Arthritis and Social Security Disability: What to Know
How to Prove Disability for Arthritis if Joint Damage Makes It Difficult to Work
Are you or a family member one of the millions of Americans who have arthritis that limits mobility, lessens the quality of life, and makes it challenging to work? This article can help.
Arthritis is a term that describes more than 100 medical conditions that cause pain, swelling, and stiffness in the joints and the tissues surrounding the joints. Some types of arthritis also affect the immune system and the body’s internal organs.
Together these conditions affect more than 50 million Americans of all ages and backgrounds, resulting in disability, despair, decreased mobility, and time missed from work and school.
Indeed, arthritis costs tens of billions of dollars in lost earnings and health care each year. Therefore, it is no surprise that arthritis is a leading cause of the need for workers compensation benefits (wage loss payments, medical care, lump sum settlements).
Medical researchers and health care providers have developed many treatments for arthritis, such as medications, physical therapy, weight loss programs, and surgery.
But what if these options do not work, and you cannot manage the symptoms enough to stay employed? What other solutions are available?
This article will discuss Social Security disability for arthritis and how it may be an option to consider if you cannot control the symptoms well enough to work.
If you have questions after reading this article or want to hire a top-rated disability lawyer for an arthritis claim, call (804) 251-1620 or (757) 810-5614 or complete the online contact form.
What are the Types of Arthritis?
Many diseases cause joint pain and swelling.
However, a person with “arthritis” usually has one of the following conditions:
Ankylosing Spondylitis
Ankylosing spondylitis is a type of arthritis that affects the spine, usually where the spine meets the pelvis. It is more common in men than women.
Ankylosing spondylitis causes inflammation between the vertebrae, the spinal column’s building blocks. The vertebrae protect the spinal cord and allow you to move, walk, twist, and get around.
Over time, ankylosing spondylitis can fuse the vertebrae, causing pain and limiting movement.
Though there is no cure, prescription medication, exercise, and a healthy diet can stop the disease’s progression and relieve some symptoms.
However, surgery can be beneficial for arthritis impacts the nerve roots or the entire joint needs replacing.
Gout
Gouty arthritis occurs when uric acid crystals accumulate in the joints, causing inflammation.
At first, gout usually occurs in only one joint. However, with time, it can impact multiple joints at once.
Gout attacks can happen suddenly, causing intense joint pain (usually affecting the big toe, ankles, or wrists) and swelling. These attacks, which may last for hours, are often crippling.
Osteoarthritis
Osteoarthritis, also known as degenerative joint disease or degenerative disc disease, is the most common type of arthritis, impacting more than 30 million U.S. adults.
Osteoarthritis begins when cartilage begins to break down. Over time, the bones in the joint change, resulting in symptoms.
You can experience osteoarthritis in any joint – large or small. However, osteoarthritis most often affects the weight-bearing joints (spine, knees, hips) and the hands.
There are several risk factors for osteoarthritis. These include:
- Gender (osteoarthritis affects women more than men – more than 25% of females have some degree of osteoarthritis by age 65)
- Obesity
Psoriatic Arthritis
Psoriatic arthritis is a chronic condition that typically occurs in people with skin psoriasis (though there are exceptions).
Psoriatic arthritis usually affects the larger joints, particularly the legs, toes, and feet. But it can also affect the back and sacroiliac joints, resulting in spondylitis.
Usually, this condition appears in people between 30 and 50, but it may develop in childhood.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune disease where your body’s immune system attacks healthy cells, causing inflammation and deformity.
This attack impacts many parts of the body at once, including the joints. And the joints in the fingers, wrists, elbows, and knees often endure the damage in the form of bone erosion.
You have a greater risk of suffering from rheumatoid arthritis if you:
- Are female
- Smoke tobacco
- Have a family member with rheumatoid arthritis
- Are obese
- Have suffered previous joint damage from an injury, such as a herniated disc in a car crash
Is There a Cure for Arthritis and Rheumatic Diseases?
No.
Unfortunately, there is no known cure for arthritis of any type.
However, different treatment options are available depending on the type of arthritis and how far it has progressed. These options include:
- Cannabis (medical marijuana)
- Diet (to reduce the weight you put on the joint)
- Exercise
- Joint replacement surgery (total or partial arthroplasty)
- Occupational therapy
- Orthotics to help body mechanics
- Orthopedic bracing
- Pain management (including steroid injections)
- Physical therapy
- Prescription medication (including oral and topical medicines)
- Transcutaneous electrical nerve stimulation (TENS unit)
What Are the Disability Benefits for Arthritis?
There are two types of disability benefits available for people with arthritis: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
Both programs share the same medical requirements. Therefore, if you are disabled under one, you are medically disabled under the other.
However, they have different non-medical requirements, waiting periods, monthly benefit amounts, and potential back pay (accrued benefits).
SSDI for Arthritis
Social Security Disability Insurance is available to anyone who has worked and paid into the social security system and meets the medical requirements. Typically, this means you have worked (and paid FICA taxes) ten of the last 20 quarters (five of the past ten years).
