How To Get Disability Benefits for Arthritis

Arthritis is a disease that encompasses several types of joint inflammation. The term is used to identify roughly 200 different conditions that affect joints and the tissues surrounding them.

Causes of Arthritis

  • Old age
  • Wear and tear of a joint from overuse
  • Obesity
  • Autoimmune disorder
  • Injury or infection
  • Family genes

Arthritis is a common medical condition, affecting more than 54 million Americans. When not managed appropriately, arthritis can have a debilitating effect on a person’s life, including the loss of mobility, an increased risk for metabolic disorders, inflammation throughout the body, risk of falls, and the decreased ability to work.

Roughly 60% of arthritis patients are of working age, and arthritis is a major cause for many Social Security disability claims. Disability compensation may be awarded through either the Social Security Disability Insurance (SSDI) program or the Supplemental Security Income (SSI) program.

How To Get Disability Benefits for Arthritis

Arthritis is a common medical condition that may qualify for Social Security disability benefits in severe cases. Most eligibility criteria for arthritis are captured in the Social Security Administration’s blue book of disabilities. This is a resource that outlines medical qualification criteria for a substantial collection of common medical conditions.

Inflammatory Arthritis

For example, under the Inflammatory Arthritis blue book listing, you’ll find rheumatoid arthritis, psoriatic arthritis, and other autoimmune-related joint conditions. Eligibility for this type of arthritis requires that the patient experience a joint deformity or persistent inflammation in at least one weight-bearing joint, like knees or hips, and at least one peripheral joint, such as a shoulder or wrist.

Individuals may also be eligible for disability benefits if their arthritis affects at least one weight-bearing joint and two internal organs, or if the cervical or dorsolumbar spine is affected, making it impossible to bend. Eligibility also extends to those who suffer persistent arthritis flare-ups that cause two or more symptoms with internal organs or body system involvement.

Osteoarthritis and other similar joint inflammation often can be found in the Social Security Administration blue book under the area of the body that it affects. Many inflammation disorders, for example, manifest around the spinal cord, so these types of medical conditions may be found in the listing for the spine. Similarly, if you’re suffering from arthritis of the shoulder, knee, or hip, it may be addressed within the SSA listing under the entries for those parts of the body.

What If My Arthritis Is Not in the Blue Book?

If your specific form of arthritis does not meet a blue book listing, that doesn’t mean your claim automatically will be denied. Even if it appears as a hidden disability simply because it isn’t immediately obvious. You still may be eligible for disability benefits under the SSA’s residual functional capacity (RFC) requirements.

In this case, the Social Security Administration will review your claim to determine whether your daily limitations are so severe that you are no longer able to work. You and your physician will receive a form to complete that can help the SSA understand how arthritis affects your day-to-day life, and what functional limitations result from the condition.

In these types of reviews, individuals with physical functional limitations who have a work history with labor-intensive types of work typically have an easier time gaining approval through an RFC than people with a sedentary job history.

Navigating the RFC Process

The claims process is challenging. However, this doesn’t mean that approval through the RFC process is impossible. Arthritis brings more symptoms than chronic pain and physical functional limitations. There are also arthritis-related sleep disturbances, depression, focus or concentration issues, and more that can affect your ability to effectively perform your job duties. Ensure the Social Security Administration has a full and comprehensive picture of how arthritis affects your ability to complete your work.

In many cases, people want to get help with their RFC forms – not only from their treating physician, but also from a qualified disability attorney who can help make sure the information provided is accurate and complete.

Whether you’re applying for disability insurance benefits under a blue book listing or completing the RFC process, make sure that the evidence and documentation you present are helpful to the SSA. Your job is to present a comprehensive and accurate case for why the SSA should approve your claim. Your doctor can be a tremendous resource when it comes to advising on what types of medical evidence and documentation should be included with your claim.

While documentation varies by case, the following are common pieces of medical evidence included with an arthritis disability claim:

  • Imaging results, including X-rays, CAT scans, MRIs, and PET scans
  • Bloodwork that documents markers for specific autoimmune or inflammatory arthritis types
  • Mobility evaluations that describe specific functional limitations
  • Any other applicable lab results for gout or other forms of inflammatory arthritis that support your claim

Top Causes of Arthritis

Arthritis appears in several forms and can spring from many different sources. Here are some of the most common causes of arthritis.

Old Age

One’s risk of developing arthritis in any of its forms increases with age. However, this doesn’t mean that arthritis can’t affect younger patients – though arthritis is most common in patients over age 65, it can affect anyone at any age.

