How To Get Social Security Disability Benefits for Osteoarthritis (Updated 2023)

Osteoarthritis results in the gradual loss of cartilage from your joints. Cartilage is a tough tissue that provides the cushioning between the bones and also form the joints. Some of cartilage's many helpful functions include: having the ability to withstand compressive forces, provide vital support to our bony areas that need flexibility, and boost the resilience of our bones. As such, cartilage is needed for proper, and painless, physical functioning. Thus, as one might expect, cartilage loss allows 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. 

Osteoarthritis 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. 

Is Osteoarthritis a Disability?

Osteoarthritis is considered a disability by the Social Security Administration, as osteoarthritis can be severe enough to prevent someone from being able to work full time. 

For osteoarthritis to be considered a disability, you need to be able to show through medical records, evidence, as well as doctors’ notes that your osteoarthritis prevents you from being able to work full time. 

When you send in your application for disability with osteoarthritis, make sure that you include all of that. You also need to have earned enough work credits from your work history as SSDI benefits are for those who could at one point work full time but can’t anymore because of a disability like osteoarthritis.

 If the SSA deems that you meet the medical and work requirements for SSDI, they will consider your osteoarthritis to be a disability and you will be able to earn Social Security disability benefits,

The Cost of Treating Osteoarthritis

According to the National Center for Biotechnology Information, osteoarthritis can be an expensive disease to treat. Osteoarthritis' economic burden is a result of the fact that it is a comorbid disease, has expensive treatment, and causes disability.

Because of its high prevalence, osteoarthritis has higher per capita expenses than rheumatoid arthritis. Approximately one-third of osteoarthritis' expenditures are for medications, and about half of its direct costs are attributed to hospitalizations.

US News and World Report indicated that the medical costs for patients suffering from osteoarthritis in the United States exceeds $185.5 billion each year, which adds up to thousands of dollars per patient.

Given that some osteoarthritis patients will seek joint replacement surgery (a very expensive surgery), among other medical treatments and procedures, the individual costs for people with osteoarthritis can vary greatly. And, even with medical insurance, the out-of-pocket expenses for those suffering from this joint disease can be astronomical.

If you suffer from Osteoarthritis and cannot work, you may be eligible for Social Security disability benefits. Find out how.

The SSA Evaluation and Medical Qualifications

The Social Security Administration (SSA) has its own medical guide made of a list of disabilities, known as the Blue Book, which determines and outlines the requirements people must meet in order to be approved for disability. Osteoarthritis falls under Section 1.00, which is the Musculoskeletal System.

In order to be approved for SSDI benefits, both your documentation and medical records will need to show that (1) you meet one or more of the listing requirements, and (2) that the pain you suffer from as a result of having osteoarthritis is severe enough to keep you from working given that it impacts your ability to perform your routine daily tasks.

Osteoarthritis is one of the spine disorders that qualifies for disability. Section 1.02 of the SSA's Blue Book addresses joint dysfunction, which says your joints must be characterized by “gross anatomical deformity," stiffness, loss of range of motion, and pain. 

Thus, if and when you apply for disability benefits through the SSA, you will need to provide them with imaging that shows stiffness and/or fusion, bony destruction, or narrowing of the joint space of your joints that are affected from your osteoarhtritis.

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 of the Blue Book addresses disorders of the spine (including osteoarthritis) that result 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 for osteoarhtritis, you can still be approved for disability benefits using a residual functioning capacity form (RFC)—a document through which your doctor can specify your limitations, treatment, and symptoms.

For instance, if you have osteoarthritis of the spine that (1) causes severe pain and (2) must be treated by narcotics, your doctor can indicate how long you are able to stand or sit without repositioning, as well as how your pain medication can impact your ability to function and thereby keep you from being able to concentrate as you normally would be able to.

Additionally, if you have any other medical conditions besides osteoarthritis, they should be noted on your RFC. This is because having more than one medical condition can cause multiple symptoms and numerous problems which can result in your disability being more prevalent as well as having a more significant impact on your ability to function in a work environment or even take care of your daily tasks and chores.

Can You Get Disability For Osteoarthritis in the Hands? 

You may be able to get disability for osteoarthritis in the hands, if your arthritis in the hands makes it difficult for you to work full time because of it. 