Your SSDI benefit amount depends on how much you earned during your career. The more money earned, the greater the SSDI payment – until the cap.
Further, SSDI allows you to receive a significant amount of back pay potentially.
For example, you applied for SSDI benefits in January 2022 but claimed you have been disabled since January 2021. The Social Security Administration (SSA) may agree with you, which would allow your back pay to begin accruing well before you applied. This is because the SSA can find you disabled up to 17 months before you applied for SSDI.
However, a five-month waiting period applies to SSDI claims.
For example, if the SSA determines you became disabled in January 2021, you are not eligible for SSDI benefits until June 2021.
SSI for Arthritis
On the other hand, Supplemental Security Income (SSI) is available only if you have limited income and resources in addition to a severe health condition. In addition, SSI does not require that you have ever worked before, but there are limits on the number of assets you may hold when applying.
If you receive approval for SSI, you will receive a pre-determined amount of money each month. Everyone who qualifies for SSI gets the same amount, subject to adjustment for household earnings. Therefore, your benefit does not depend on how much you earn during your career.
Because of this, SSI typically pays less than SSDI.
Another disadvantage of SSI is that you cannot receive back pay before the date you applied. So you must submit your application right away.
However, SSI does not have a waiting period, which helps offset this disadvantage.
Disability Benefits Can Help Cope with Chronic Pain by Relieving Financial Stress
If you live with chronic pain from arthritis, you know how challenging simple, everyday activities can become. And how these challenges can take a toll on mental health.
Living without income or disability payments is difficult at best but unbearable to manage if you are also trying to cover basic expenses like rent, childcare, groceries, utility bills, and other costs.
Disability benefits can offer some relief by providing financial assistance for necessities (food, water, shelter, clothing, personal hygiene, power for your home) so that you do not have to try to work and risk re-injury or worsening your condition. This can reduce some stress and allow you to focus on getting better without worrying about how you will pay your rent or afford groceries this month.
Disability Benefits Offer Access to Health Care and Home Modifications
Qualifying for disability benefits will make you eligible for Medicare or Medicaid, depending on whether you receive SSDI or SSI.
You can use this health care coverage to cover medical expenses related to arthritis, including medication, surgery, pain management, therapy, and durable medical equipment (crutches, wheelchairs, canes)
However, Medicare and Medicaid do not cover all types of health care for arthritis.
Therefore, you can use the disability benefits for arthritis to cover co-pays and deductibles and alternative treatment methods such as acupuncture and supplements/herbal remedies.
Further, Medicare does not cover home modifications.
Therefore, you can use the disability benefits for home modifications to help you deal with challenges from arthritis symptoms.
Standard vehicle and home modifications for people living with arthritis include:
- Installing wheelchair ramps or railings if you have limited mobility
- Widening doorways and hallways to make maneuvering around the house easier
- Lowering countertops and cabinets in the kitchen, so they are more easily accessible
- Adding grab bars next to toilets and in showers/bathtubs
The options for home modifications are endless, so discuss what you would need with your doctor, case manager, or social worker if you decide to apply for disability benefits due to arthritis.
What Evidence Do You Need to Get Disability for Arthritis?
The Social Security Administration uses a five-step sequential evaluation process to determine claims.
You have the burden of proof for the first four steps. However, this burden shifts to the SSA at step five.
Let us look at what you need to prove to obtain disability benefits for arthritis and what evidence you can offer to do so.
Are You Working?
The first step to receiving disability for arthritis is proving that you are not working or earning more than a specific amount per month.
If you are working and making more than this amount, you are engaged in substantial gainful activity (SGA). And persons performing SGA cannot receive disability benefits – no matter how bad their symptoms or how much money they are losing because of the condition.
Typically, you prove that you are not engaged in SGA through testimony and the earnings records pulled by the SSA.
Have You Been Diagnosed with Arthritis, and Is It a Severe Health Impairment?
Next you must prove that a health care provider diagnosed some form of arthritis. And that your condition is one that severely impacts your ability to function.
The SSA will consider arthritis a severe medical impairment if it significantly limits your ability to do everyday activities, such as dressing yourself, bathing, or cooking.
Do You Meet one of the Disability Listings Applicable to Arthritis?
The SSA has a Listing of Impairments (listings) that describe severe medical conditions that are so severe it will presume they prevent a person from performing gainful activity regardless of their age, education, or past work.
The listings do not include all possible medical conditions. But for those included the listings state the specific medical criteria an applicant must meet for the listing to apply.
If you satisfy the criteria, the SSA will find you disabled.
If you do not – and many people do not – the SSA will move to the next steps in the valuation. Indeed, only 10 percent of the people found disabled by a musculoskeletal disorder meet a listing. The other 90 percent are found disabled at a later step.
The following impairments might apply to your arthritis claim:
- 1.15: Disorders of the skeletal spine resulting in compromise of a nerve root
- 1.16: Lumbar spinal stenosis resulting in compromise of the cauda equina
- 1.17: Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint
- 1.18: Abnormality of a major joint in any extremity
- 11.08: Spinal cord disorders
- 14.09: Inflammatory arthritis
I recommend that you review these listings and their stated criteria when seeking disability benefits for arthritis. They provide an overview of the type of evidence you should develop and present.
