Facts about Rheumatoid Arthritis and Filing 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

1. Rheumatoid arthritis affects the joints of the hands and feet, causing pain and swelling. Rheumatoid arthritis is an inflammatory disorder and an autoimmune disorder. Autoimmune disorders cause the body's immune system to attack healthy tissue along with harmful cells.

2. Rheumatoid arthritis is a chronic condition that typically develops in middle age, between 40 and 60. There is no cure, but a variety of treatment options are available.

3. Rheumatoid arthritis is also more common in women, who are at least twice, maybe even three times, as likely to develop the condition than men.

4. Primary symptoms of the condition include pain, swelling and tenderness in joints. Fatigue, stiffness, fever and weight loss are also all possible symptoms that add to the debilitating nature of the condition.

5. The lining of joints are damaged in rheumatoid arthritis, causing breakdown of cartilage and bone. Eventually the joint will lose its shape and become permanently deformed.

6. Rheumatoid arthritis usually begins in the small joints and progresses to much larger joints such as the shoulders, hips, neck and even jaw. The condition is also typically symmetrical in occurrence of symptoms.

7. This condition often occurs in periods of flares and remission, where symptoms may flare up in severity and then decrease to very minimal discomfort.

8. While it is known that rheumatoid arthritis is an autoimmune disorder caused by the destruction of the lining of joints, it is not known why this occurs. Certain genes may cause a predisposition for other conditions that are thought to trigger the disease, like particular infections.

9. A variety of treatment options exist for rheumatoid arthritis, ranging from pain killers to suppressing the immune system to total joint replacement surgery. Some prescription drugs, like disease-modifying antirheumatic drugs, cause serious side effects include liver damage and severe lung infection.

10. Typically, medications with the least harmful side effects are used first, then as the disease progresses more drastic measures are taken to control symptoms and attempt to prevent complications.

Qualifying for disability benefits with this condition

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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