Medical Criteria Needed to Qualify with Osteoarthritis (Updated 2024)

Receiving a health diagnosis such as osteoarthritis can be a life-changing experience. Sadly, while your life may have permanently changed, the financial responsibilities of life do not go away.

The Social Security Disability Insurance Program (SSDI) was developed to assist people, such as yourself, who are disabled due to a diagnosis such as osteoarthritis.

Not everyone who has osteoarthritis will automatically be awarded financial assistance for the condition. In fact, many people who are medically eligible for disability benefits with osteoarthritis are denied disability due to a lack of sufficient medical documentation.

You are responsible for providing the evidence regarding their condition and its severity by correctly stating who has treated your condition as you've received treatments for osteoarthritis.

Is Osteoarthritis a Disability?

Yes, Osteoarthritis is considered a disability by the SSA. If you have been diagnosed with osteoarthritis your joints are most likely to be stiff, leading to severe pain. Because of the severity of osteoarthritis, the Social Security Administration (SSA) has determined that it is a disability, meaning you may be eligible to receive disability benefits. In the long term, osteoarthritis may limit your ability to undertake even the simplest of tasks. 

When submitting your SSDI application to the SSA your diagnosis and medical evidence should be in the SSA’s Blue Book listing. Osteoarthritis is given a mention in section 1.04 of the Blue Book which is “Disorders of the Spine.”

You need to provide evidence showing nerve root compression which limits the spine’s movement, muscle weakness, and sensory or reflex loss if the lower back is involved.

Spinal arachnoiditis is another symptom of osteoporosis which should be confirmed by a pathology report of a tissue biopsy, or through medically acceptable imaging results.

Osteoarthritis causes a severe burning sensation or painful dysesthesia, which means you have to regularly change position or posture. Lumbar spinal stenosis leading to pseudo-claudication is another example of the onset of osteoporosis and should be confirmed by established by the results from medically acceptable imaging.

Osteoarthritis leads to chronic nonradicular pain and weakness which significantly restricts movement. If you have been diagnosed with osteoarthritis and you have the medical evidence that matches one or more of the features found in the Blue Book the SSA will confirm that you qualify for Social Security disability.

Medically Qualifying For Disability For Osteoarthritis

The SSA uses its own medical guide made of a list of disabilities, colloquially known as the Blue Book, to determine whether or not your unique osteoarthritis diagnosis will qualify for Social Security disability benefits. All conditions found in the Blue Book contain specific medical criteria and symptoms that you must have evidence of to be approved. In other words, when thinking about the resources that offer some signs that you will be approved for disability, the Blue Book is a good primary resource to use. 

While Osteoarthritis is not specifically listed in the Blue Book, the condition is covered in the Musculoskeletal section, 1.00, of the Blue Book. Additionally, depending on the underlying disease, it may also be considered under the Inflammatory Arthritis section, 14.09.

To help you with the information-gathering process, here is the most relevant medical evidence that you will need to provide to give you the best chance of being approved for SSDI with osteoarthritis.

Evidence Needed For Your Osteoarthritis Disability Claim

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your osteoarthritis. You should be able to provide the following evidence. Records from your physician should include your presenting symptoms, the progression of your disease, as well as the results of a full physical examination. The physical examination notes from your osteoarthritis should include:

  • An explanation of any weight-bearing joints involved, such as the hip, knee, or ankle, and how it affects your ambulation and mobility.
  • An explanation of any peripheral joints involved, such as the shoulder, elbow, wrist, and hand, and how they affect your fine and gross motor movements.
  • Any visible deformity to your joints such as subluxation, contractures, bony or fibrous ankyloses, or any instability of your joints.

