Arthritis and Social Security Disability

What is Arthritis?

Arthritis affects more than 53 million Americans, according to the Arthritis Foundation, and the term “arthritis” describes more than 100 forms of painful and inflammatory joint diseases, including Osteo, Rheumatoid, Psoriatic, Infectious, and other types of arthritis.

While arthritis is most prominent in older adults, it affects people of all ages, and according to the Arthritis Foundation, is the leading cause of disability in the U.S. Great strides have been made in recent decades for treating arthritis.

Many Americans are still crippled by the pain, swelling, mobility impairments, and other debilitating effects of arthritis. But, is arthritis a disability?

If your arthritis prevents you from working then you may be able to qualify for Social Security Disability benefits. These benefits provide ongoing, monthly support, allowing you to cover everyday living expenses, medical bills, and other financial obligations.

The Costs of Arthritis

Individuals who live with arthritis know the costs of the disease far exceed monetary measures. Albeit, the medical bills, high prescription costs, and frequent doctor visits add up quickly, but arthritis also takes its toll on all aspects of life.

People with joint disease must often sacrifice social interactions, limit or cease work, and minimize their activities in their personal lives. And when it comes to measuring the monetary costs of arthritis, you must consider not only medical bills and prescription prices, but also case-specific expenses.

These may include home modifications, the costs of living assistance devices, and transportation fees for people with crippling or disfiguring arthritis that are no longer able to operate a vehicle.

The Journal of Occupational and Environmental Medicine reports rheumatoid arthritis patients face average medical expenses of $2,000 to $10,000. Biological treatments for autoimmune-related joint diseases tack on $2,500 or more on average every month, and according to the American College of Rheumatology, these costs are projected to rise.

Advanced joint disease leads to lost work time and may eventually prevent employment entirely. If this happens, you must find a way to survive without income from earnings.

Disability benefits from the Social Security Administration (SSA) and health coverage through Medicare and/or Medicaid can be the answer to financial woes when arthritis puts an end to your employability.

Medically Qualifying for Benefits for Arthritis

Most people that receive disability benefits for arthritis either meet or match a Blue Book listing. The Blue Book outlines medical qualification criteria, including the severity level your arthritis must meet and the medical evidence the SSA needs to see in your records.

The listing under which you may qualify depends on the type of arthritis you have:

Rheumatoid, Psoriatic, and other autoimmune-related joint diseases are reviewed under the Inflammatory Arthritis listing. This listing requires your arthritis causes deformity or persistent inflammation and affects:
- at least one major weight bearing joint (hip, knee, or ankle) and at least one peripheral joint (fingers, wrist, elbow, or shoulder)
  OR
- at least one peripheral joint and involves at least two organs or body systems, causing two or more persistent symptoms like weight loss, fever, fatigue
  OR
- your cervical or dorsolumbar spine and:
  - makes it impossible for you to move or bend
    OR
  - severely limits your ability to move or bend and also involves two or more organs or body systems, causing persistent symptoms like fever, fatigue, or weight loss
  OR
- your ability to function on a daily basis due to repeated or persistent flare-ups that cause two or more symptoms with organs or body system involvement
Osteo and other forms of arthritis may be reviewed under the listing for the area of the body that is most severely affected by the disease:
- Disorders of the spine, which requires your spinal arthritis causes:
  - Nerve root entrapment or compression with severe neurological affects in your extremities
    OR
  - Narrowing of the spinal canal (spinal stenosis), resulting in pain, weakness, and severe difficulty or an inability to move or walk effectively
    OR
  - Inflammation of connective tissues surrounding the spinal cord (spinal arachnoiditis) that causes you severe pain or neurological disturbances that make it difficult or impossible to remain in one position for any longer than two hours.
Major dysfunction of a joint, which requires:
- You are unable to move effectively or walk due to arthritis in your knee, ankle, or hip OR
- You cannot perform tasks due to arthritis in your hand, wrist, or shoulder.

Qualifying for Disability without Meeting a Listing in the Blue Book

If you cannot meet or march a listing, you’ll have some additional work to do to satisfy the SSA’s “residual functional capacity” (RFC) review requirements.

An RFC looks at your daily limitations to determine if your arthritis is so severe that you cannot work in any job that you would otherwise be qualified to perform.

People with physical functional limitations that have always worked in more labor-intensive jobs often have an easier time getting approved through an RFC than people with mostly a sedentary work history.

However, arthritis symptoms can include much more than just pain, stiffness, inflammation, or fatigue.

The SSA will take all of your symptoms into account, as long as you provide thorough details of how your arthritis affects you.

Any arthritis-related sleep disturbances, depression, thinking, or concentration issues, among other symptoms, can help explain to the SSA why you’re unable to work.

Your doctor can help describe your functional limitations in the technical terms the SSA needs in order to approve you for benefits. You and your doctor will receive RFC report forms to complete, if you don’t qualify under a Blue Book listing.

Get help with your forms if you need it. Consult with your doctor in addition to a Social Security advocate or attorney, if necessary before submitting these RFC forms, but be sure to hit the SSA’s deadline for their return.

How to Apply for Disability Benefits with Arthritis

A big part of getting approved for benefits is having the right evidence in your medical records. The types of tests, reports, and other evidence necessary with an arthritis application depends on the listing under which you may qualify for benefits.

Your doctor can help you understand the Blue Book evidence requirements and can make sure the appropriate records are available for the SSA to review your claim.

Although evidence required varies, arthritis applications usually must include at least the following:

Imaging results, like CAT scans, x-rays, MRIs, or PET scans
Mobility evaluations, stating specific functional limitations
Blood work documenting markers for autoimmune or inflammatory arthritis types
Other lab work for gout or other forms of inflammatory arthritis

A disability application can be filed in a couple of different ways, though the disability program for which you’re applying makes a difference. You may qualify for both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

For SSI, your application has to be made via a personal interview with an SSA representative. This is usually done at a branch office. You can stop by the office nearest you or call 1-800-772-1213.
For SSDI, your application can be completed at the local office or you can fill it out and submitted online.

Forms You Need to Fill Out

Several forms are required as part of both application processes. These forms include questions about your finances, work history, education, and your medical condition. Be prepared to provide detailed answers and don’t leave any questions blank.

Even if a question doesn’t apply to you, you should indicate that on the application. Blanks lead to delays in the processing of your claim and may even cause the SSA to question your eligibility for disability benefits.

Before starting your application, look over our resource on successfully applying with arthritis.

Talk to a Social Security Attorney Today

You have a lot to gain from a successful Social Security disability claim. A successful claim wouldn’t just mean consistent financial support for your ailment—it would also grant you the kind of stability that you may have been missing out on for years now.

Unfortunately, winning a claim isn’t a cakewalk, which is why you should consider consulting a Social Security disability attorney or advocate.

Your attorney will use his or her knowledge and experience to fight on your behalf and help you get the benefits you need—and you don’t even need to pay your lawyer unless you win.

A successful Social Security claim could be life-changing, so don’t wait to get an evaluation and talk to a Social Security disability attorney as soon as possible.

To speak with a Social Security Attorney in your area today, take our Free Disability Evaluation to see if you may qualify.