Ever wonder how severe your arthritis needs to be for you to qualify for disability?
Millions of Americans and their families receive Social Security Disability Insurance (SSDI) benefits. Yet, many people who may be eligible for the program are either unsure of their eligibility or are intimidated by the application process.
Before taking a look to see if your arthritis qualifies for SSDI, let’s first understand what arthritis is.
What Is Arthritis?
The causes of arthritis are poorly understood, despite its widespread prevalence. In fact, there is no such thing as a single disease known as arthritis. It is a colloquial term for illness or pain associated with joint tissue. Moreover, it has been estimated that there are over one hundred forms of arthritis and their associated conditions.
Arthritis may and does affect people of any age, sex, and ethnicities, and it is the biggest cause of disability in the United States. According to the Arthritis Foundation, rheumatoid arthritis affects almost 60 million adults and 300,000 children. It is more prevalent in women and becomes more prevalent as people age.
Types Of Arthritis
According to some sources, your chances of gaining disability depend on the type of arthritis you have. Some of the most common types include:
- Degenerative arthritis – A condition in which the cartilage that cushions the bones begins to deteriorate over time.
- Inflammatory arthritis – A disease in which the immune system attacks healthy joints and causes uncontrolled inflammation (e. g. rheumatoid arthritis and psoriatic arthritis).
- Infectious arthritis – When a virus or fungus entering the joint triggers an inflammatory reaction.
- Metabolic arthritis – The result of a buildup of uric acid in the joints of the body, resulting in gout.
Unfortunately, while any form of arthritis might impair your ability to carry out daily tasks owing to joint swelling and discomfort, the Social Security Administration (SSA) treats them all differently.
How The SSA Determines Disability With Arthritis
In the case of arthritis, you must get medical treatment for at least three months before the SSA may evaluate the extent and seriousness of your illness and determine if you qualify for Social Security Disability benefits.
Wherever you have arthritis, whether in your hands, feet, knees, or back, you may be eligible for disability benefits if you have medical documentation to support your claim. Additionally, you must meet certain financial conditions in order to qualify for disability claims.
To determine if you qualify for Social Security disability benefits as a result of your arthritis, follow the procedures below.
Procedures To Follow In Order To Qualify
The SSA conducts the following procedure to assess whether an individual qualifies for Social Security Disability benefits due to arthritis:
The SSA considers first whether you are currently employed. If you are currently employed (earning at least $1,350 per month), you will be prohibited from receiving Social Security Disability benefits based on your established ability to work.
To be eligible for Social Security Disability Insurance (SSDI), one must have a sufficient number of employment credits. These are acquired by employment and the payment of Social Security taxes. Generally, if you’ve worked five out of the last ten years, you’ll have sufficient work credits. Depending on your age, you must have a certain number of credits to qualify for SSDI.
Supplemental Security Income (SSI) may be available if you do not have sufficient work credits but have limited income and assets. SSI is only available to people with assets less than $2,000 (or less than $3,000 if married). Since SSI is based on household income, the Social Security Administration will consider the income of your spouse when determining your financial eligibility.
The SSA decides if your arthritis is acute enough to prevent you from undertaking routine work-related physical tasks. Among these activities are the following:
- Sitting or standing
- Kneeling or walking
- Lifting heavy objects and difficulty using fine motor skills
Depending on the tasks that your arthritis precludes, you may be considered capable of performing intense, moderate, light, or sedentary activities.
The Social Security Administration assesses whether your arthritis satisfies their medical standards. To qualify for benefits, an arthritic individual must have swelling and pain in his or her joints, as well as limited or painful joint movement.
To qualify for benefits with arthritis, you must meet the SSA’s Blue Book entry 14.09 Inflammatory arthritis. According to this listing, you must be suffering the following to qualify for disability:
- Persistent inflammation or deformity in one or more major peripheral weight-bearing joints, resulting in an inability to walk effectively, or in one or more peripheral joints in each upper extremity, leading to an inability to perform fine and gross movements adequately
- Inflammation or deformity of one or more peripheral joints, involving two or more body systems or organs, with at least one of the organs or body systems involved exhibiting a considerable degree of severity, and at least two constitutional symptoms or signs (such as fatigue or fever)
- Ankylosing spondylitis
- Repeated inflammatory arthritis symptoms with at least two constitutional signs (such as limitations of daily activities or maintaining social functioning)
This Blue Book listing can be used to evaluate a range of disabling illnesses, including psoriatic arthritis and rheumatoid arthritis.
If a person is not medically qualified for Social Security disability benefits based on observable symptoms, the SSA will assess whether you can reasonably be anticipated to undertake any previous type of employment.
If the SSA concludes that you cannot perform any previous work, they will evaluate your age, education level, prior experience, and overall mental and physical health to determine if you might reasonably be trained to perform any other available work. If they believe you can be trained to perform some type of employment, they will deny you Social Security Disability benefits.
How to Improve Your Chances Of Getting Approved
Although SSA does consider arthritis as grounds for claiming disability benefits, the truth is that most people’s first application gets rejected. Here are some things you can do to improve your chances:
Consult A Disability Attorney Or Advocate
Because the rules and regulations governing Social Security disability benefits have become increasingly complex over the years. Thus, it makes sense to retain the services of an attorney or skilled advocate to assist you with your application and throughout the process.
Local attorneys and advocates are also typically familiar with the system’s judges and adjudicators, which can significantly increase your chances of getting your claim accepted.
Ensure You And Your Rheumatologist Are Aligned
The story you and your doctor tells the SSA about your illness and difficulties should match, as this establishes credibility. If you’re considering filing for benefits or believe you may need to in the future, request that your rheumatologist begin documenting the activities you’re unable to perform in his records.
Consider Obtaining A Psychological Assessment
Depression and anxiety are not uncommon among patients with severe arthritis, impairing their capacity to work. If that is the case for you, including a psychological assessment in your paperwork, is critical because it can be hugely helpful in receiving benefits.
Adhere To Your Physician’s Treatment Plan
We hope you’re already doing this for your own health’s sake, but the SSA needs to see that you’re following medical advice. It demonstrates that you’ve been making an effort to improve.
If your claim is denied, you normally have 60 days from the day you are notified of the decision to appeal. The notice letter will specify which of the four stages of appeal you should pursue: reconsideration, a hearing by an administrative law judge, Appeals Council review, or Federal Court review.
It can be difficult and frustrating to apply for disability benefits. However, it’s always good to know the facts and understand how to boost your application. To check if your disability claim has a chance of getting approved, check out this article discussing the top signs to look out for.