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The requirements for filing for disability with arthritis




 
"If I have arthritis, what are the medical requirements for Social Security disability?"

Arthritis may be determined to be a disabling impairment for the purposes of Social Security disability or SSI provided it prevents you from working at the Substantial gainful activity, or SGA, level. SGA is a monthly earnings limit that Social Security considers to be self-supporting, therefore you would not be considered disabled if you were earning over SGA.

In fact, Social Security claims representatives must evaluate your work activity during their disability interview process. If you are performing SGA-level work activity, they will deny your disability claim without considering any of your medical evidence.

As with any condition, there are two ways of being approved for disability. The first method of being awarded disability benefits is by satisfying the criteria of a Social Security listing.

Social Security will evaluate the severity of your arthritis with Social Security impairment listing 1.02.

1.02 Major dysfunction of a joint (s) (due to any cause).

This dysfunction must be evidenced by subluxation, contracture, bony or fibrous ankylosis, or instability. And, you must have stiffness and chronic joint pain characterized by a limitation or abnormal motion of the affected joint or joints.

In addition to the above-mentioned criteria, you must have:

A. Involvement of a major peripheral weight bearing joint (hip, knees, or ankle) that results in an inability to ambulate effectively.

Social Security’s definition of effective ambulation is as follows:

An individual must be able to sustain a reasonable walking pace for a sufficient distance, so as to allow for activities of daily living. They must be able to do this without the help of a companion’s assistance to and from a place of employment or school.

Ineffective ambulation might include the inability to walk without the assistance of a walker, two crutches, or two canes. Or, the inability to walk a block at a reasonable pace on rough or uneven surfaces, use standard public transportation, carry out routine activities (shopping, banking, household chores, etc.), or the inability to climb a few steps at a reasonable pace with the use of a single hand rail.

For the purposes of Social Security disability determinations, the ability to walk independently in one's home without assistive devices does not, in and of itself, constitute effective ambulation.

OR

B. Involvement of one major peripheral joint in each upper extremity (wrist-hand, elbow, or shoulder) that prevents the ability to perform fine and gross movements effectively.

Social Security’s definition of inability to perform fine and gross movements effectively is as follows:

An extreme loss of function of both upper extremities that interferes significantly with an individual’s ability to independently initiate, sustain, or complete activities. In order to use upper extremities effectively, an individual must be able to sustain functions (pushing, pulling, grasping, reaching, and fingering) that enable them to carry out activities of daily living.

Some examples of an inability to perform fine and gross movements effectively might include (but are nor limited to) the inability to prepare simple meals, feed oneself, take care of personal hygiene, short or handle papers or files, or place files in a cabinet that is at or above waist level.

The impairment listing provides the Social Security approval criteria needed to meet or equal 1.02. If your arthritis is severe but does not meet the listing criteria, you may still be able to be medically approved for disability benefits through a medical vocational allowance. These allowances involve an evaluation of your work prior to becoming disabled, your job skills, your age, your education, and the functional limitations caused by your arthritis.

If the disability examiner determines that your arthritis is so severe that it would prevent you from performing any of your past work, and any other kind of work when the above requirements are considered, you may be approved for disability benefits for arthritis.

Resources:

1. Can I get disability for arthritis?
2. Applying for disability with Rheumatoid Arthritis
3. Can I get SSI for RA, Rheumatoid Arthritis?
4. Will Carpal Tunnel Syndrome and arthritis in my hands qualify for disability?


Qualifying for disability benefits without satisfying a listing

If you cannot satisfy the criteria of a listing, then whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records, as well as the information gathered from your history of work (which will allow Social Security to determine your skills, and the requirements of your past work).

This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.

In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.



Work history and how it affects a claim

As said, if you cannot be approved through a listing, then qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child.

In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.

The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).



Why are so many disability cases lost at the disability application and reconsideration appeal levels?

There are several reasons but here are just two:

1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.

Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.

2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.















Return to:  Social Security Disability Resource Center, or read answers to Questions





























Related Body System Impairments:

Applying for disability for arthritis and medical treatment
Can I file for disability because of arthritis if I am still working?
Requirements for filing for disability with arthritis
Am I disabled with degenerative arthritis, bone spurs in neck, spine and hips, and joint space narrowing?
Will Carpal Tunnel Syndrome and arthritis in my hands qualify for disability?
Carpal Tunnel Syndrome and Filing for Disability
Osteoarthritis and Filing for Disability
Repetitive Stress Injury and Filing for Disability
Facet Arthritis and Filing for Disability
Polymyalgia Rheumatica and Filing for Disability
Rheumatoid Arthritis, Social Security Disability, and Applying for Benefits
Psoriatic Arthritis and Filing for Disability
Rheumatoid Arthritis and Filing for Disability
Arthralgia and Filing for Disability



Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI


These pages answer some of the most basic questions for individuals who are considering filing a claim.

How to Apply for Disability - What medical conditions can you apply and qualify for?
How long does it take to be approved for SSI or Social Security disability?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it