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Social Security Disability Benefits for Gout

Gout is a chronic condition that causes recurring episodes of acute inflammatory arthritis. Gout involves redness, tenderness, stiffness, and swelling of the affected joints. If the big toes become infected, it is sometimes referred to as podagra.

If you suffer from chronic gout and it impacts your ability to work, you may be eligible for Social Security Disability benefits if your gout meets the requirements of the Social Security Administration’s (SSA) listing for inflammatory arthritis.

The SSA oversees the Social Security Disability Insurance (SSDI) program, which offers monthly benefits to workers who have become disabled because of medical conditions or serious accidents. In order to be eligible to receive SSDI benefits, you have had to work to earn sufficient credits and to have paid in enough taxes to the SSA.

Your gout is caused by high uric acid levels in your bloodstream, which result in crystallized deposits in your joints and tendons. Your gout can sometimes lead to additional problems or symptoms, including:

  • Outgrowths caused by uric acid crystals near the joints
  • Rapidly deteriorating kidney functioning
  • Kidney stones

Your gout can be treated using a variety of options. The most common treatment options used for the condition include:

  • Steroids
  • Febuxostat
  • Probenecid
  • Non-steroidal anti-inflammatory medications
  • Colchine
  • Allopurinol
  • Dietary Changes
  • Lifestyles Changes
Gout Social Security Benefits

At one time in their lives, about 4% of the entire population will experience gout. The symptoms can vary greatly, ranging from very mild to severely debilitating. People of all ages can suffer from gout. And while many may suffer from a mild case on occasion, you may be one of the individuals who suffer from a chronic condition that impacts your life day after day.

The Cost of Treating Gout

The Gout and Uric Acid Education Society reports that patients who are treatment-resistant or elderly could pay anywhere from $16,925 to $18,362 per person to manage their gout. The study conducted in 2016 indicated that hospitalizations for gout doubled from 4.4 to 8.8 patients per 100,000 from 1993 to 2011.

An additional study published in the Seminars in Arthritis and Rheumatism during February 2015 reported that these figures are expected to climb. However, new medications are being created to treat the disease, so that may reduce the financial burden and help improve the outcome for those of you who are suffering from the disease.

The SSA Evaluation and Medical Qualifications

The SSA has a medical guide, which is called the Blue Book, that has specific requirements established for specific medical conditions in order for an individual to be considered disabled and eligible for SSDI benefits.

While there is no specific listing for gout, there is a listing for inflammatory arthritis, to which gout is closely related.

Listing 14.09 is for inflammatory arthritis. If you meet any of the following conditions pertaining to inflammatory arthritis, you will meet the requirements of eligibility for Social Security disability benefits.

  • Two or more of your bodily systems are significantly impacted by your gout.
  • You have at least two of these following symptoms – chronic fever, weight loss, malaise, or fatigue.
  • Any of your major peripheral joints in your upper extremity, including hands, shoulders, elbows, and wrists, make it impossible for you to perform either fine motor or gross motor movements.
  • Any of your weight bearing joints, such as your ankles, hips, and knees are affected to the degree that you cannot effectively walk.

Another way you may qualify for disability benefits for gout are if you have chronic gouts of inflammatory arthritis that cause malaise, fever, weight loss, or severe fatigue if you can show that your condition results in severe limitations for any of the following:

  • Social functioning
  • Daily living activities
  • Difficulty with concentration
  • Difficulty with completing tasks in a timely fashion

To qualify for disability benefits using the Blue Book, you must be able to provide medical records that indicate your condition meets the criteria despite your attempts at therapy and treatment. During the consideration process for benefits you must continue to see your healthcare provider and carefully follow your physician’s instructions.

Benefits are not awarded for those who are only partially disabled. Benefits are only available for those who are fully disabled and will be disabled for a minimum of a year. The first six months that you are disabled are a waiting period for which you are not eligible to receive monthly benefits.

Using the Residual Functioning Capacity and Medical-Vocational Allowance for Disability Approval

If you don’t meet the requirements of the Blue Book listing, you may still be eligible to receive Social Security Disability benefits if you prove the severity of your symptoms and condition using a residual functioning capacity (RFC) and the medical-vocational allowance.

The Disability Determination Services of the SSA will look at all of your medical and mental conditions in order to determine if you can be reasonably expected to perform any kind of work. If you can’t do your past work, they will check to see if you can do sedentary light-duty work.

Using the medical-vocational allowance, they will consider your past work experience, any training you have received and if it can be transferred to another job, your educational background, and your age. If they determine that you have demonstrated that your condition or your combined conditions are so severe that you are unable to perform any kind of work, you will be approved for Social Security disability.

The RFC is completed by your medical provider and specifies your conditions, your symptoms and side effects, and your limitations. As an example, if your gout is so severe you cannot stand for more than an hour, that should be indicated. If your gout prevents you from walking significant distances, that should be noted as well.

Also indicate any lifting limitations, and if you are unable to bend frequently. The RFC is given major consideration when the Disability Determination Services team is deciding whether to award benefits for your case. As mentioned before, provide as much documentation as possible as evidence for your case.

Applying Specific Medical Tests to Your Case for Disability

There are several medical tests that are used to diagnose gout, including blood tests, urinalysis, x-rays, scans, and more. These test results should be included with your disability claim. The SSA may order a medical evaluation and mental evaluation with doctors that they choose at their expense. These evaluations are informational purposes only and not for medical treatment.

The more information that is provided and gathered, the stronger your case. Provide as much information as possible so you can expedite your case. The process can be lengthy and your claim can be denied twice. You can file an appeal each time. The final step is to request a hearing before an administrative law judge who will rule on your case.