reference guide. This detailed list provides quick guidance for a review by the examiner to assess if your particular set of limitations is so severe that your work history, age, and education do not have to be considered in a disability determination. Each diagnosis listed must be accompanied by certain findings for the diagnosis to meet the listing and allow approval based on the listing.

SSA recognizes inflammatory arthritis could qualify as a disabling disease if it is accompanied by the following findings.

  • Deformity or swelling of an ankle, knee, or hip joint with:
    • At least two of the following symptoms: fever, loss of weight, fatigue, or a general feeling of discomfort.
    • At least two organs or systems affected with one being moderately involved.
  • Continuing or recurring bouts of inflammatory arthritis with a minimum of two systems impacted along with daily living tasks, cognitive functioning, or social activities being negatively affected.
  • Being unable to walk because of a deformity or inflammation of a weight bearing joint.
  • Continuing inflammation of one or more major arm joints in both arms severe enough to prevent normal daily activities, such as shopping, personal hygiene, feeding oneself, or driving.

Spondyloarthropathies (joint disease of the vertebrae of the spine) or Ankylosing Spondylitis (spinal joints becoming inflamed and fused).

How to Qualify For Benefits from a Back Problem
One of the most common osteoarthritis afflictions is when it attacks the spinal vertebrae. To meet the SSA’s spinal listing requirements, you have osteoarthritis diagnosed in your spine, as well as:

  • An inflammation of the membrane (arachnoid) which covers spinal cord nerves. This issue would require you to change positions twice or more every couple of hours.
  • Limiting the motion of the spine due to compression of the spinal nerve root causing problems with walking and bending.
  • Compression of the spinal canal in the lumbar area causing walking to be extremely difficult.

Impairment Listings for Individual Joints
 SSA has specific impairment listings for different joints of the body the disease could attack. A number of these listings deal with a person’s spine. These listings help disability examiners quickly approve cases for benefits if you meet the minimum requirements set out in the listings.

If you do not meet those requirements, there is another method to obtain approval for benefits. To accomplish this, you must be able to show the SSA your impairments are so severe they limit your ability to perform tasks required by jobs that you could otherwise qualify for. Examples of such impairments that might qualify you for benefit are being unable to sit for a long period of time, stand or walk for a distance, bend over, pick objects up, push or pull objects, carry objects, or manipulate objects.

Other Ways to Meet the Listings For Benefits from a Back Problem
If you do not qualify for benefits from the impairment listings for back problems, you may be eligible under a broader classification of a major dysfunction of a joint. To succeed with this category, you must have an obvious joint distortion. Such a distortion would be visible by using medical imaging techniques, such as, an MRI. Examples of such impairments are the joint being fused (ankylosis) or a compression of the space in a joint has occurred. Coupled with this would be a history of the loss of a range of motion, along with stiffness and pain in the joint.

A further requirement is the dysfunction must be occurring on both arms. It must exist in at least one hand, a wrist, an elbow, or a shoulder in each arm. Because of this stringent requirement, you must have a great difficulty in performing daily tasks such as preparing meals, performing daily hygiene, or completing simple house cleaning jobs without another person’s assistance.

A second option would be if your dysfunction existed in an ankle, a knee, or a hip causing much difficulty in walking. Illustrations would be if you were unable to climb a set of stairs at a reasonable speed even using a handrail; if you were required to use a walker, two canes, or two crutches; or needed another person’s help in the workplace, around the home, , or in activities such as shopping for groceries.

Residual Functional Capacity
If your illness or injury does not meet the listings, you can still qualify for benefits if your residual functional capacity (RFC) is such that you cannot perform any work that you would be qualified for absent medical limitations. Residual functional capacity is your ability to perform certain physical or mental functions. Your physician, if willing, can complete either a physical or mental RFC form for you. Sometimes the claims examiner will order a consultative examination for you so that an RFC evaluation can be made, but there is no guarantee this will be done. This test may be applied if the more straightforward limitation listings are not met by your particular circumstances.

When an RFC statement is available from your physician or obtained by SSA, it determines your physical or mental work capacity for an eight-hour shift, five-days a week. In the case of a physical evaluation, the final result will show if you are qualified to perform none, sedentary, light, medium, or heavy effort jobs. With the results from this test, the SSA will determine whether you are able to perform any type of work you are suited to perform even with your arthritis restrictions.

If performed, this evaluation is divided into two areas:

  • Upper Extremity
    If your arthritis affects your arms, hands, or shoulders, your RFC may show you do not have a full capability of lifting, pushing, gripping, or performing manual dexterity tasks, such as typing, writing, or filing. Even sedentary jobs could be difficult for you.
  • Lower Extremity
    If your spine or legs are affected by your arthritis, you could be limited in walking, bending, or climbing. Deskbound jobs may be the only ones you would be qualified to perform. This type of work would include sitting type jobs and would involve lifting no more than ten pounds. You could be required to stand or walk for up to two hours and carry light objects, so depending on the seriousness of your arthritis; you may even be disqualified for that type of work.

