Table of Contents
- What is Osteoarthritis?
- Is Osteoarthritis a Disability?
- The SSA’s Definition of Osteoarthritis
- Types of Osteoarthritis
- Can I get a Disability Benefit for Osteoarthritis?
- Criteria for Getting Disability with Osteoarthritis
- Should I Apply for Disability with Osteoarthritis?
- What are the Disability Benefits Available for Osteoarthritis?
- Talk to a Disability Lawyer
- Additional Resources
If your physician has diagnosed you with Osteoarthritis and you are finding it difficult, or impossible, to go to work, you could qualify for Social Security Disability (SSDI) benefits with Osteoarthritis.
What is Osteoarthritis?
Osteoarthritis is the gradual loss of the cartilage in your joints and commonly affects what the medical profession calls load-bearing joints. Osteoarthritis may become so painful that it limits what you can do. If you believe you qualify for SSDI with osteoarthritis you should consult a disability lawyer to help you through the often difficult process.
Is Osteoarthritis A Disability?
Osteoarthritis is considered a disability by the United States Social Security Administration (SSA). Osteoarthritis can be debilitating as it can cause severe mobility issues and pain. Osteoarthritis can affect many joints, including the knee.
Even tri-compartmental osteoarthritis or osteoarthritis in the knee is a disability.
The SSA’s Definition of Osteoarthritis
To qualify for disability benefits, you will need to meet the criteria of a listing in the SSA's Blue Book. In order to meet the criteria of the listing for osteoarthritis for having an abnormality of a major joint, you will need to provide copies of medical records, including medical imaging reports such as MRIs or x-rays that show fused joints or bones, joint space narrowing, or destruction of bone.
Your osteoarthritis must also show you have a history of joint pain or stiffness, and a loss of motion or stability of the joint. You must also have supporting documentation that shows:
- You need to use a walker, wheelchair or scooter, or two canes or two crutches that require both hands OR
- You can’t use one hand because of your arthritis and you need your other hand to operate a one-handed wheelchair, crutch, cane, or other device OR
- You can’t use either of your arms or hands to begin, sustain, and finish work
If osteoarthritis of the knee has required surgery, you may qualify under Blue Book Listing 1.17, which is for reconstructive surgery or fusion of a major weight-bearing joint. You will need documentation of reconstructive surgery or fusion, evidence that you have difficulty moving that has lasted or that is expected to last 12 months, and proof showing you need a walker, two canes or two crutches, or a wheelchair or scooter that requires the use of both hands.
Types of Osteoarthritis
Typically, osteoarthritis is divided into two main general categories. These two categories are primary and secondary.
- Primary osteoarthritis is the most common type of osteoarthritis. Primary osteoarthritis has no identifiable cause and its effects are generalized—largely impacting the hips, knees, spine, fingers, thumbs, and big toes.
- Secondary osteoarthritis happens as a result of a preexisting abnormality(s) in a joint. These preexisting abnormalities can come from prior injury or trauma, infectious or inflammatory arthritis, or metabolic, genetic, or congenital joint disorders.
Both primary and secondary osteoarthritis can qualify for disability, and they have the same fundamental eligibility criteria.
Can I get a Disability Benefit for Osteoarthritis of the Spine, Knee or Hip?
Yes, you can get disability benefits for osteoarthritis of the spine, knee, and/or hip, so long as the severity and symptoms of your osteoarthritis meet the criteria of the SSA’s Blue Book listing.
Criteria for Getting Disability with Osteoarthritis
The criteria for the osteoarthritis listing can be found under Section 1.00, Musculoskeletal Disorders, in the Blue Book. If you study this listing and find that its criteria fit your diagnosis of osteoarthritis of the spine, knee, or hip, you will be asked to include copies of medical records when you apply for SSDI. The medical evidence and records people normally must submit alongside their application include the results of MRIs and/or x-rays that indicate that the applicant has the following:
- fused bones or joints;
- destruction of bone;
- narrowing of the joint space;
- joint pain or stiffness;
- loss of joint movement;
- loss of stability of the joint.
And, to prove that your osteoarthritis is debilitating, you will need to highlight in your application that you (1) require help with movement, and (2) are Blue Book, which is a medical guide that determines who qualifies for SSDI benefits. Osteoarthritis is classified under Section 1.00, which is the musculoskeletal system. The Blue Book is the list of conditions that qualify for disability. If you are seeking approval for SSDI benefits for osteoarthritis, the documentation you provide and your medical records should indicate that you meet at least one of the requirements and that any pain you are suffering due to osteoarthritis is so severe that you are unable to work and it also has an impact on your ability to complete daily routine tasks.
