If you suffer from osteoporosis and it is debilitating, you may be eligible to receive Social Security disability benefits. The Social Security Administration (SSA) has the Social Security Disability Insurance (SSDI) program. The SSDI program offers monthly benefits who meet their requirements for being disabled.
In order to be eligible for benefits, you have to have worked to earn a sufficient amount of credits and paid in enough taxes to the SSA. The application process is very detailed and it can take months to get a decision on your case. If you are approved for benefits, your minor children may also be eligible to receive a monthly benefit check based on your credits earned from work.
However, there are several different approaches that can be used to gain benefit approval. Osteoporosis results in overly fragile, porous bones which lead to frequent broken bones, severe joint pain, and other serious symptoms. Osteoporosis can cause you to suffer from serious medical problems, including autoimmune disorders, parathyroid disorders, kidney disease, and more.
While the SSA usually doesn’t administer benefits for osteoporosis alone, they do offer benefits for some related disorders. You may also qualify for benefits if you have combined effects of multiple conditions that cause severe limitations. Osteoporosis is a serious health condition that is often seen in conjunction with other health conditions or that leads to additional problems.
While men do suffer from osteoporosis, more women are diagnosed with the disease each year. Actually, four times more women than men are diagnosed. A major health problem in the U.S., about 10 million people in the country are estimated to have the disease. Another 34 million are believed to suffer from low bone mass, which increases the risks of an osteoporosis diagnosis.
With osteoporosis, you may suffer from severe joint pain, repeated broken bones, kidney disease or failure, hormone and vitamin deficiencies made obvious by the parathyroid and blood tests, and severe autoimmune deficiencies. Suffering from these symptoms combined can prevent you from working or participating in your regular daily activities. Osteoporosis can be a disabling condition, with significant effects on your life.
Is Osteoporosis Considered a Disability?
The Blue Book is the list of conditions that can qualify for Social Security disability benefits.
Even though osteoporosis is not listed specifically in the Blue Book, if your condition is so severe that you will be unable to work for at least months because of it, then you could still be considered from by the SSA and receive payments from Social Security Disability Insurance (SSDI).
For example, osteoporosis can cause chronic kidney disease. If you have had least three hospitalizations within a consecutive 12-month period and occurring at least 30 days apart because of symptoms related to chronic kidney disease, you could be considered disabled by the SSA and you could receive SSDI benefits.
In order to qualify, each hospitalization must last at least 48 hours, including hours in a hospital emergency department immediately before the hospitalization.
The Cost of Treating Osteoporosis
According to the National Center for Biotechnology Information, the average cost of treating a patient with only osteoporosis is around $645 per year, but those with a fracture saw an increase up to $939 per year. Outpatient care costs counted for the highest percentage of mean total costs of care, which is about 38% of the total health care resources that were consumed.
The overall cost for osteoporosis was $4.6 million in health care resources and $411,684 in direct costs. Older women, ages 60 to 64 with the disease, paid out much higher costs, totaling about $17,403 per patient per year. The most utilized drug for osteoporosis treatment is estrogen, providing about 41% of the osteoporosis-specific prescription utilization for women ages 45 to 65 with osteoporosis.
The SSA Evaluation and Medical Qualifications
The SSA uses a medical guide with listings for the different body systems. This guide, called the Blue Book, has specific criteria that must be met in order for an individual to be approved for disability benefits. Osteoporosis is often seen in kidney disease, autoimmune disorders, and parathyroid problems.
There are several symptoms and disorders related to osteoporosis that may meet Blue Book criteria.
These are some sections that have impairments listed:
- Section 6.00 – Kidney Disease
- Section 9.00 – Parathyroid Disorders
- Section 14.00 – Autoimmune Disorders
Bone fractures are the most common symptoms of osteoporosis, and because the condition results in your bones being brittle and unable to properly heal, you could qualify under one of these listings:
- Section 1.06 – Broken Bones in the Lower Body
- Section 1.07 – Broken Bones in the Upper Body
To qualify using any of these listed conditions, your medical records must specifically meet the Blue Book requirements. However, you may still meet the requirements to be approved for disability by using the medical-vocational allowance.
Using the Medical-Vocational Allowance and the RFC for Disability Approval
You may also qualify for benefits by meeting a listing in terms of severity level and symptoms or by proving your daily living activities and residual functioning capacity (RFC) are so negatively impacted by your condition that you can no longer to maintain gainful employment.
The RFC clearly specifies your limitations and how your symptoms can impact your ability to function and conduct normal activities. With osteoporosis, you have to use extreme caution because an incident that may not harm the normal healthy individual could leave you suffering from a broken bone.
As an example, your RFC may indicate that you cannot bend or lift because of the increased risks of fracturing vertebrae or breaking ribs. You may not be able to stand as long because of the severity of your joint pain in your back, hips, knees, and ankles. Walking significant distances may be impossible because of your severe joint pain from the disease.
Reaching above your head, grasping items, and holding items could be too difficult for you because of past breaks of your arms and hands, or severe joint pain in your elbows, wrists, or finger joints. Your doctor needs to specify your limitations in detail, and explain your pain level, your symptoms, and the severity of your condition.
When using the medical-vocational allowance, the Disability Determination Services office will consider your age, education level, work experience, and any transferable skills. After determining you cannot perform your past work, they will decide if you are suited for sedentary, lighter duty work.
Osteopenia and Disability Benefits
Like osteoporosis, there is no listing for osteopenia in the SSA’s Blue Book. However, just because there is no listing for it, doesn’t mean that you can’t qualify for disability with osteopenia.
You can qualify for disability with osteopenia, your symptoms just need to match another listing in the SSA’s Blue Book.
There are two listings in the Blue Book that related to broken bones in the upper and lower body. If your fractured and broken bones related to your osteopenia will force you to be out of work for at least 12 months and your symptoms and conditions match one of the listings in the Blue Book, you could get disability for osteopenia.
When the SSA says being able to ambulate effectively, it means if you are able to work and earn a gainful living. If you are unable to ambulate effectively because of your osteopenia for at least 12 months, you could qualify for Social Security Disability Insurance benefits (SSDI).
Applying Specific Medical Tests to Your Case for Disability
Those diagnosed with osteoporosis undergo extensive testing. Those tests include blood tests, various lab work, bone density scans, x-rays, MRI scans, CAT scans, and more. Those test results as well as your reports from physical therapy should be included with your medical records and treatment notes from your physicians.
Everyone taking medications to treat osteoporosis needs to have regular testing, and these documents should also be included with your file. It is not uncommon for the SSA to order an independent medical evaluation by a doctor of their choice and at their expense. This is for informational purposes only and not for medical treatment.
In order to strengthen your case, provide as much documentation and records as possible with your initial application. Ensuring the Disability Determination Services team has the details about your condition is the key to a successful case. Speak with a disability lawyer today who may be able to help you with your case!