If your rating shows you are unable to perform sedentary jobs, you should be approved for disability benefits. If you are able to function in any of the sedentary, light, medium, or heavy classifications, the Disability Examiner will try to match your age, prior work history, skills, and education to potential occupations to see what other types of jobs you would be qualified to perform. Once you reach an age of 50 or so, the SSA will more likely have the opinion you would not be able to learn a new skill depending on your previous experience and educational background.

Rating Categories

  • A sitting job with no lifting is a Sedentary Rating.
  • A Light work rating would expect you to often carry 10 pound objects and be able to lift 20 pound objects. You would be expected to stand or walk for most of the day.
  • For a Medium rating work, you should be able to lift 50 pounds and often carry 25 pound objects during the day.
  • A Heavy rating means you can frequently carry 50 pounds with the ability to lift 100 pounds.

Inability to Do Any Work
In addition to the lifting, carrying, standing, sitting requirements, here are other examples to show an inability to do even sedentary work:

  • The need to take frequent sick days
  • Required to lay down during the day
  • Unable to focus on tasks
  • Necessity of keeping one leg elevated
  • Having vision problems
  • Being unable to work in a noisy environment
  • Being unable to work with others
  • Having balancing difficulties while standing or walking
  • Must switch between standing and sitting throughout the work day

Summary
If arthritis has taken away your ability to work, you may well qualify for disability benefits. These medical conditions are very complex and the limitations of your disease need to be presented to an SSA disability examiner very clearly to improve your chances for a successful claim approval. Because of this, it may be to your advantage to seek the help of an experienced attorney who specializes in Social Security disability cases.

Although many claims are denied initially, more are approved during an appeal process. You can represent yourself during this process, but your chances for approval will certainly rise if you have a Social Security Disability lawyer helping you with an appeal. By using an attorney who specializes in Social Security Disability law and procedures, you will be able to benefit from their knowledge in obtaining the properly worded medical paperwork, avoiding appeals or winning an appeal. Understanding the complexities of disability law could result in a favorable decision on your behalf. And, you may be able to avoid an appeal by submitting full information about your condition and limitations for your initial claim without depending on Social Security to request your records.

Social Security Disability Benefits for Arthritis
3.8 (75%) 4 votes

  • Dear Melinda,
    You previously said your checks were stopped in July. The payment for July 27 would be for July and the payment for July 28 would be for August. You will not receive another payment until September. You should also receive a notice explaining why these checks were issued.
    Sincerely,
    Jane

  • Dear Chef,

    The examiner is actively working on your claim, which is a good thing, and she has chosen to engage you in the process, presumably to be sure she gathers all the pertinent information. It is routine to request medical records, but not all examiners contact the claimant by phone.

    Sincerely,
    Kay

  • Dear Chef,

    You have posted this information several times, but you have not asked a question. If you have a question, please let us know and we will try to respond.

    Sincerely,
    Kay

  • Dear Mary,

    Apparently a decision was made on your claim and then it was randomly chosen for a quality assurance (QA) review to see whether the decision was correctly documented. Once the review has been completed either the decision will be supported or the claim will be sent back for more documentation. You should be notified when the review has been completed.

    Sincerely,
    Kay

  • Dear Paris,

    Here are the two answers that were given to you.

    Hi Paris,

    Without more information, its a bit difficult to answer your question. What medical records does the judge need? Why did she not have the medical records in time for the hearing? She could need more medical evidence because she is not yet convinced you are disabled or she might be convinced but want to make sure that outstanding medical evidence doesn’t show you’ve improved recently. So it’s very hard to tell. As to you wait, once all the evidence has been received and reviewed by the judge, the guideline is for her to get a decision to you within sixty days; however, it often takes longer. You can call the hearing office to find out where your claim is in the post-hearing appeal process.
    —–
    I answered most of your questions yesterday. As to how long it takes to get medical records, that really depends on the facility and the amount of records. You could be proactive by contacting the record departments of the facilities the judge is waiting for records from and ask them nicely if they can get the records back to the judge just a little bit sooner. Sometimes a personal request can help.

    May I offer the suggestion of either bookmarking the page with your computer browser or copying the URL (internet address) so you will have it to look up the right page later.

    Sincerely,
    Kay

    Sincerely,

  • Hi Paris,

    I answered most of your questions yesterday. As to how long it takes to get medical records, that really depends on the facility and the amount of records. You could be proactive by contacting the record departments of the facilities the judge is waiting for records from and ask them nicely if they can get the records back to the judge just a little bit sooner. Sometimes a personal request can help.

    Sincerely,
    Disability Adviser

  • Dear Wanda,

    If you are earning $1,170 gross or less per month, you can file an application while you are working; otherwise, you would need to either stop work or reduce hours and earnings to apply.

    I am unable to predict whether or not you would be approved. You must be disabled not only from the occupation you now perform but also from other occupations you could perform if you did not have medical limitations. Your work experience, age, and education are taken into consideration in addition to your medical condition.

    Sincerely,
    Kay

  • You are welcome, Donna.

