Can you win a Social Security Disability or SSI case if you have ankylosing spondylitis?
Ankylosing spondylitis is seen regularly on Social Security Ddisability and SSI disability applications. It is a spondylarthropathy and an autoimmune disorder that causes stiffening of the spine and damage to various other joints. In severe cases, it can affect the eyes (iritis), causing the need for cortisone eye drops, affect the heart (inflammation of the aorta and damage to heart valves), and can also affect essential weight-bearing joints (in some cases, requiring total joint replacement). Ankylosing spondylitis can also impair one's breathing by limiting the ability of the ribcage to expand.
Filing a disability claim with this condition
Can you win a Social Security Disability or SSI case if you have ankylosing spondylitis? As with any medically diagnosed condition of a physical or mental nature, if the condition prohibits or substantially limits your ability to work, there is the potential that it may qualify you to receive disability benefits. You may be approved for disability benefits under the SSD or SSI program if a medically determinable impairment results in your inability to work and earn what the Social Security administration considers to be a substantial and gainful income.
If that is the case, you should consider filing an application for disability benefits. And you should do it as soon as possible. If you've already filed a claim, of course, and have been denied, you may want to seriously consider finding competent and qualified representation to maximize your chances of winning your case. This should absolutely be done if your case will be heard by an administrative law judge, or ALJ, at a hearing and perhaps should also be done if the case is at the reconsideration appeal level since approximately 90 percent of those appeals are routinely denied, thus requiring the need to request a disability hearing.
The disability determination is made through a five step method of deciding claims. In this five step process, SSA will decide whether or not a person's condition has been disabling (to the extent that it prevents substantial and gainful work activity) according to the SSA definition of disability for at least one full year. This one-year period is the minimum duration time period required for determining if a condition is disabling.
Note: an individual does not have to be out of work for one year before filing a disability claim with SSA. In the course of evaluating a claim, a disability examiner or judge can review the medical evidence and project whether or not the individual's condition is severe enough that it will ultimately last a full year. If it is thought that it will last less than that time, it will be denied on the basis of "duration".
As part of the five step sequential evaluation process, a decision-maker will investigate to see whether or not the claimant has a condition that satisifies what is referred to as a listing.
Being approved for disability through the listings
There is no specific listing set aside solely for ankylosing spondylitis. However, ankylosing spondylitis is given consideration under listing 14.09 which is part of section 14.00, Immune System Disorders. Listing 14.09 is for inflammatory arthritis and ankylosing spondylitis is covered under part C.
To receive consideration for ankylosing spondylitis in listing 14.09 you must have a diagnosis of Ankylosing spondylitis or other spondyloarthropathies with:
1. Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 45' or more of flexion from the vertical position (zero degrees); or
2. Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 30' or more of flexion (but less than 45') measured from the vertical position (zero degrees), and involvement of two or more organs/body systems with one of the organs/body systems involved to at least a moderate level of severity.
D. Repeated manifestations of inflammatory arthritis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
1. Limitation of activities of daily living.
2. Limitation in maintaining social functioning.
3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.
What happens if a person does not get approved on the basis of this listing? They may also get approved through the medical vocational decision process in which their medical records and work history are reviewed to determine if their condition is so severe that they no longer possess the abiltiy to go back to their past work and do not possess the ability to perform some type of other work for which their age, education, current capabilities (mental and physical) and job skills might make such work suitable.
These two pages discuss this topic in more detail:
1.How Will Social Security Decide a Disability Case that's filed?
2. Medical Vocational Allowance Approvals for Social Security Disability and SSI.
More about the condition itself
Ankylosing spondylitis, like other autoimmune problems, seems to involve a genetic basis; however, this seems to be more of an inherited predisposition to developing the condition versus the condition being directly passed on. And while the autoimmune disorder MS seems to affect three times as many women as men, ankylosing spondylitis seems to affect men predominantly, with the male to female ratio being close to 2 to 1.
The keys to limiting the severe effects of ankylosing spondylitis are 1. proper diagnosis and 2. proper treatment. When the condition is diagnosed and a medication regiment is set in place to tackle the inflammation that comes with ankylosing spondylitis, it can be held in check. However, the symptomology of ankylosing spondylitis is sometimes mistaken for the symptoms associated with other conditions, such as mechanical lower back strain.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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