If you have been diagnosed with osteoarthritis and it has impacted your ability to work, you may qualify for Social Security Disability benefits.
Osteoarthritis results in the gradual loss of cartilage from your joints. A tough tissue that provides the cushioning between the bones that form the joints, it is needed. Cartilage loss will allow the bones to rub up against one another, causing cysts and bone spurs.
What doctors call your “load-bearing” joints, such as the hands, hips, knees, feet, and spine are usually those that are affected. The disease usually begins in one joint, but can spread to others. It is also known as a degenerative joint disease because the condition can worsen.
It can either be a primary or secondary condition. If you have primary osteoarthritis, your pain and symptoms are most often the result of the stress suffered by weakened or weight-bearing joints.
If you suffer from secondary osteoarthritis the arthritis is a symptom from a separate primary condition, such as a joint injury or inflammation caused by other diseases.
Osteoarthritis is different from rheumatoid arthritis because osteoarthritis just attacks the joints while rheumatoid arthritis attacks joints and bodily organs. Osteoarthritis can be a very painful condition that limits an individual’s ability to function normally.
The Cost of Treating Osteoarthritis
According to the National Center for Biotechnology Information, osteoarthritis can be an expensive disease to treat. The economic burden is because it is a comorbid disease, has expensive treatment, and causes disability.
Because of its high prevalence, it has higher per capita expenses than rheumatoid arthritis. About one-third of the expenditures are for medications, and about half of the direct costs are attributed to hospitalizations.
US News and World Report indicated that the medical costs for patients suffering from osteoarthritis in the U.S. exceeds $185.5 billion each year, which adds up to thousands of dollars per patient.
Those individual costs can vary greatly because some patients will seek joint replacement surgery, which is expensive. Even with medical insurance, the out-of-pocket expenses for those suffering from the joint disease can be astronomical.
The SSA Evaluation and Medical Qualifications
The Social Security Administration (SSA) has its own medical guide, known as the Blue Book, which determines the requirements to be approved for disability. Osteoarthritis falls under Section 1.00, which is the Musculoskeletal System.
In order to be approved for SSDI benefits, your documentation and medical records will need to show that you meet one or more of the listing requirements and that the pain you suffer from osteoarthritis is severe enough to keep you from working and it impacts your ability to perform your routine daily tasks.
Section 1.02 addresses joint dysfunction, which says your joints must be characterized by “gross anatomical deformity”, stiffness, loss of range of motion, and pain. You will need to provide imaging that shows stiffness or fusion, bony destruction, or narrowing of the joint space of the joints that are affected.
In addition, you will have to show that at least one – your hip, knee, or ankle – is impacted to the extent that:
- You are impaired to walk without using an assistive device and sustaining a reasonable pace while walking a sufficient distance in order to carry out your daily activities such as going to and from school or work.
- Your hand, wrist, elbow, or shoulder are impaired so severely they can’t perform gross or fine movements like sorting files, pulling, pushing, preparing meals, or reaching.
Section 1.04 addresses disorders of the spine, including osteoarthritis, resulting in:
- The compromise of the spinal cord or a nerve root that shows evident compression of a nerve root with loss of motion, pain, reflex loss, sensory loss, or motor loss.
- Spinal arachnoiditis that has been medically confirmed with symptoms of painful distortion of the sense of touch of severe burning that cause the need for change of posture or position more frequently than every two hours.
- Lumbar spinal stenosis that has been medically confirmed and that causes severe weakness and cramps that impact your ability to effectively walk. Under Section 1.00 obesity is considered a factor.
Meeting Disability Criteria with an RFC
If you don’t meet the requirements of the Blue Book’s guidelines you can still be approved for disability benefits using a residual functioning capacity form (RFC) in which your doctor specifies your limitations, your treatment, and your symptoms.
As an example, if you have osteoarthritis of the spine that causes severe pain that must be treated by narcotics, the doctor can indicate how long you can stand or sit without repositioning and how the pain medication can impact your ability to function and keep you from being able to concentrate as you normally should.
Any other medical conditions should also be noted because more than one medical condition can cause multiple symptoms and numerous problems, resulting in your disability being more prevalent and having a more significant impact on your ability to function in a work environment or even take care of your daily tasks and chores.
