Can I get Social Security Disability for Osteoarthritis?
Can I get disability benefits if I am suffering from the effects of Osteoarthritis?
Author: Attorney Lonnie Roach
According to the Centers for Disease Control, osteoarthritis affects 21.2% of adults in the U.S. Osteoarthritis is the most common type of arthritis and the leading cause of work disability. More than half of U.S. adults with arthritis are of working age, and though some cases of osteoarthritis are not severe, the condition can limit the type of work an individual does or prevent them from working at all.
Most osteoarthritis is the result of wear and tear on the joints that develops when cartilage in joints gradually deteriorates.
Though it occurs most frequently in the hands, knees, hips and spine, osteoarthritis can affect any joint. Symptoms develop gradually and become worse over time as pain and discomfort become more intense.
In addition to pain, symptoms include:
- Swelling around a joint;
- Tenderness when pressure is applied to a joint;
- Stiffness in joints;
- Loss of flexibility and reduced range of motion;
- A grating sensation when a joint moves; and
- Bone spurs – extra bits of bone that form around a joint
These symptoms can cause you to miss work and jeopardize your ability to maintain employment.
Osteoarthritis can’t be reversed, but treatments can reduce pain and increase mobility.
Doctors frequently prescribe a combination of medications and lifestyle changes that includes over the counter medications to relieve pain, corticosteroids by injection or orally, physical therapy, exercise, and weight management. Demonstrating that you are following your doctor’s treatment plan is an important part of qualifying for disability benefits.
Can I Qualify for Social Security Disability if I have Osteoarthritis?
If you have Osteoarthritis and cannot maintain employment, you may be eligible for disability benefits, but to qualify you will need to satisfy both the financial and medical requirements set forth by the SSA.
- Financial Requirements:
- Medical Requirements:
Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements.
You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants. If you earn more than the SGA amount, your claim will be denied, and if you have not worked enough recently to earn the necessary amount of work credits, Social Security will deny your claim.
As the pain and stiffness caused by osteoarthritis worsens, it can severely limit an individual’s ability to walk, use their hands and arms, or even sit at a computer for a long period of time.
In some cases, a hip or knee replacement may be required. But even though it can be disabling, osteoarthritis is not listed as a separate impairment in Social Security’s Blue Book, a manual which lists impairments Social Security considers disabling and may automatically qualify for benefits. However, if you have severe trouble walking or using your fingers, you may not be able to perform sedentary work or jobs that require even a short time of standing or walking.
The Blue Book has a few listings under which Social Security evaluates osteoarthritis; and you have the best chance for approval if your condition matches one of the following impairments:
- 1.15 Disorders of the skeletal spine resulting in compromise of a nerve root(s)
- 1.16 Lumbar spinal stenosis resulting in compromise of the cauda equina
- 1.18 Abnormality of a major joint(s) in any extremity
Be aware that there are very specific criteria for each impairment.
To meet the requirements of a listing for spinal disorders (1.15 or 1.16), you must have a diagnosis of osteoarthritis in your spine and:
- Narrowing of the spinal canal in the lower back affecting nerve roots and making it extremely difficult to walk or use your hands; or
- Compression of a spinal nerve root limiting the motion or your spine and making it difficult to walk or use your hands.
To qualify under listings for joint dysfunction (1.18), you must show medical evidence of one of the following:
- An obvious deformity in a joint, evidenced by medical imaging such as an x-ray or MRI; or
- Destruction of bone; or
- Joint space narrowing; or
- Fused joints or bones (ankylosis).
- You must have a history of joint pain, stiffness, instability and reduced range of motion; and
- Documentation of the need to use a walker, two canes or two crutches, or a wheelchair or scooter that requires both hands; or
- You are unable to use one hand due to osteoarthritis and need to use the other to operate a one-handed wheelchair, cane, crutch or other device; or
- You are unable to use either arm or hand for work.
You may also be eligible for disability benefits if you have had reconstructive surgery of a major weight bearing joint such as a hip or a knee (See Section 1.17), but you must be able to provide:
- Documentation of reconstructive surgery or fusion; and
- Evidence that you experience extreme difficulty moving that has lasted, or is expected to last 12 months; and
- Proof that you need a walker, 2 canes or two crutches or a wheelchair or scooter requiring both hands.
Social Security evaluates your claim based on your medical evidence which includes doctors’ notes, hospital records and laboratory tests.