Under Section 1.02 is joint dysfunction, which states your joints must suffer from stiffness, loss of ability to move, and pain. To prove you qualify for SSDI benefits with osteoarthritis, you need to show images that show fusion or stiffness, bone destruction, or the decline of the joint space between the joints that are most affected. As well as this evidence of osteoarthritis, you will be required to show that either your hip, ankle, or knee are affected so much that you need an assistive device to help you go about your normal routines. Alternatively, you can show your elbow, shoulder, wrist, or hand is impacted so much that you are unable to do things like sort files, pull and push movements, prepare meals, and reach out to complete essential tasks.
If osteoarthritis affects the spine which causes loss of ability to move, extreme pain, and sensory or motor loss and it can be proved, these are also grounds for eligibility to receive SSDI benefits. There are other disabilities caused by osteoarthritis which may also qualify for SSDI. If you do not meet SSDI criteria through the Blue Book, there are other options available to you that could result in your case meeting approval for osteoarthritis disability benefits. This is through the residual functional capacity (RFC) form. This is when your physician specifies what your limitations are, the treatment you require, and your symptoms.
Further Reading: What Conditions Qualify For Disability?
Should I Apply for Disability with Osteoarthritis?
If your osteoarthritis appears to meet the criteria for disability benefits, your next step will be to apply for disability benefits. Given that the application process can take many months, the sooner you begin the process the better.
If you’re unsure whether your osteoarthritis meets the criteria we have outlined here, here are some additional guidance to help you determine what the appropriate next step(s) is for your particular situation:
You should apply for osteoarthritis disability benefits now if:
- You have been diagnosed with and treated for osteoarthritis.
- Your symptoms make you unable to continue working—despite receiving treatment.
- You have another medical condition—in addition to osteoarthritis—that qualifies for disability benefits.
Consider waiting and applying for osteoarthritis disability benefits later if:
- You have moderate symptoms or your symptoms are improving with treatment.
- You have not stopped working yet—even if you believe you will stop working eventually.
You probably shouldn’t apply for osteoarthritis disability benefits if:
- You’re able to keep working because your osteoarthritis is manageable enough.
- You make more than $1,550 (the 2024 income limit for SSI and SSDI) each month.
What Are the Disability Benefits Available for Osteoarthritis?
Both SSDI and SSI belong to a group of government programs that provide assistance to individuals who can’t work due to a disabling medical condition. More specifically, both programs offer regular financial assistance via monthly paychecks as well as medical coverage via health insurance—SSI provides Medicaid and SSDI offers Medicare. The main difference between SSDI and SSI is that they help different groups of people.
SSDI is a program for people who have a sufficient work history and have thereby paid into Social Security taxes. To be eligible for SSDI in 2024, you must:
- Have a sufficient number of work credits (based on the individual’s age) from working in the past.
- Have a medical condition that meets the SSA’s strict criteria for and definition of disability.
SSI is for people who have little income and few assets. In other words, SSI is a needs-based program. In addition to having a qualifying medical condition, one must adhere to the following income limits to be eligible for SSI in 2024:
- You (as an individual) must have an unearned income* of less than $943 per month ($1,415 per month for a couple).
- An individual who gets SSI in 2024 can earn up to $1,913 per month in “earned income”** ($2,827 per month for a couple) and still receive their SSI benefits.
- Your assets are worth no more than $3,000 for a couple or $2,000 for an individual.
*Unearned income refers to the income that people receive even though/if they don’t work to get paid (e.g., Social Security benefits, certain pension payments or veterans’ compensation, workers’ compensation, unemployment, etc.).
**Earned income refers to money made from working.
You May Need a Disability Lawyer For Your Osteoarthritis Application
You have much to gain from winning an SSDI benefits claim. Osteoarthritis is a long-term disability, so being awarded an SSDI benefit gives you the financial support you need for years to come. Unfortunately, it is never easy winning a benefit of this type, so you should consider consulting with a disability lawyer who will use his or her experience and knowledge to work on your behalf to get the benefits you need to help you lead a more normal life.
- A Disability Lawyer Can Increase Your Likelihood of Getting Approved for Disability Benefits
- What Conditions Qualify For Disability?
- What Is SSI?
- SSDI Application
- Disability Lawyer
- Can You Get Disability If You Haven't Worked Enough
- How Long Does Disability Last?
- Disability Claims Process
- How Do I Speed Up My Disability Claim?
- Blue Book
- Can I Work With Osteoarthritis?
- How the Blue Book Can Help with Your Osteoarthritis SSD Claim
- Breaking News: New Data Projects Significant Decrease in SSA’s 2024 COLA