Can I get SSDI for arthritis?

What does the SSA Blue Book say?

Arthritis is one of the most prevalent and debilitating conditions in the United States. According to the Arthritis Foundation almost 54 million Americans have an official diagnosis, including almost 300,000 children. Recent studies suggest that as many as 91 million Americans may actually have arthritis, including those who have been diagnosed and tens of millions more who report symptoms consistent with a diagnosis.

Arthritis occurs when there is pain, stiffness, and/or inflammation in the joints. In many cases, it is the breakdown of cartilage over time leads to dysfunction and arthritis. Cartilage breakdown often happens with repetitive motion in the most used joints, such as those in the hands, wrists, and knees. Arthritis can be caused by older age, autoimmune disorders, obesity, fractures or breaks in the bones, or bacterial or viral infections. The inflammation, stiffness, and often associated swelling can cause significant pain resulting in a loss of function in the affected joints.

There are more than 100 different types of arthritis affecting nearly 1 in 4 adults in America. Any of these types may affect your ability to perform everyday activities and ultimately limit your ability to work and earn an income. The Social Security Administration (SSA) recognizes arthritis as a potentially disabling condition that may qualify for Social Security Disability Income (SSDI) benefits.

What Kinds of Arthritis Qualify For Disability Benefits

Common types of arthritis fall into four pathologic categories: degenerative, inflammatory, metabolic, and infectious. Typically degenerative and inflammatory types of arthritis present the chronic symptoms consistent with the SSA’s criteria for disability, however if your condition is severe enough to affect your ability to work you may qualify for SSDI benefits no matter which type of arthritis you are suffering from.

Degenerative arthritis is the most common form of arthritis, affecting nearly 30 million Americans. It occurs when the cartilage cushioning bones in joints begins to wear away, causing pain, swelling, and problems moving the joint. Most commonly affecting the hands, feet, hips, and knees, there is no cure for degenerative arthritis and severe cases often lead to joint replacement surgery.

Inflammatory arthritis refers to several types of arthritis, often autoimmune and systemic, characterized by inflammation of the joints. Types of inflammatory arthritis include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, lupus, Sjogren’s syndrome, and other autoimmune disorders. Common symptoms include pain, swelling, joint tenderness, and morning stiffness that lasts for more than an hour. Because many forms of inflammatory arthritis are systemic, symptoms may spread throughout the entire body.

Metabolic arthritis, also known as Gout, is caused by high levels of uric acid in the blood which results in needle-like crystal formations that can cause sudden severe pain, swelling, and tenderness which may last for hours up to weeks at a time.

Infectious arthritis is caused by a bacterial or viral infection in the joint, resulting in painful arthritic symptoms in the area. Most of the time infectious arthritis is a short term condition lasting up to a few weeks. To qualify for SSDI the infectious arthritis must be a chronic condition, expected to last for at least 12 months.

How Does the SSA Determine Benefits for Arthritis

The SSA uses a five step process to determine if you qualify for benefits due to your arthritis condition:

1. Determining if you can work

In order to qualify, your arthritis must keep you from holding gainful employment; so if you are currently working, you will likely be denied. Social Security Disability provides benefits for people who are not able to support themselves due to their inability to work. If you are currently working and earning less than $1,220 per month you may still qualify for benefits.

2. Is your arthritis considered severe?

The SSA considers how your arthritis is preventing you from fulfilling work duties. Physical functions such as your ability to stand for long periods of time, hold or lift objects, or bend and kneel are assessed using the medical records you provide and the Residual Functional Capacity (RFC) form. The RFC analysis and associated form is often completed by your doctor and is a key component in proving disability from arthritis.

3. Does your arthritis meet the SSA’s medical criteria listed in the Blue Book?

The Social Security Administration maintains a list of medical conditions and impairments that are considered disabling. Several conditions/impairments associated with arthritis are included in this list. If your condition/impairment appears in the Blue Book, you must meet the SSA’s specific requirements of that condition which may include documented evidence of certain symptoms or limitations.

