Psoriatic Arthritis and Filing for Disability
Inflammatory arthritis, which includes psoriatic arthritis, is an array of disorders that differ in cause, course, and outcome. Clinically, inflammation of major peripheral joints may be the dominant manifestation causing difficulties with ambulation or fine and gross movements; there may be joint pain, swelling, and tenderness. The arthritis may affect other joints, or cause less limitation in ambulation or the performance of fine and gross movements.
However, in combination with constitutional symptoms or signs (severe fatigue, fever, malaise, involuntary weight loss), inflammatory arthritis may result in an extreme limitation.
Psoriatic arthritis is a mere nuisance for some people, but for others it is a very painful debilitating disease. If a person's psoriatic arthritis causes significant joint pain and stiffness, it would be considered a valid medical condition to list on an application for SSD or SSI.
How is psoriatic arthritis considered for disability?
This condition falls under the classifications of immune system impairments and would be evaluated under section 14:00, Immune System - Adult. More specifically, it would most likely be evaluated under listing 14.09 of Immune System impairments ' Inflammatory arthritis.
If the disability applicant is able to meet impairment listing 14.09, they will be approved automatically for disability. However, if they are not able to meet this listing the disability specialist (the disability examiner) may consider musculoskeletal impairment listing 1.02, Major Dysfunction of a Joint , or 1.04, Disorders of the spine, in an effort to medically approve the claim.
Often, disability applicants are unable to meet the requirements of any impairment listing but are still unable to work because of their significant limitations. They have to prove that their psoriatic arthritis causes limitations that prevents them from performing SGA level work activity.
They can accomplish this through A) the information contained in their medical records (i.e. Xray, MRI, CT), and through B) the information provided in their vocational work history; specifically, what types of jobs they have performed, the functional requirements of each of those jobs, and the job skills that could allow them to perform other types of work. This will allow the disability examiner to do a residual functional capacity evaluation. If they find that the individual cannot do any past work or other kinds of work, the claim may be approved through a medical vocational allowance.
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 Psoriatic Arthritis
1. Psoriatic arthritis is a type of arthritis that occurs along with psoriasis in an estimated 10-30 percent of cases. Psoriasis is a skin condition that causes patches of skin to become red and scaly.
2. Psoriatic arthritis usually develops after skin symptoms, but it is possible for symptoms of arthritis to occur first. Joint pain, stiffness and swelling are the most common symptoms of psoriatic arthritis.
3. Typically the onset of arthritis is about 10 years after the skin condition develops, so 30-50 years old.
4. Symptoms of both psoriasis and psoriatic arthritis may come and go in periods of time called flare-ups and remission. These chronic conditions worsen over time.
5. Psoriatic arthritis may occur in five different ways, and individuals may experience all of the during the course of their condition. Pain may occur on only one side of the body, on both sides of the body at the same time, in the finger joints and in the spine.
6. The fifth type is arthritis mutilans which is much more rare. It is a severe form of arthritis that destroys small bones in the hands.
7. Psoriasis with nail lesions is the greatest risk factor for developing psoriatic arthritis. Family history of the condition also plays a large role in determining risk.
8. Psoriatic arthritis affects men and women equally. The specific types of arthritis that affect men and women tend to differ.
9. Psoriatic arthritis may be difficult to diagnose precisely. Doctors can perform a variety of tests, including x-rays and joint fluid samples, to determine what might be causing symptoms.
10. Sed rate is a blood test that measures how far & quickly red blood cells fall from the top of a glass tube during an hour. Inflammation causes a higher Sed rate. Rheumatoid factor is an immunity protein that is present with rheumatoid arthritis, but not psoriatic arthritis, helping doctors distinguish between the two.
More on qualifying for disability benefits with Psoriatic arthritis
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 Social Security 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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