How Does Arthritis Limit You?
You should present testimony and medical evidence about the areas listed below.
To present your claim effectively, I recommend submitting medical records, hospital admission/discharge summaries, operative reports, and pharmacy records – anything that can help your case.
I also recommend asking your doctor for a disability letter explaining your diagnosis, clinical findings (objective and subjective), and limitations from arthritis. For example, a disability report from an orthopedic surgeon or neurologist can persuade the judge to award benefits.
- Accidents: Tell the judge about any motor vehicle crashes or work accidents you have had that contributed to your arthritic condition.
- Age: You have a greater chance of receiving disability for arthritis if you are 50 or older.
- Arthritic pain: Tell the court about the location, distribution, intensity, and frequency of your pain from arthritis. For example, tell the court if the pain radiates from your back down your legs. Or if the pain burns.
- Assistive devices: Tell the court if you have a prescription for or need a walker, canes, or crutches to get around.
- Comorbidities: Adults with arthritis are more likely to suffer from obesity (testify to height, weight, and weight fluctuations), diabetes, heart disease, chronic fatigue, and depression. Each of these conditions may limit you further.
- Diagnostic imaging: Use any X-rays, MRIs, or CT scans you underwent if they are helpful. If they are underwhelming or negative, then ask your treating physician to explain the relative lack of correlation between imaging findings and damage to the joint, particularly during the initial stages of arthritis. The medical literature supports it.
- Difficulty using your upper extremities: If arthritis causes an inability to use your arms or hands, tell the court specific examples of your troubles. For example, explain how often you drop things or the problem reaching overhead to get something out of a cabinet.
- Emotional impact: Arthritis causes physical symptoms that may worsen your mental health. I recommend asking your doctor to evaluate your mental health or refer you to a psychologist or therapist if your symptoms seem out of proportion to objective findings on imaging.
- Frequency of gout attacks (if applicable): Gouty arthritis comes in waves. Describe the frequency of the attacks and how long it takes to get back to baseline after you have one.
- Inability to ambulate: Tell the court how far or long you can walk at a reasonable pace without help and what challenges you have going up and down stairs, walking over uneven surfaces such as hills, and completing tasks such as grocery shopping. I also recommend describing your gait. If you limp, tell or show the court.
- Inflammation: Explain to the court where you have swelling, how often you have it, and what relieves it. For example, tell the court if you must regularly elevate your legs above waist level due to swelling.
- Medical treatment: Arthritis treatments are not always successful or effective in reducing pain levels or improving mobility. Tell the court about your efforts and how they failed if you have tried standard treatment options, including surgery, with little to no success.
- Medication side effects: Some arthritis medicines help pain and other symptoms but cause drowsiness, fatigue, or headaches.
- Past work history: Tell the court, in detail, about each physical requirement of your past jobs and how your arthritis prevents you from performing specific tasks. Even sedentary desk jobs include job duties that are tough to do with arthritis.
- Physical examinations: Exams showing muscle spasms, limited range of motion, and consistent pain complaints to your doctors strengthen your claim.
- Postural activities: Tell the court how arthritis symptoms limit your ability to lift, carry, push, pull, squat, kneel, crouch, or crawl.
- Social life: Explain how symptoms from arthritis have diminished your quality of life and prevented you from seeing friends, going out to eat, etc.
- Work attempts: Testify about jobs you have lost or quit because arthritis interfered with your abilities. This anecdotal evidence bolsters credibility.
Why Should You Hire a Disability Lawyer for an Arthritis Claim?
If arthritis impacts your ability to work, live independently, or participate in activities that you enjoy, then disability may be a helpful solution.
And if you want to apply for disability benefits because of arthritis, speaking with an experienced disability attorney is the right move. A lawyer can help you understand the application process, what evidence you will need to provide, and the likelihood of success.
A top-rated SSD lawyer can also talk with your doctors and present your case before the administrative law judge (ALJ) assigned to your claim. Familiarity with how that judge runs their courtroom is invaluable in close cases requiring an evidentiary hearing.
Some of you might be reading this page after the SSA has denied your application for disability benefits.
Do not worry. It is not too late to act.
You might have appeals available to you. But if not, you can reapply for Social Security disability after receiving a denial. For example, many of my clients hire me after losing their initial claim with other representation.
Hire a Disability Attorney Today!
The Social Security disability process has been called a maze. And that description fits.
Fortunately, you do not have to navigate the maze alone. Instead, you can hire an experienced, dedicated, and reliable lawyer to help you obtain disability benefits for arthritis and joint damage.
If you are ready to get the back pay and monthly benefits you deserve so that you can focus on managing symptoms from arthritis, contact me for a free consultation. You can reach me by e-mail at cpollardjba@gmail.com, telephone at (804) 251-1620 or (757) 810-5614, or online.
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