4. Assessment of past work and current function

If the observable symptoms of your arthritis do not appear in the Blue Book, the SSA may still award benefits if you can show that you are no longer able to do the work you used to do. The SSA can look into your past work to determine if you are still able to carry out those functions necessary to complete the job. If your arthritis has resulted in significant change in your ability to perform work tasks, you may still qualify by “equaling a disability listing” or under a medical-vocational allowance.

5. Can you do other types of work?

If you are unable to do your previous job, the SSA considers if you are capable of doing any other type of work. Based on your previous work experience, education, age, and other work-related skill sets, the SSA will evaluate your condition and symptoms to determine if you may be able to perform other gainful activity. If the SSA finds that you are not capable of performing other work, you should be granted benefits.

The Blue Book on Arthritis

The Blue Book is the SSA’s list of medical impairments which qualify for Social Security disability. The Blue Book details specific criteria for each condition listed. Although the Blue Book is available online, it can be difficult to interpret for those who are not well-versed in the medical and legal fields. A qualified disability attorney can help you navigate and understand the Blue Book and all other aspects of your disability application.

The SSA provides four separate listings related to arthritis: Listing 1.02, Listing 1.03, and Listing 1.04 in the Musculoskeletal Systems domain, and Listing 14.09 in the Immune System Disorders domain.

Listing 1.02 - Joint Dysfunction

Major dysfunction in your joints is a common outcome for those suffering from arthritis. Joint dysfunction that limits or prevents your ability to work and that can be proven by sufficient medical evidence may qualify for SSDI benefits. To qualify under Listing 1.02 you must prove joint deformity resulting in chronic pain and stiffness that prevents full use of your joint; such deformities include misalignment, excess boniness, and shortening of the joint.  Qualifying conditions include dysfunction in hips, knees, ankles, or feet which make it difficult to walk; or dysfunction is shoulders, elbows, wrists, or hands which make it difficult to hold a pen, lift objects, or type.

Listing 1.03 - Surgery of a Weight-Bearing Joint

Reconstructive and fusion surgeries are common in severe cases of arthritis. If your arthritis has caused you to undergo surgery on a weight-bearing joint (such as a hip or knee), and you can no longer walk on your own for a period of at least twelve months, you may qualify under Listing 1.03.

Listing 1.04 - Disorders of the Spine

If you suffer from arthritis of the spine, you may qualify under Listing 1.04 if your condition comprises a nerve root or the spinal cord with one of the following complications: nerve root compression, spinal arachnoiditis, or lumbar spinal stenosis. Each of these complications include additional criteria which must be met to qualify under Listing 1.04. Your doctor is your best resource to understand whether or not your arthritis meets one of these listing criteria.

Listing 14.09 - Inflammatory Arthritis

If you do not qualify under any of the listings in the Musculoskeletal System domain (as mentioned above) you may qualify under Listing 14.09 in the Immune System Disorders domain. Objective medical evidence must be provided proving your arthritis has caused one of the following:

• Swelling or deformity of the hip, knee, or ankle joints causing extreme interference with your ability to walk or ambulate on your own
• Swelling or deformity of the shoulder, elbow, wrist, or hand joints resulting in difficulty performing activities of daily living or the ability to take care of yourself
• Swelling or deformity of the hip, knee, ankle, foot, shoulder, elbow, write, or hand with:
• associated disease in at least two organs or body systems, or
• at least two of the following symptoms: severe fatigue, malaise, weight loss or fever
• Ankylosing spondylitis with fixation of the lower or upper spine resulting in limited spinal flexibility

Seek Additional Advice

If your arthritis is preventing you from work, but you do not meet the standards outlined in the Blue Book, you may still be able to qualify for SSDI through “equalling a disability listing” or  medical-vocational allowances.

Since most Social Security Disability claims are initially denied and later approved in the appeals process, seeking help from a qualified Social Security attorney will ensure you exhaust all your options when trying to qualify for disability benefits.