Social Security Disability Benefits for Inflammatory Arthritis

If you suffer from arthritis, you may experience severe pain, joint swelling, and stiffness. It may impact your ability to do your normal daily activities or work. To summarize it, arthritis is the swelling of joints. It can be caused by many things, such as the body’s’ immune system attacking parts of the body and causing damage to tissues either in or near the joints, infection, excessive wear, obesity, age, or injury. There are different kinds of arthritis and they impact your body’s joints in different ways.

The joints are located where one bone connects or meets with another. Cartilage provides a bit of cushioning for the point of contact for the bone surfaces. The joint capsule, which encloses the joint, is lined with a synovium membrane, which keeps the joint lubricated with a synovial fluid that it secretes. Inflammatory arthritis can affect and damage the larger joints, such as the hips, elbows, knees, shoulders, and others. Rheumatoid arthritis, which is a kind of inflammatory arthritis, typically impacts the smaller joints such as those in the hands and feet.

Inflammatory arthritis can be crippling, causing severe pain, difficulty moving extremities, and even advancing to mobility issues. Arthritis can be life-changing. If you have inflammatory arthritis, you may get some relief by using pain relievers and anti-inflammatory medications. The swelling exerts pressure on your joint, enlarging it and possibly causing deformities that lead to erosion of the cartilage that is in the joint as well as around it.

Inflammatory Arthritis Social Security Benefits

Common symptoms that accompany inflammatory arthritis:

  • Joint pain
  • Stiffness
  • Swelling Loss of Motion
  • Redness of the Affected Joint

Exercise and physical therapy may be beneficial in helping strengthen the muscles that surround and support the affected joints. If you have an advanced case of inflammatory arthritis, surgery may be necessary to fuse the joint for immobilization or it may require replacement.

The Cost of Treating Inflammatory Arthritis

According to the Arthritis Foundation, treating inflammatory arthritis can be expensive. Of course, you will have co-pays for doctor visits and you may be referred to specialists such as a rheumatologist and an orthopedic surgeon. You will have co-pays for prescriptions, such as pain killers, anti-inflammatory drugs, and if your inflammatory arthritis is rheumatoid arthritis, you may have more expensive medications, which are called biologics. The cost of care for doctor visits and medications can vary from $500 to $10,000 per month.

If your inflammatory arthritis advances and requires joint replacement surgery for your hip or knee, that can costs anywhere from $30,000 to more than $100,000 depending on the severity of the situation, the complexity of the surgical needs, the physician and the hospital. So regardless of the severity of the arthritis, it is easy to see you will have ongoing costs as you seek relief and various treatment options.

Medical Qualifications and the SSA Evaluation

The SSA uses a medical guide, which is called the Blue Book. It lists bodily systems and conditions that qualify for SSDI benefits. Each condition has specific conditions that must be met. Disability benefits are only available to those who are unable to work for at least a year, and there are no partial disability benefits available.

The Blue Book does have an impairment listing for inflammatory arthritis. There are detailed diagnostic criteria that are used to determine if the disease is far enough advanced to warrant disability benefits for the claimant. There are several criteria that must be met for inflammatory arthritis, these include:

  • Ongoing inflammation or deformity in one or more weight-bearing joints that cause an inability to walk, OR
  • Ongoing inflammation of one of more major peripheral joints in each arm, which limit the ability to perform large and small movements effectively, such as personal hygiene, shopping, preparing meals, etc. OR
  • Swelling or deformity of at least one major joint with:
    • Impact to two or more organs or systems with at least one of them impacted moderately OR
    • At least two of the systemic symptoms, such as fatigue, fever, weight loss, or malaise, OR
  • Inflammation and fusing of the spinal joints, known as ankylosing spondylitis or other joint diseases of the vertebral columns OR
  • Ongoing or recurrent manifestations of inflammatory arthritis with at least two of the systemic symptoms that impact he claimant’s daily activities, social functioning or cognitive functioning.

Depending on the kind of inflammatory arthritis, you may be diagnosed with lab tests involving blood draws, urine or joint fluid, imaging such as x-rays, CT scans, ultrasounds, and MRIs, or even arthroscopic surgery.

Getting Disability Approval Using the Medical-Vocational Allowance and a RFC

If you suffer from severe inflammatory arthritis but don’t meet the criteria set forth in the Blue Book listing, you may still be granted approval based on the medical-vocational allowance and the use of a residual functioning capacity (RFC), which will clearly state your limitations. As an example, your arthritis may severely impact your hips and knees keeping you from standing more than two hours at a time or from bending, squatting, and lifting.

Your limitations are considered along with your age, educational level, work experience and transferable skills. It is determined if you can be trained to perform some other kind of work instead of your past work. They will consider if you can perform lighter duty work, such as work that is sedentary and doesn’t require as much physical activity.

When the RFC is completed by your physician, he or she needs to clearly state any limitations inflicted by the disease, any restrictions ordered by doctors, any medications and their side effects such as drowsiness or dizziness, and any other medical conditions that you may suffer from and how they impact your ability to perform your daily tasks or your job. The RFC should give a detailed picture of your abilities and limitations.

Applying Specific Medical Tests to Your Disability Case

There are several medical tests that are used to diagnose inflammatory arthritis and the severity of your particular condition. These test results must be supplied with your disability application so the SSA can make an informed decision. The SSA may order a medical evaluation with the physician they choose at their cost. This evaluation is for informational purposes only and can help with the decision process. A mental evaluation may be ordered to determine if your chronic condition causes depression or anxiety that impacts your ability to concentrate or work well with others.

Inflammatory Arthritis and Your Social Security Disability Case

If you are denied benefits during the initial stage of the application process, make sure that you consult with a qualified Social Security Disability advocate or attorney as soon as possible. These professionals will help you understand why your initial application for Social Security Disability was denied and they will begin to help you gather the evidence that will be needed to prove your case during the disability appeal process. Your chances of winning an appeal in order to overturn the SSA's denial of your Social Security Disability benefits are much greater with the help of a disability advocate or a disability attorney.

To learn more about filing for SSD benefits with inflammatory arthritis or to learn more about working with a Social Security Disability lawyer, simply fill out the form for a free evaluation of your case.