  • Dear CJ,

    The vocational expert’s not identifying a new occupation that your husband can perform is testimony in your husband’s favor.

    If your husband is approved for Social Security Disability (SSD aka SSDI), benefits begin to accrue the later of twelve months before the month he applied or the sixth full calendar month of disability, as established by Social Security. If he is approved for Supplemental Security Income (SSI) and his established disability date is prior to his application date, his benefits will begin the month following the month of application unless he applied on the first of the month in which case benefits will begin with the month of application. Back pay will be paid up through the month before regular monthly benefits begin.

    Sincerely,
    Kay

  • Dear Donna,

    Refusing to wait for additional medical evidence and saying she has all she needs should be an indication that she is recommending approval of your claim. Of course, there is no guarantee. Plus she could submit an approval and the reviewing physician might not think what she submitted was enough supporting evidence. Regarding your question about the claims examiners, some stick to the facts and rules and some throw out clues.

    Sincerely,
    Kay

  • Dear Walter,

    I do not see what you are referring to when you refer to “these.”

    Sincerely,
    Kay

  • Dear Toni,

    The new rule means that all medical evidence and opinions are to be evaluated on the same basis without giving special consideration to the treating physicians’ opinions; it does not mean that the examiner or judge will necessarily accept the consulting physician’s opinion to be more valid. It would depend on which doctor backed up their opinion best with evidence.

    Sincerely,
    Kay

  • Dear Walter,

    What you cite sounds pretty much the same as always. Where did you see these published?

    Sincerely,
    Kay

  • Dear Walter,

    I have not been able to find rules changes effective May 1, 2017. Does the letter say what the changes are and how they affect the review of your appeal.

    There were some rule changes that were effective on March 27, 2017. One of the new rules effective March 27, 2017 was that extra weight will no longer be given to your own physicians over a consulting physician with whom you have an evaluation at Social Security’s request or over Social Security’s medical consultants. Similarly, extra weight will not longer be given to determinations by other agencies such as the Veterans Administration. Other changes were to the claimant’s advantage such as including physicians assistants and certain Advanced Practice Registered Nurses as acceptable medical sources.

    Sincerely,
    Kay

  • You are welcome, Donna.

  • Dear Donna,

    Evidence you send directly is supposed to be considered. Whether or not the examiner, who sounds overwhelmed, does so is another story. You can ask her to do anything, but you have no control over whether she does.

    I suggest that your main focus, rather than trying to get the supervisor involved would be to make sure that your missing records get sent in. At most, after they are sent, you could ask to talk to a supervisor and then say that the examiner didn’t request the right dates and seemed reluctant to review any you sent directly and you want to be sure they are considered. If you can get the doctors’ offices to send in the information, they could perhaps use a copy of the fax cover sheet with the bar code but show that it has come from them and not you. If that seems too much for you, get the missing records and send them yourself.

    A full review is supposed to be completed for both an approval or denial, so in theory it should not be easier to deny than approve, although your idea that a consultative examination was requested may not be too far off.

    If you are denied, request a copy of the claim file to help you address the critical points in your appeal and hopefully avoid having to appeal again and wait a year or more for a hearing.

    Sincerely,
    Kay

  • You are welcome, Walter.

  • Dear Walter,

    Your attorney saying that your case is a complex one is probably good in the sense that he or she recognizes that it is complex and will work to address the issues. There is no way to know whether you will be approved or not, but the attorney would not have taken your case if there were not a reasonable possibility of approval. The one comment I would have is that if your or your attorney has not gotten a copy of your claim file, it would be advisable to do so to see the exact reasons for denial and to check all the evidence you want considered is in file.

    Sincerely,
    Kay

  • You are welcome, Donna.

  • Dear Donna,

    Each person’s combination of illness, symptoms, and medical care is different, so while there are general guidelines, there is not specific medical treatment that must be received for a claim to be approved. In your case, you were being treated for symptoms for a period of time before the diagnosis; you just start going to the doctor, get a diagnosis and apply; so you prior efforts to get treatment are rather like “time served.” In other words, I wouldn’t worry about it. When you go to the consultative examination (CE), point out the lumps to the doctor.

    Sincerely,
    Kay

  • Dear Donna,

    I encourage you to make certain that your physicians send in your medical documentation because it sounds as if you cannot count on the examiner to request the records. The records from 2016 when one of the underlying problems was discovered will be important with regard to documenting test findings that lead to correct diagnosis. Lastly, you have the right to submit your own statement about your activities of daily living without the form, but it might be better to do so only if you are denied and have to appeal, given that the examiner did not want to consider such a statement.

    Sincerely,
    Kay

  • Dear Lisa,

    The majority of your friend’s income is coming from Supplemental Security Income (SSI), which is a public assistance program. This means that the benefits are quite low. Rent in government-subsidized housing is one-third of income. I suggest that your friend apply for public housing, either publicly owned property or Section 8 housing. With his severe disability, he might get priority placement or not have to be on a waiting list for too long.

    Sincerely,
    Kay

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