Medical Evidence From Your Doctor Related To Your Ability To Work

As osteoarthritis is not specifically listed as a condition in and of itself, it is vital that your physician document the following:

  • Any inability to ambulate effectively, such as to walk reasonable distances or to use stairs
  • Any required use of assistive devices such as a cane, walker, or crutches
  • Any pain that you experience related to movement
  • Any inability to perform fine and gross motor movements
  • Your ability, or lack thereof to travel without a companion to and from work
  • Any difficulties you have with grocery shopping, banking, using public transportation, preparing a meal, feeding yourself, showering, etc.
  • If you have had surgery, such as a joint replacement (e.g., shoulder, knee, hip replacement, etc.), surgical records from your orthopedic surgeon should be included. Of specific importance is any surgery that you have required on a weight-bearing joint.
  • X-rays, CT scans, MRIs, radio-nuclear bone scans, or other imaging results that may help to confirm your diagnosis or the severity of your arthritis.
  • Electro-diagnostic procedures, such as nerve conduction studies, if applicable
  • Neurological or spinal exams, as appropriate
  • Procedural notes, such as cortisone injections

Evidence Needed Related to Your Osteoarthritis Medications and Treatments

Many patients who have osteoarthritis take medications, which may include analgesics, NSAIDs, corticosteroids, and hyaluronic acid. Other treatments for osteoarthritis include physical therapy, occupational therapy, and lifestyle modifications.

Your physician must document the following of your osteoarthritis:

  • Medications you receive, including the doses
  • How often you require medication
  • Any side effects that you have experienced related to your medications
  • Any physical or occupational therapy that you receive and how often it is required
  • Any changes to your life as a result of your osteoarthritis

Information on your reactions and side effects to your treatments for osteoarthritis are essential to provide to the SSA because not every person with osteoarthritis will meet a Blue Book listing. So long as you can prove that you’re still too ill to work due to osteoarthritis complications that will persist for at least one year, you might still qualify if you pursue the claim further.

Evidence Needed Related to Your Quality of Life and Ability to Care for Yourself

As osteoarthritis is not specifically listed in the Blue Book, your physician must document your quality of life and ability to care for yourself. The majority of people who have arthritis do not qualify for SSDI benefits through the Blue Book musculoskeletal listing.

However, you still may be too ill to work. If this is the case, your physician should provide notes documenting his or her opinion regarding your limitations and inability to function without unscheduled breaks or days off.

The more specific that your doctor is about your limitations, the better your chances are of being approved for disability benefits. If you are unable to work due to limitations from your disease, you may still qualify for disability through a residual functioning capacity assessment.

Find Out If You Qualify For Disability In Minutes

Tips For Getting Disability With Osteoarthritis

If you have osteoarthritis and you haven’t applied yet, or if you have applied and were denied, remember that medical evidence listed in the Blue Book is arguably the most important factor in your SSDI application for arthritis.

While you don’t need to provide medical documentation to the SSA yourself, it is helpful to be as organized as possible. When you visit your doctor, it is a good idea to present a written list of symptoms and side effects that you are experiencing.

There are several ways that your physician can help including:

  • Ensuring that your full medical history is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects
  • Carefully document your physical exam, including all limitations

Osteoarthritis Disability Living Allowance

Osteoarthritis is a severe disabling condition and can prevent a sufferer from continuing the sort of employment they have been doing before. Osteoarthritis may be so severe that the Social Security Administration (SSA) may approve disability benefits payments through the Social Security Disability Insurance (SSDI) scheme. This scheme is available for those people who have been employed for some time before they developed osteoarthritis and have contributed social security insurance payments to their payroll taxes.

Whether you are eligible for SSDI payments or not will depend on how long you have worked and how many work credits you have accumulated over your lifetime of work. Your symptoms are the other main criteria that are assessed before a decision about awarding disability benefits payments is made.

The amount of SSDI payments that are made assuming that your application is approved is determined by what is quite a complicated formula. The average earnings you received over the period you were working are used to determine what the SSA calls your primary insurance amount (PIA).

Once this has been determined, the SSA uses a calculation to work out how much your monthly disability allowance should be. In 2023, the maximum monthly payment is $3,627 a month. The average monthly allowance is $1,483. The amounts are adjusted at the start of each year according to an assessment of the annual increase in the cost of living.

Get Help With Your Osteoarthritis Disability Claim

A Social Security disability attorney or advocate can assist you in ensuring that your claim for disability is thorough, thus increasing your chances for approval. Use our Social Security Benefits Calculator to see how much you could be able to earn in disability benefits. Consider a Free Evaluation with a disability advocate or attorney that takes cases in your area today—Disability lawyers are only paid if you win your osteoarthritis claim.


Additional Resources