Wear and Tear of a Joint From Overuse

Osteoarthritis is commonly caused by the overuse of a joint, which leads to wear and tear over time. This type of overuse typically damages the cartilage of the joints, causing it to break down and fail to effectively serve its purpose of absorbing impact to the affected joint.

Treatment for osteoarthritis often includes a combination of medication, dietary changes, physical or occupational therapy, chiropractic care, topical creams, and heat and cold therapy. The primary goal of treatment is to control arthritis pain, reduce overall joint damage, and improve the patient’s overall quality of life.

Common medications for osteoarthritis may include analgesics, nonsteroidal anti-inflammatory drugs, and steroids. Some medications may be prescribed only for arthritis pain management, while others may be recommended by your doctor to address the underlying inflammation associated with arthritis.

Obesity

Carrying extra weight for your frame can worsen or exacerbate the symptoms typically associated with osteoarthritis. For this reason, one of the first remedies a physician may prescribe is losing weight. Maintaining a healthy and appropriate weight is also helpful for a couple of other reasons.

Eating a healthy diet rich in antioxidants and high in fruits, vegetables, fish, and nuts also can decrease the level of inflammation in the body, as can regular exercise. In addition, regular, moderate exercise helps keep your muscles and joints more flexible, which can help reduce the joint pain and inflammation associated with arthritis. Swimming and other water workouts are often ideal for arthritis patients since they require little to no stress on the joints and can have a therapeutic effect.

Foods derived from animals and foods high in processed sugar often are attributed to higher levels of inflammation and increased joint pain in arthritis patients. These also are foods your doctor may recommend you avoid to maintain a healthy weight for your frame.

Autoimmune Disorder

Rheumatoid arthritis is the result of an autoimmune disease that causes the body’s immune system to attack healthy body tissue, which leads to inflammation within the joints and also commonly within organs.

Within the joints, the disorder targets the synovium. These soft tissues normally produce a fluid that both nourishes cartilage and lubricates the joints, keeping them both healthy and functioning normally. When the synovium is attacked, eventually both cartilage and bone are destroyed.

The exact cause of rheumatoid arthritis is currently unknown, though researchers have discovered genetic markers that may indicate an increased risk of developing it. Treatment for rheumatoid arthritis may include corticosteroids or disease-modifying antirheumatic drugs (DMARDs), which suppress the immune system.

Injury or infection

Some forms of arthritis, like septic arthritis, can result from infection within the joint that occurs when bacteria travel through the bloodstream and settle within the joint. The same effect also can occur when a penetrating injury deposits bacteria directly into the affected joint, leading to infection. Knees are the most common joint affected, though septic arthritis also can affect hips, shoulders, and other joints. Treatment usually includes antibiotics and/or draining the joint with a needle or during surgery.

Family genes

Some people may be more genetically predisposed to developing arthritis than others, especially when it comes to osteoarthritis. Some hereditary forms of osteoarthritis may be caused by genetic mutations related to collagen production.

How To Apply for Arthritis Disability Benefits

When it comes to the specific claim submission process, that depends on whether you’re applying for SSDI benefits or SSI benefits – the processes vary slightly, as outlined below:

For an SSDI claim, an application for disability benefits can be submitted online, or you can apply in person at a local SSA office.

For SSI, you will initiate your claim via a personal interview with an SSA representative, typically in person at a branch office. To find out more, visit the Social Security Administration office nearest you or call 1-800-772-1213.

No matter which type of claim you pursue, make note that you must complete and submit several different forms. These forms will require you to share information regarding your work history, education, finances, and the details of your medical condition.

Provide detailed answers to each question without leaving any questions blank. If a question doesn’t apply to you, don’t just skip it. Instead, explain why the question doesn’t apply so that reviewers know it wasn’t inadvertently missed. Questions left blank often led to processing delays, or could even lead to denial of your claim.

Before you start, gather all of your medical records and information. This information is essential to accurately present your situation. It helps the Social Security Administration make an accurate disability determination. By the time you prepare your claim, you likely will have undergone many medical tests, so make sure you have copies of all of them to show the progression of your condition over time.

You also can work with your physician on appropriate documentation to support limitations in movement. You may want to consider consulting with a Social Security advocate or a knowledgeable and trusted disability attorney, who can evaluate your claim and help make sure all proper forms are submitted and all necessary medical documentation included.

Disability Benefits for Arthritis

People who suffer from severe arthritis that prevents them from working may be eligible for SSDI or SSI disability benefits. If you think you might be eligible for Social Security disability benefits through either program, it’s important to get started.

Talk with a qualified disability attorney or a Social Security advocate to find out whether your specific situation is likely to qualify for Social Security disability benefits. A knowledgeable attorney or disability advocate can help you get started with your Social Security disability claim.

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About the Author: Usman Babar

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