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Medical Criteria Needed to Qualify with Rheumatoid Arthritis

Approximately 1.5 million people in the United States live with Rheumatoid Arthritis, also called RA. The intensity and severity of the disease are different for everyone. While some people may only have minor fatigue and aches, others are completely disabled.

If you have been diagnosed with Rheumatoid Arthritis that renders you unable to work, there could be financial help available to you.

The Social Security Disability Insurance (SSDI) program was created to assist those who have become disabled due to an illness such as Rheumatoid Arthritis.

Although some individuals are unable to work due to the severity of their Rheumatoid Arthritis, many are denied disability benefits upon applying with the Social Security Administration (SSA).

It is imperative that you be able to provide sufficient medical evidence regarding your condition and its severity.

What are the Symptoms of Rheumatoid Arthritis?

Symptoms of rheumatoid arthritis vary from person to person with some people showing little to no symptoms for months at a time to other people feeling it for months at a time with flares. Rheumatoid arthritis tends to start in the joints of the hands and feet, then progressing to other parts of the body.

Symptoms of rheumatoid arthritis include stiffness in your joints, which makes it harder to move and use than they normally would. Other symptoms of RA in the joints include swelling, pain, as well of warmth or redness in the joints.

If you are experiencing those symptoms and your RA makes it difficult for you to work full time, you may qualify for Social Security disability benefits. Before applying, it's important you make sure you meed the medical criteria outlined in the SSA's Blue Book.

The Importance of the “Blue Book”

The Social Security Administration maintains a list, known as the Blue Book, of conditions known to be disabling. Rheumatoid arthritis is listed in section 14.09, titled “Inflammatory Arthritis.”

Each condition in the Blue Book contain specific criteria and symptoms that you must have to be approved.

The easiest way to be approved for disability benefits from the SSA is to meet the criteria listed for a particular condition in the Blue Book.

You should work with your rheumatologist to determine if you meet the requirements listed in the Blue Book, and to ensure that you have completed all of the medical tests required by the SSA.

Evidence Needed Related to Your Rheumatoid Arthritis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your rheumatoid arthritis.

You should be able to provide documented medical evidence of the following:

  • Pain or deformity in a weight-bearing joint such as a knee or hip
  • Challenges getting around, including the need for a walker, crutches, cane, or a wheelchair, or other assistive devices
  • Pain or deformity in any joint in your upper arms that makes performing fine motor skills difficult, such as writing or filing
  • Any organ involvement, such as cardiac or pulmonary disorders related to your RA diagnosis
  • Severe fatigue or malaise
  • Fevers
  • Involuntary weight loss
  • Any related problems with other body systems.

Several tests will help to confirm your diagnosis, and the following should be included in your records:

  • Blood antibody tests: Typical antibodies for Rheumatoid arthritis may include anti-nuclear antibodies (ANA) and rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibodies (anti-CCP)
  • Approximately 80% of people with RA test positive for the RF
  • Inflammation blood tests: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may also be tested.
  • Imaging tests: x-rays, CT-scans, or MRIs might be performed to assist with diagnosis and to rate the severity of your disease.

While any doctor can provide this information, the SSA gives more weight to the opinion of medical specialists.

Therefore, it’s essential that you work with your rheumatologist to gather this medical information.

Medical Criteria Needed to Qualify with Rheumatoid Arthritis

Evidence Needed Related to Your Rheumatoid Arthritis Medications and Treatments

Many patients who have rheumatoid arthritis take medications, which may include analgesics, NSAIDs, steroids, and disease-modifying anti-rheumatic drugs (DMARDs), In some cases, some people may still require steroid injections or pain blocks.

Other treatments for RA include physical therapy, occupational therapy, and lifestyle modifications. Joint replacement surgery is sometimes necessary in certain cases.

It is critical that your physician documents the following:>

  • Medications you take, and what their dosage is
  • How often you need medication
  • Side effects of your medication, if any
  • Any physical or occupational therapy that you receive and how often it is required
  • Any changes to your life as a result of your rheumatoid arthritis

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

The Blue Book indicates that people with Rheumatoid Arthritis may qualify for benefits if they experience constitutional symptoms along one of the following:

  • Limitations of activities of daily living (ADLs): This may include, but is not limited to, performing household chores, personal hygiene, taking public transportation, or paying bills.
  • Limitation in maintaining social functioning: This may include communicating appropriately with others, managing sustained relationships, and interacting independently with others.
  • Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace: This may include finishing projects on time, keeping up a reasonable pace at work, and the ability to work with rheumatoid arthritis without excessive breaks.

If you have difficulty working due to RA symptoms like the ones above, you should make sure your doctor documents these symptoms.

Many people with Rheumatoid Arthritis may not qualify for SSDI benefits through the Blue Book listing. However, you still may be too ill to work.

You may be eligible for benefits through a medical vocational allowance.

Steps You Can Take to Win Your Disability Claim

Winning your disability claim for Rheumatoid Arthritis is dependent on your ability to provide sufficient medical evidence.

You will need to prove to the SSA that your rheumatoid arthritis is severe and disabling enough to keep you from earning a living.

The best thing that you can do for your case is to gather medical documentation. You may need to visit the records department at your hospital, as well as gather all of the medical documents from your doctor, physical therapist, and all others involved in your care.

It is beneficial to be as organized as possible when applying for Social Security disability benefits. Keep a list of all of your healthcare providers, as well as their telephone numbers, email addresses, and fax numbers.

When you visit your doctor, it is a good idea to present a written list of symptoms and side-effects that you are experiencing, so that you can discuss them together.

There are several ways that your rheumatologist 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 documenting your physical exam, including all limitations
  • Recording any mental health issues that you are experiencing as a result of your RA.

Many individuals who are applying for Social Security disability decide to enlist the help of an experienced disability attorney or advocate Your chances for approval go up substantially when you are working with a disability expert.

Evaluations are always free, and lawyers are only paid if you win your claim.