Osteoarthritis can be a crippling affliction which in its later stages can prevent you from effective work. It is treated as a disability by the Social Security Administration (SSA), but applications for SSDI or SSI benefits can often fail for one reason or another. In fact, 75% of disability benefit applications are denied at their first attempt.
If this is what has happened to you, you have the right to appeal the decision. The appeal process progresses through several stages and you may be successful at one of these stages, if you have been able to convince the SSA that your condition is sufficiently debilitating to warrant a benefit being granted.
Good, effective documentation and proof of the severity of your osteoarthritis as well as legal help from an experienced disability attorney can lead to a successful appeal.
How to Appeal the Decision
The first stage of an appeal is to request that the SSA reconsiders their decision. This is basically a review of the original assessment by the Disability Determination Services (DDS). During reconsideration, a new examiner and medical consultant are assigned to review the information supplied about your condition.
Failing success following a DDS review, you can request an official hearing which will be heard by an Administrative Law Judge (ALJ). A request for a hearing must be made within 60 days of receipt of a denial of SSDI or SSI benefits by the SSA.
The ALJ will review the process undertaken by the SSA to determine whether it was done appropriately following established procedures. In up to 50% of cases in which a hearing has been held, a decision to deny benefits is reversed by the ALJ concerned.
There are two further steps in the appeal process, although only 2 to 5% of appeals are successful by the time it gets to this stage. The first step, following an unsuccessful hearing is to request a further review by the Appeals Council and again failing that ask for a Federal review.
Blue Book for Condition
The Blue Book does not have a specific listing for osteoarthritis. It is considered under two separate sections of the Book, under the Musculoskeletal section, 1.00 and the Inflammatory arthritis section, 14.09. The criteria considered depend on how your specific condition developed.
Evidence required to match the Blue Book criteria includes:
- A full medical history supplied by your doctor;
- A full medical examination;
- Evidence of surgery performed together with results of all tests;
- Description of pain experienced;
- Description of any difficulty in mobility experienced.
Consider an RFC
As osteoarthritis is not explicitly listed in the Blue Book, this can lead to a denial of your SSDI or SSI benefit application if the criteria are not matched exactly by the information supplied by you. One way to pre-empt this or to help when considering an appeal is to ask your doctor to make an assessment of your residual functional capacity (RFC).
This, in short, is an assessment of your capacity for physical work, i.e. what you can and cannot do. You may be granted a medical vocational allowance if your RFC is assessed alongside all the other information about your condition that you have supplied.
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You will need to keep in contact with your doctor and other medical professionals who have treated your condition throughout the appeal process in case they are requested to supply additional clarification of your disability. Because a decision about SSDI or SSI benefits is of such importance, you should consider retaining a disability attorney to help you with legal assistance as you go to appeal.