How to Qualify
In order to qualify for Social Security Disability with arthritis, you must meet the basic disability requirements set by the Social Security Administration (SSA).
In order to receive disability benefits, you must have a condition which prevents you from performing any available work. Additionally, the condition must be expected to last at least one year from the time of onset.
Those with arthritis applying for disability benefits, will need to meet the Blue Book listing 14.09. You will need to provide medical documentation supporting that you meet the SSA listing for inflammatory arthritis. In addition, you will need to meet be within specific financial limitations.
Different Areas Where You Can Get Arthritis
Arthritis is an inflammation of the joints, the tissue around the joints and surrounding tissues. Since there are joints all over the body, it’s possible to get arthritis in many locations even though it’s most common in the hands, knees and back.
Over time, the cartilage in joints will break down, which leads to inflammation and arthritis. That’s why the condition is so common in hands and knees since those are two areas that are used all the time.
Arthritis can also be caused by injury, such as an old sports injury or a repetitive motion injury. The latter is one of the reasons arthritis can make doing work so difficult. Imagine working in a factory that requires you to pull levers or assemble parts.
Arthritis in the hands would make this work difficult, and so some people find themselves unable to perform their jobs and must seek out assistance.
You can file a claim for Social Security disability benefits with arthritis. You will need to demonstrate that your condition makes you unable to perform the requirements of your job, which is why collecting medical evidence is the most important part of your application.
How the SSA Determines Disability with Arthritis
In the case of arthritis, you must receive medical treatment for at least three months before the SSA will make a determination regarding the extent and severity of your condition and whether or not it qualifies you for Social Security Disability benefits.
No matter where you develop arthritis, whether in your hands, feet, knees or back, if you have medical evidence to support your claim, you may be eligible for disability benefits. You will also need to meet financial requirements to qualify for disability benefits.
Follow the steps below to find out if you qualify for Social Security disability benefits due to your arthritis.
Steps to Take In Order to Qualify
To determine whether a person qualifies for Social Security Disability because of arthritis, the SSA uses the following steps:
The SSA first determines whether you are currently working. If you are gainfully employed (in 2020, gainfully employed is defined as earning $1,260 per month), you will be disqualified for Social Security Disability based on your demonstrated ability to perform substantial gainful activity.
To qualify for Social Security Disability Insurance (SSDI), you will need to have enough work credits. These are earned by working and paying Social Security taxes. Typically, if you have worked five of the last ten years, you will have enough work credits. Depending on your age, there are a specific number of credits you must have to qualify for SSDI.
If you do not have enough work credits, but your income and assets are limited, you may be eligible for Supplement Security Income (SSI). SSI is meant for those of extreme financial need, so you must have less than $2,000 in assets (or less than $3,000 in assets if married). SSI is based on household income, so your spouse’s income will be considered when the SSA is determining if you are financially eligible.
Medical Requirements For Disability Benefits With Arthritis
The SSA determines whether your arthritis is severe enough to hinder you from performing physical activities commonly required for working. These activities may include such things as:
- sitting or standing
- kneeling or walking
- lifting and use of fine motor skills
Depending on which activities your arthritis hinders you from performing, you may be deemed capable of heavy, medium, light, or sedentary work. In some cases, those who are approaching retirement age may qualify for Social Security Disability benefits even if they are deemed capable of sedentary work if they lack the qualifications listed in the Blue Book to perform the sedentary work which is available.
The SSA determines if your arthritis meets their medical criteria. To meet the disability criteria to qualify for benefits, an arthritic person must have swelling and pain, and his or her joint movement must be limited or painful.
You will need to meet the SSA’s Blue Book listing 14.09 Inflammatory arthritis in order to qualify for benefits with arthritis. According to this listing, to qualify for disability you will need to be experiencing:
- Persistent inflammation or persistent deformity of one or more major peripheral weight-bearing joints resulting in the inability to ambulate effectively or one or more peripheral joints in each upper extremity resulting in the inability to perform fine and gross movements effectively
- Inflammation or deformity in one or more peripheral joints with involvement of two or more body systems or organs with one of the organs or body systems involved in at least a moderate level of severity and at least two constitutional symptoms or sings (such as fatigue or fever).
- Ankylosing spondylitis
- Repeated manifestations of inflammatory arthritis with at least two constitutional symptoms (such as limitations of daily activities or maintaining social functioning).
