Social Security Disability Benefits for Arthritis

By / April 19, 2017 / Apply for SSD / 12 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 or moderate, to severe and debilitating, which will affect your ability to collect and how much you can collect, from Social Security Disability (SSD). We will explain what you need to document and prove to qualify for benefits.

Causes and Symptoms of Arthritis
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.

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.

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.

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

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.

Documentation Needed
Proper medical records are essential in filing a successful disability claim with the 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. Only after your arthritis has been treated for three months, will the SSA review your claim. 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 started?
  • 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 $1170 per month or less? (2017 standards).
  • Are you incapable of working at a Heavy, Medium, Light, or Sedentary level?
  • Is the disease causing chronic pain and swelling and joint motion that makes it painful or restricted?
  • Are you incapable of performing work based on your age, skills, previous jobs, mental capacity, and education?
  • Is it impossible for you to be trained to perform any similar work?

If all those questions show you have severe arthritis by Social Security’s standards and no other jobs would be appropriate, you should be approved for benefits.

Blue Book to Assess Impairments
The SSA has prepared a list of impairments, called 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 severe enough to qualify you for benefits. The SSA recognizes inflammatory arthritis could qualify as a disabling disease, and here are some examples of the impairments the examiner will consider:

  • 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).

Impairment Listings for Individual Joints
The 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 most jobs. Examples of such impairments are– being unable to sit for a long period of time, not able to stand or walk for a distance, not able to bend over, cannot pick objects up, the inability to push or pull objects, or not able to carry objects.

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 and causes problems with walking and bending.
  • Compression of the spinal canal in the lumbar area.
    This causes walking to be extremely difficult.

Other Ways to Qualify 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 impairments would include if the joint was 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; needed another person’s help around the home, or to do work, or to go to a store for groceries.

Residual Function Capacity Test
A third method of qualifying for benefits is with a Residual Function Capacity Test (RFC). This test is applied if the more straightforward limitation listings are not met by your particular circumstances.

It determines your physical work capacity for an eight-hour shift, five-days a week. 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 what type of work you are suited to perform even with your arthritis restrictions.

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 fall 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 see what other types of jobs you would be qualified to perform.

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.

However, 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.

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 a 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 most such 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.

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.

Social Security Disability Benefits for Arthritis
5 (100%) 1 vote

  • 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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