Applying Specific Medical Tests to Your Case for Disability
Several medical tests are used to show the severity of osteoarthritis. Those tests include x-rays and MRIs. Blood work may also be used to show the amount of inflammation in the body. You should provide as many medical records and as much documentation as possible to prove your case.
But there are some instances when the SSA will order an evaluation at their expense to confirm the severity of your case.
You may be denied for benefits twice and you can appeal those decisions before asking for a hearing before an administrative law judge (ALJ). The ALJ will sort through all the documentation, medical records, RFCs, and statements to determine if you do meet the vocational-medical allowance for approval for benefits.
Your age, educational background, skills level, and past work history are taken into consideration and the ALJ will determine if you can transfer your skills over to a less physical position.
You have a lot to gain from a successful Social Security disability claim. A successful claim wouldn’t just mean consistent financial support for your ailment—it would also grant you the kind of stability that you may have been missing out on for years now.
Unfortunately, winning a claim isn’t a cakewalk, which is why you should consider consulting a Social Security disability attorney or advocate. Your attorney will use his or her knowledge and experience to fight on your behalf and help you get the benefits you need—and you don’t even need to pay your lawyer unless you win.
A successful Social Security claim could be life-changing, so don’t wait to get an evaluation and talk to a Social Security disability attorney as soon as possible.
What To Do If Initially Denied Benefits for Osteoarthritis
You applied for Social Security disability benefits and your claim was denied. The first thing you need to know is that there is no need to panic. Being denied is more common than you think. A majority of claims are denied at first, and then they are reevaluated during the appeals process, with a relatively large amount awarded benefits after a second look. What is important is that you reapply immediately. You have a 60-day window to appeal the decision, and time is of the essence.
While appeals are very common, the decision on the appeal takes longer than the decision on the initial claim. You have likely been waiting for your initial decision for some time already, so submitting your appeal quickly will help to speed up the process. When submitting your appeal, you need to make sure your application is as complete is possible so that your chances of approval increase the second time around.
With so many claims submitted every day, the Social Security Administration will deny a vast majority of claims upon first read simply because there is not enough medical documentation to support the need for disability benefits. Take time to reflect on the documentation you submitted in your initial claim, and try to provide even more details about your condition.
For reference, you should have a complete medical report outlining your condition, results from all lab tests and imaging (such as x-rays, CT scans and MRIs) and the treatment plan. Make sure you include a list of any medication you have been prescribed, and be sure to discuss any side effects you have experienced as a result.
In some cases, the side effects from treatment can be just as detrimental to performing the requirements of your job as the condition itself. If physical therapy is part of your treatment plan, then include what the therapy schedule is and how that impacts your ability to work. The upside is that since time has passed since you initially filed, you might have new evidence to support your claim or you might have encountered new setbacks that would support your need for disability benefits, thus making your claim even stronger. Make sure you include any information received from doctor visits from the time you applied until the time you resubmit the application because there might be new information that will help your case.
You will also have the opportunity to speak with an administrative law judge at a disability hearing. During the hearing, the judge will listen to the facts of your case and consult with a medical expert and a vocational expert, both of whom will provide testimony in their respective fields. You are able to bring witnesses to this hearing, and in some cases having your doctor present can help to strengthen your case.
The appeals process can be challenging, though, and so you might consider working with a Social Security disability benefits attorney to increase the chances that your appeal will be approved.
Working With a Disability Benefits Lawyer
There are lots of reasons that working with a Social Security disability lawyer makes sense during the appeal process. You may have missed something in your initial application, or you might not have provided all of the necessary information for the SSA to make their determination. And since time is of the essence, it is advantageous to work with someone who can review your application and instantly see what needs to be added in order to increase the chances of approval.
Disability attorneys know how the system works. They understand that the vast majority of disability claims are initially denied, and they know what information is missing in order to make the case stronger the second time around.
Most disability attorneys work on a contingency fee basis, so they will not require payment unless you win your case. Some attorneys will base their fee on a percentage of any back pay to which you are entitled, either 25% of the back pay or $6000, whichever amount is less. The payment system allows you to hire a disability attorney without worrying about paying attorney fees upfront, and that will allow you to focus on your case and your condition.
Being approved for SSDI can be a lengthy process. To learn more visit the SSA website or call 1-800-772-1213 to start the benefits application. If you have any questions about your osteoarthritis, you can ask in our forum here, or read our article on tips on applying for disability benefits with Osteoarthritis.