What are the requirements for disability with arthritis?
Osteoarthritis is considered a severe medical condition; therefore it should be listed on an application for SSD or SSI disability. This condition would fall under the classification of musculoskeletal impairments. The Social Security Disability Blue Book listings address musculoskeletal conditions under adult listing 1.00, Musculoskeletal System ' Adult.
Social Security defines musculoskeletal impairments as a disorder that could be the result of congenital or hereditary conditions, or pathologic processes. They may also be the result of degenerative, infectious, traumatic or developmental events, vascular, toxic/ metabolic diseases, inflammatory, or neoplastic disease (cancer).
Osteoarthritis is a degenerative condition that affects the joints of the body, unlike rheumatoid arthritis, which affects multiple body systems. This does not mean osteoarthritis is necessarily any less debilitating. Osteoarthritis is evaluated under section 1.02 of the adult musculoskeletal listing and if your condition meets the standards provided in the listing you may qualify for disability benefits immediately.
Of course, as with any condition, there are two ways of being approved for disability. The first method of being awarded disability benefits is, as we said, by satisfying the criteria of a Social Security listing.
The second method, if you don't meet a listing, is done when a disability examiner at DDS, or a an ALJ disability judge at a hearing determines that you lack the ability to return to work. In this second method, known as a medical vocational allowance, your work history and medical records are analyzed to see if you or cannot go back to your past work, or switch to some type of other work.
Method 1 - Getting approved for disability on a listing
For a possible listing approval for arthritis, i.e. osteoarthritis, 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.
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.
Method 2 - Getting approved for arthritis, osteoarthritis through a medical vocational allowance
The impairment listing provides the Social Security approval criteria needed to meet or equal 1.02. Unfortunately, most disability applicants are not able to meet listing 1.02. This does not mean they will not be able to receive disability. 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.
What do you need to prove in your arthritis disability claim?
You have to prove that your osteoarthritis is characterized by pain, stiffness, and loss of motion in one of the following in the hip, knee, or ankle. And that this causes you to be unable to walk without an assistive device and you are unable to walk at a reasonable pace for a sufficient distance to perform routine daily activities. Or, if you have hand, wrist, elbow or shoulder problems, your condition must prevent you from performing gross or fine motor movements such as; pushing, pulling, reaching, or other routine movements necessary for routine daily activity.
You can accomplish this by providing A) medical records which include imaging that shows stiffness or fusion, bony destruction, or narrowing of the joint space in the joints that are affected, and B) the information you provided in your vocational work history; specifically the types of work you have done, the functional requirements of each of your jobs, and the skills you possess that could help you transition into some other type of work.
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. You may be surprised to know, of course, that simply having a diagnosis of osteoarthritis is not a requirement that will qualify you for disability. Social Security considers the ways and extent a person is functionally limited, because this is what will impact their ability to engage in work activity. So practically any condition can result in a disability award if it is limiting enough to restrict all work.
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?
More on 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 losing or winning 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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