Arthralgia and Filing for Disability
Social Security considers arthralgia (joint pain) to be a severe medical condition that may impact an individual's ability to engage in work activity. Therefore, it is an acceptable medical condition to include on an application for SSD or SSI disability.
Some of the most common causes for arthralia are gout, lupus, arthritis, inflammation, bursitis, traumatic injuries, fibromyalgia, osteoporosis, or certain types of cancer.
If an individual is filing for disability on the basis of arthralgia (joint pain), there are a few ways they could be approved for disability.
The most common listing that they could meet or equal would be the Musculoskeletal listing, 1.02, Major Dysfunction of a Joint. This listing requires that they meet one of these two conditions in addition to having medical imaging which shows joint damage.
1. Both upper extremities (hand, wrist, elbow, or shoulder) affected to the point that they are unable to effectively perform either gross or fine movements. <!middle_ad_-->
2. One weight bearing joint (ankle, hip, or knee) affected to the point that their ability to walk is significantly affected.
Or, they may be able to meet the requirements of an impairment listing for the underlying cause of their arthralgia.
For example, if the joint pain is caused by cancer, they could be evaluated under 13.00, Malignant Neoplastic Diseases, or they may equal a listing in 14.00, Immune System if their joint pain is the result of lupus or rheumatoid arthritis. If the requirements of any impairment listing are met, they will be approved for disability benefits.
Unfortunately, many disability applicants have significant pain and limitations that render them unable to work, but they still do not meet the requirements of an impairment listing. Even so, they still may be able to be approved for disability but to prove their disability they must be able to substantiate that they are unable to work in a manner that is self-supporting due to their ongoing joint pain.
It is especially important in this kind of disabilty case that their medical evidence include lab testing, MRIs, CT scans, x-rays, or any other evidence that shows that the joint pain is the result of a verifiable medical condition. It is good to have detailed physician notes that describe their joint pain, the cause of their joint pain, treatment, medications, surgeries, and limitations.
Equally important to the determination process is the vocational work history because it provides detailed information about work history. The work history should include types of work done, the functional requirements of each of their jobs, and what job skills they might have that could allow a person to be reasonably trained for some other kinds of work.
Social Security will use both medical records and work history to make their determination as to the disability applicant's ability to perform substantial work activity. If they are able to show that arthralgia is so severe that it precludes all past work and other types of work, they may be approved for disability.
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition Arthralgia
1. If the word arthralgia sounds familiar to you, it is probably because you know the word arthritis. Arthralgia, like arthritis, means joint pain. Arthritis, however, is joint pain due to inflammation. Arthralgia is the term used to describe the condition caused by non-inflammatory joint pain.
2. Arthralgia is a symptom that occurs due to another condition. Allergic reactions, particularly to medications, can cause arthralgia. Injuries, such as sprains and strains from overuse or exertion, can also cause the symptom. Other conditions include autoimmune diseases (lupus is one example) and infectious diseases (such as hepatitis, influenza, Lyme disease, measles and mumps) can be underlying conditions causing non-inflammatory joint pain.
3. Diagnosing arthralgia requires determining the underlying condition causing the pain. This is first approached in the form of an interview, followed by a physical examination and blood work testing. The interview is framed with questions that help determine the most probable source of arthralgia and therefore the appropriate tests can be administered.
4. Arthralgia can be treated by addressing the underlying condition. Treatment can be as simple as stopping the medication causing an allergy or taking antibiotics for an infection. It can be as intensive as joint replacement or controlling immune system dysfunction with immunosuppressant drugs.
5. Alleviating pain through medication such as over the counter pain medications, like ib profen, or prescription pain killers, can also be a part of treatment.
6. Other pain management techniques can also be helpful through the course of arthralgia, depending on what is causing the symptom. Rest, warm baths, stretching and other light exercises, as well as massage therapy and chiropractic care, may all contribute to alleviating joint pain.
7. Almost everyone is likely to experience some degree of pain from arthralgia during their lifetime, due to the number of conditions that can cause arthralgia. However, women are more likely than men to experience this symptom as a consequence of another condition, and age seems to increase the likelihood as well.
Qualifying for disability benefits with Arthralgia
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.
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.
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.
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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