Getting Disability Benefits for Arthritis

Arthritis occurs when there is inflammation of the joints. Fractures or breaks in the bone, obesity, age, autoimmune disorders, and bacterial or viral infections can all cause arthritis. Arthritis can cause significant pain, redness, and swelling of the joints and often limits one's ability to perform everyday activities.

Can I Get Disability for My Arthritis?

To decide whether you should be approved for disability based on your arthritis, the Social Security Administration (SSA) goes through several steps. If you are working, the SSA will first determine whether you are working above the substantial gainful activity (SGA) level. For 2011, this amount was $1,000 or more a month. This means that if you earn $1,000 or more per month, the SSA will find that you are engaged in SGA, and your claim will be denied.

If the SSA determines you are not working at the SGA level, it will next determine whether your arthritis is expected to last at least 12 months and is a “severe” impairment. Under the SSA’s standards, a “severe” impairment is one that causes a significant impact on your ability to do work-related activities.

At the next step, the SSA must determine whether your arthritis meets (or "equals") one of the conditions established in the SSA's Listing of Impairments; if your arthritis meets the criteria under a condition in the Listing of Impairments, your claim for disability will be automatically approved. If it doesn't, you may still be able to get disability benefits another way (see below).

Does My Arthritis Meet a Listing?

The SSA lays out the criteria needed for arthritis to be a qualifying medical condition under four separate listings in the SSA's impairment listings: Listing 1. 02, Listing 1.03, Listing 1.04, and Listing 14.09.

Listing 1.02, Joint Dysfunction

If your arthritis has caused major dysfunction of any of your joints, you may be automatically eligible for disability under Listing 1.02. To qualify under Listing 1.02 you must prove that your arthritis has caused some type of deformity, such as excess boniness, misalignment, or permanent shortening of a joint, with chronic pain and stiffness that prevents you from using your joint fully. You must have x-rays or other images of the joint that show the joint space narrowing, bony destruction, or ankylosis (crookedness) of the joints. In addition, you have to have arthritis in either:

• the hip, knee, or ankle that causes significant difficulty walking, or
• the shoulder, elbow, or wrist/hand that prevents you from doing activities like holding a pen, typing or lifting.

If you suspect you would qualify under this listing, ask your doctor if your x-rays show a type of deformity mentioned above.

Listing 1.03, Surgery of a Weight-Bearing Joint

If you have undergone reconstructive surgery or surgical arthrodesis (fusion) of a major weight-bearing joint, such as a hip or knee, as a result of your arthritis and you can no longer walk on your own effectively (and are not expected to walk well on your own within a year), you could be approved automatically for disability under Listing 1.03.

Listing 1.04, Disorders of the Spine

If you suffer from arthritis of the spine (including osteoarthritis and facet arthritis), you may qualify for disability under Listing 1.04. In order to qualify for disability under Listing 1.04, you must show that you suffer from an arthritis-related disorder of the spine that compromises a nerve root or the spinal cord with one of the following complications:

Nerve root compression that causes wide-spread, nerve-related pain, limited flexibility, and weakened muscles, with a loss of reflex and sensation. If the lower back is involved, then you must have a positive straight-leg test.

Spinal arachnoiditis (inflammation of the protective membranes that surround the nerves of the spinal cord) that results in painful burning or other abnormal sensations and requires you to change positions more than once every two hours.

Lumbar spinal stenosis (narrowing of the spinal canal) that causes non-nerve related pain in the lower back, lower limbs, or buttocks, with weakness in the lower extremities that makes walking on your own difficult (that is, you need to use a walker or crutches or need assistance getting to work).

Because the listing criteria are complex, ask your doctor to determine whether your arthritis meets one of these listing requirements.

Listing 14.09, Inflammatory arthritis

If you don't qualify for disability under any of the above listings, you may qualify under Listing 14.09, Inflammatory arthritis (this includes rheumatoid arthritis, psoriatic arthritis, and reactive arthritis). To meet Listing 14.09, you must provide objective medical evidence that your arthritis has resulted in the following:

• Swelling or deformity of:
  • your hip, knee or ankle joints that causes extreme interference with your ability to walk on your own, or
  • your shoulder, elbow or wrist/hand that makes it difficult to take care of yourself and perform your day-to-day activities.
• Swelling or deformity of your hip, knee, shoulder, elbow, wrist/hand, or ankle/foot with:
  • associated disease in at least two of your organs or body systems, with one organ or body system affected more than minimally, and
  • at least two of following: severe fatigue, malaise, weight loss, or fever.
• Ankylosing spondylitis (inflammatory disease that causes your bones to fuse together) with:
  • Fixation of the lower or upper spine with extremely limited flexibility of 45°, or
  • Fixation of the upper or lower spine with limited flexibility at 30° to 44°, and an associated disease in at least two of your organs or body systems at least one of which is moderately affected
• Repeated episodes of inflammatory arthritis, with at least two of the following:
  • severe fatigue, fever, malaise, weight loss, and
  • severe limitations in one of the following:
  •  
    • your ability to perform daily activities like cooking, cleaning, getting dressed, and bathing
    • interacting with others or doing things for pleasure you used to enjoy
    • finishing tasks at a normal rate (because of your inability to maintain concentration, duration, or speed).

What If My Arthritis Doesn’t Meet Any of the Listings?

You may still be approved for disability even if your arthritis doesn’t meet an official SSA impairment listing, though it will be more difficult. If the SSA determines your arthritis doesn’t meet a listing, it must establish whether you are able to do your past work, or other work, despite the symptoms of your arthritis. The SSA will consider your age, education, past work experience, and impact of your arthritis symptoms in deciding whether you can be expected to work. For this reason, it's easier for older, less educated applicants to win a claim for disability.

To inform the SSA of the impact your arthritis has on your life and your ability to work, you should ask your doctor to fill out a Residual Functional Capacity (RFC) form. An RFC will discuss how your ability to perform work-related activities like sitting, standing, walking, pushing, pulling, feeling, fingering, and lifting is limited as a result of your arthritis. For example, if your arthritis has caused malformation, swelling and pain in your fingers and wrists, your RFC should explain that you are unable to type, use a pen, or perform other work that requires the use of your hands and fingers. This limitation alone would preclude most work.

If you require a prescription for a cane or walker, your RFC should state that you have difficulty with balance, carrying, lifting, and pulling. Also, because many arthritis sufferers experience significant back pain, your RFC should state whether you are unable to sit for more than four hours and whether you require frequent unscheduled breaks, change your positions, or would need to lie down at times throughout the day. The inability to sit for more than four hours would likely result in a disability approval.

If the SSA determines that in light of these restrictions from your arthritis, there is no work you can perform, your claim will be approved.

It is important that your RFC be supported by objective medical evidence like x-rays, CT scans, MRIs, and blood work. In addition to the RFC form, make sure your doctor provides the SSA with as much medical documentation as possible.