Social Security might also request an independent examination by a doctor of Social Security’s choosing. Be prepared to submit:
- detailed physical exam reports, including descriptions of orthopedic or neurologic problems;
- imaging and diagnostic tests such as x-rays and MRIs showing evidence of physical abnormalities;
- doctors’ notes describing your subjective symptoms, such as the frequency and severity of your pain and/or inability to perform activities of daily living like cooking, cleaning, and shopping;
- reports from surgical procedures;
- documented need for an assistive device, such as a cane or walker;
- medications and side effects; and
- history of physical therapy and any other treatments tried and what the results were.
Discuss your condition with your medical providers and make sure they describe your limitations and symptoms in their notes in detail.
Social Security will compare your doctor’s notes with what you say in your application. You will need to demonstrate that you are following your doctor’s treatment plan, and despite that your medical condition still prevents you from working full-time.
Additionally, it’s important to keep track of your work absences.
Once Social Security determines your limitations caused by your condition, they will have a vocational expert assess whether a person with those same limitations is employable. If your condition or the treatment rendered for that condition causes you to be absent regularly two or more days a month or be “off-task” 15% or more of the workday, most vocational experts will find you unemployable.
If your osteoarthritis doesn’t match a listed impairment, you may still qualify for SSDI based on your limitations.
Social Security will conduct a Residual Functional Capacity assessment to evaluate how your disability affects your ability to perform your old job or if there is any other job you are able to perform, taking into account whether or not you are able to drive, your age, and level of education. For example, if you have difficulty walking on uneven surfaces, climbing stairs, or bending, you may be limited to sedentary jobs. If you have osteoarthritis in your shoulders, arms, or hands, you may be restricted from work that requires lifting, reaching, typing, writing, or grabbing. If Social Security decides you cannot do your old job or don’t have the skills to perform a new job, you may be approved for a Medical-Vocational Allowance.
If you are 55 or older or have another medical condition you may get approval.
Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.
Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.
You may also be eligible for Social Security Disability benefits if you have another medical condition, such as obesity.
If you are overweight, Social Security must consider how extra weight together with osteoarthritis limits your functionality and causes more pain than a person who has arthritis alone. One disorder alone may not meet the criteria of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.
Should you file a claim?
If you believe that you meet Social Security’s medical and financial requirements, you should apply for benefits.
If you are still unsure or would like to talk to someone, please contact us at 512-454-400. We are always ready to take your call and discuss your options with you free of charge. We are happy to help folks just like you find the best solution for their personal situation.
How do I file for Social Security Disability benefits?
Once you have decided to file a claim, you can take the first step and apply for Social Security Disability benefits in person at your local Social Security Administration office, online, or over the phone.
After your application is submitted, Social Security will send your file to the state’s Disability Determination Services office (DDS). A claims examiner will request and review your medical records and may call you for an interview or additional paperwork. When the claims examiner has enough information, Social Security will make a decision and notify you by mail. Normally, this takes three to four months, but could take longer. Don’t be discouraged if your initial application is denied – most are – and you will have the opportunity to appeal.
- File a Request for Reconsideration with the Social Security Administration to completely review the case.
- If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success. You certainly don’t have to hire us, but you should seriously consider hiring some advocate to help you at this point. Your benefits are in the balance and having someone by your side who understands the criteria the SSA seeks for approval can make all the difference.
- If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
Do I need a disability attorney for SSDI?
If you have osteoarthritis and cannot work, you may be eligible for Social Security Disability benefits, but qualifying is complicated and most initial applications are denied.
You may certainly file a claim on your own, but evidence shows that your chances for approval are increased significantly if you have legal representation. At each potential stage of the process, from the initial application stage to the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.
What if I don’t qualify for SSDI?
If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury. You can check eligibility requirements and begin the application for SSI online or by calling Social Security at 1-800-772-1213. In addition to SSDI and SSI benefits, you may be able to get financial assistance from a privately purchased long-term disability policy or a policy through your employer.
I have long-term disability insurance – should I file a claim?
Yes – you should file a claim as soon as you become disabled.
Long-term disability insurance (LTD) protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, do not quit your job before you file a claim because LTD coverage is good only as long as you are employed, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Also, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.
Do I need a disability attorney for a long-term disability insurance claim?
It doesn’t matter if you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer; filing a claim for long-term insurance is a complex process.
The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. Again, you don’t have to hire us, but you should seriously get help at this point. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
Your Free Initial Consultation
At Bemis, Roach and Reed, if we can't help you, we will try to find the right attorneys for you.
We offer each of our prospective clients a free no obligation one hour phone or office consultation to see if we can help you and if you are comfortable with us. We know how difficult a time like this can be and how hard the decisions are. If we can be of assistance to you and help you find a solution to your issue we will even if that means referring you to another attorney.
Or simply call
to schedule your
Let's get you Started:
If you could provide us with some basic information about your claim we will get right back with you with a free case evaluation and schedule your Free Consultation Today.