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.
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.