Symptoms of arthritis in the hands include pain in the hands in fingers, swelling in your hands and joints, and stiffness and weakness in your hands and joints.

 If you are able to show that your arthritis hands by having a sufficient amount of medical evidence to back up your claim that you can no longer work anymore because of your arthritis in the hands, you may be able to qualify for Social Security disability benefits.

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 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

So, you applied for Social Security disability benefits with osteoarthritis and your claim was denied. The first thing you need to know is that there is no need to panic. 

Being denied with osteoathritis is more common than you think. In fact, a majority of disability claims are denied at first, and then are reevaluated during the appeals process, with a relatively large amount of these reevaluated claims ultimately being awarded benefits after this second look.

If you are someone whose initial disability benefits claim has been denied, the most important thing you can do is reapply immediately. This is because you have a 60-day window to appeal the SSA's initial decision regarding your claim, and time is of the essence. 

Be sure to look out for the signs that you will be denied for disability.

While appeals with osteoarthritis are very common, the decision on the appeal takes longer than the decision on the initial claim. It is likely that, around the time that you found out about your initially denied claim, you had been waiting for this initial decision for quite some time already. 

As such, your ability to submit your osteoarthritis appeal quickly will help to speed up the appeals process. When submitting your appeal, you need to make sure your application is as complete as possible so that your chances of approval have a better chance of increasing the second time around.

Given that the Social Security Administration has so many claims submitted every day, they will deny a vast majority of claims upon first glance and read through. 

This is simply because many of the applications do not have enough medical documentation to support the applicant's need for disability benefits. 

As such, it is crucial that you take time to reflect, review, and focus on the documentation you submitted in your initial claim, so that you are able to try and provide even more details about your condition the second time around. 

For reference on what these additional details regarding your condition should look like, 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 your treatment plan. 

You should also make sure that you included a list of any medication(s) you have been prescribed for your condition, and be sure to discuss any side effects you might have experienced as a result of these medicines.

In some cases, the side effects from treatment for osteoathritis 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 you should include what your therapy schedule is and how that impacts your ability to work. The upside here is that, since time has passed since you initially filed your claim, you might (1) have new evidence to support your claim, or (2) you might have encountered new setbacks that would support your need for disability benefits—both of which ultimately make your claim even stronger. Finally, it is important that you make sure you have included any information you've received from your doctor visits—from the time you initially applied through the time at which you resubmit the application—because there might be new information in there that could help your case.

You will also have the opportunity to speak with an Administrative Law Judge (ALJ) at a disability hearing. During this hearing, the judge will listen to the facts of your case and consult with both a medical expert and a vocational expert. Both the medical and vocational experts will provide testimony in their respective fields as it relates to your osteoarthritis and application. You are able to bring witnesses to this hearing, and, in some cases, it can help strengthen your case if you are able to have your doctor present at the hearing as one of your witnesses. 

Nonetheless, the appeals process can be challenging. As such, you might consider working with a Social Security disability benefits attorney to help you increase your chances that your appeal will be approved.

Get a Free Case Evaluation

There are lots of reasons that support and justify disability applicants working with a Social Security disability lawyer or disability attorney during the appeal process. For example, you might 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 on your own (i.e., without a disability attorney). Thus, a disability attorney could review your initial application and subsequently help you gather documentation that will better support your osteoarhtritis case. And, given that 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 your chances of approval.

Disability attorneys fundamentally know how the disability benefits system works. For instance, disability attorneys understand that the vast majority of disability claims are initially denied, and they oftentimes know what information was missing in these initial applications. Therefore, they can help pinpoint what your initial application was missing and tell you what you need to include in order to make your case stronger the second time around. Disability attorneys will also be able to tell you what paperwork you need in order to qualify for disability with osteoarthritis. 

Most disability attorneys work on a contingency fee basis, meaning that they will not require payment from you 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). This payment system allows you to hire a disability attorney without having to worry about being able to pay attorney fees upfront, and this is precisely what will allow you to focus on your case as well as your condition and health.

Considering applying for Social Security disability benefits but not sure how much you’ll earn per month? Our Social Security Disability Calculator can help you determine how much you’ll receive from the SSA before you file for disability.

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, or are still wondering "is osteoarthritis a disability?" and/or "can you get disability for arthritis of this nature?", you can read our article on tips on applying for disability benefits with Osteoarthritis.

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