This Blue Book listing can be used to evaluate different forms of arthritis, such as psoriatic arthritis, rheumatoid arthritis or psoriatic arthritis as well as a variety of other disabling conditions.
If a person is not deemed medically qualified for Social Security disability based on observable symptoms, the SSA will consider whether you can reasonably be expected to perform any type of work which you have done in the past.
If the SSA determines that you are unable to perform any work which you have performed previously, they will consider your age, your level of education, your previous experience, and your overall mental and physical health to determine whether you could reasonably be trained to do any other kind of available work. If, in their estimation, you can be trained to do some form of work, you will be denied Social Security Disability benefits.
Medical Evidence to Support Your Claim
The Social Security Administration is tasked with processing your application. They use the guidelines in the Blue Book to determine your eligibility to receive disability benefits, and that’s why the evidence you provide is so very important.
Each case is different, but the guidelines provide a baseline to determine eligibility and the information you provide helps to paint a picture of your unique situation.
The most important piece of evidence you can provide is a report of your diagnosis from your doctor. This includes:
- the diagnosis itself
- results of blood or lab tests
- imaging such as x-rays or CT scans
- and any other information used to make the diagnosis.
You should also include your treatment plan, including:
- medications prescribed
- physical therapy information
- report of how the treatment is working
- any side effects you’re having to medications (this can play a role in the decision)
Be sure to provide a list of all of the doctors who have treated you, along with where you received treatment. This is important in case the SSA needs to reach out with questions.
It’s important to include as much information as possible so that the SSA can make their determination without having to request additional information. The more information you provide, the easier it is for them to make a decision.
Qualifying With Arthritis Using a Medical-Vocational Allowance
In some cases, an applicant might be able to qualify for Social Security disability benefits using a medical-vocational allowance. The medical-vocational allowance comes into play when someone files for Social Security disability benefits with a condition that doesn’t completely prevent him or her from working, but it does have the potential to limit the ability to work.
Some of the considerations used to determine whether a medical-vocational allowance is appropriate include residual function capacity (RFC), age, education and past work experience.
The Social Security Administration evaluates claims based on an applicant’s extertional and nonexertional limitations and whether they prevent the applicant from completing his or her job.
Your residual function capacity is the maximum amount of work that you are able to perform as a result of your condition as determined by the SSA. Each person’s RFC is different and this is what makes your medical documentation so important.
- Nonexertional demands of work include mental ability, posture and balance, use of hands (manipulative), visual, ability to communicate orally and aurally, and environmental.
- Exertional demands of work include movements, including walking, standing, sitting, lifting, carrying, pushing and pulling.
Essentially, the SSA will consider whether an applicant’s arthritis is impacted by the exertional and nonexertional demands of the job. If there is a reason that arthritis will prevent a person from doing his or her job, then a medical-vocational allowance will be considered.
As an example, consider an occupational therapist who uses her hands to work with her patients. On a daily basis she massages muscles, strains and sprains in order to help her patients recover. Upon developing arthritis in her hands, she is no longer able to push on or manipulate stiff muscles, which is a core function of her job.
There are no ways to accommodate or work around the requirements of her job. As a result of her arthritis, she is unable to work. This would be a prime case of a medical-vocational allowance, as her arthritis does not make her disabled by definition but it does prevent her from performing her job.
When it comes to receiving Social Security disability benefits, making sure that you have the proper medical documentation is the most important.
The Next Steps to Take
Statistically, your best chance of having a Social Security Disability case approved because of arthritis comes during your hearing before an Administrative Law Judge.
During this hearing, you will be allowed to have representation, and will also be allowed to make your case in person regarding why your arthritic condition keeps you from being able to work. You will also be allowed to bring witnesses who can testify on your behalf regarding the effects your condition has had on your ability to work.
Consult with a Social Security Attorney
If the SSA determines that your arthritis precludes you from performing any kind of available work, they will approve your claim and you will begin receiving social Security Disability benefits. It is worth noting that most initial claims are denied.
If your claim is denied, you should consider consulting a Social Security Disability attorney (if you’re not already working with one) regarding the best way to go about the appeals process.
Many Social Security Disability claims which are initially denied are later approved in the appeals process. While you are allowed to represent yourself at all stages of the process, you are much more likely to win your case if you are represented by an experienced Social Security disability lawyer.