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
It is estimated that 32.5 million people in the U.S. are affected by osteoarthritis. Commonly known as degenerative arthritis, osteoarthritis (or “OA”) is the most common joint disorder in this country. Approximately 10% of men and 13% of women over 60 experience symptoms, and this number is likely to increase as the population ages. If you are suffering from the effects of Osteoarthritis you may qualify for disability benefits.
Osteoarthritis occurs most frequently in the hands and fingers, hips and knees, though it also can affect the shoulder and the spine.
The condition develops when cartilage in joints gradually deteriorates. The joint is where two bones come together and cartilage is the tough, rubbery tissues that covers the ends of bones. As cartilage breaks down, irritation develops in the joint and surrounding tissue. Cartilage can’t repair itself because there are no blood vessels in cartilage.
Symptoms develop slowly and worsen over time; as osteoarthritis advances, pain becomes more intense. Other common symptoms include:
- Swelling caused by soft tissue inflammation around a joint;
- Tenderness when pressure is applied to a joint;
- Stiffness in joints;
- Loss of flexibility and reduced range of motion;
- Crepitus – a grating sensation when a joint moves;
- Bone spurs – extra bits of bone that form around a joint.
Most osteoarthritis is the result of aging and wear and tear on joints over time, but a variety of risk factors can contribute and make a person more vulnerable to the condition. Among them:
- A past injury, like a torn cartilage or dislocated joint;
- Repetitive stress on a joint caused by a sport or a job that requires kneeling, climbing, heavy lifting or similar actions;
- Gender (women are more likely to develop osteoarthritis);
- Certain diseases and medical conditions that affect the joints, like diabetes or another type of arthritis;
- Bone deformities/malformed joints;
- Poor posture.
Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from Osteoarthritis. If you have been denied disability don’t give up!
To diagnose osteoarthritis, a doctor will first look for tenderness, swelling, redness and reduced flexibility in joints.
Imaging tests like MRIs and x-rays can detect malformations in bones and cartilage loss. Blood tests and a joint fluid analysis may be performed to rule out other conditions. Osteoarthritis can’t be reversed, but treatments can reduce pain and increase mobility. Doctors frequently prescribe a combination of medications and lifestyle changes, including:
- Over the counter medications like Tylenol and Ibuprofen to relieve pain and reduce swelling;
- Topical gels and patches that can numb the joint area and provide pain relief;
- Corticosteroids, by injection or oral;
- Cymbalta – the antidepressant duloxetine approved by FDA for musculoskeletal pain;
- Exercise, physical therapy, and occupational therapy to strengthen muscles and learn ways to perform everyday tasks that don’t place stress on joints;
- Heat and cold therapy;
- Weight management;
- Adequate rest and sleep.
Qualifying for Disability for Osteoarthritis
Osteoarthritis 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 and qualifying for Social Security Disability Income can be problematic. To evaluate osteoarthritis, Social Security uses the criteria of listed impairments which have similar symptoms and limitations.
We evaluate disorders of the skeletal spine (vertebral column) or of the upper or lower extremities that affect musculoskeletal functioning under these listings.
We use the term “skeletal” when we are referring to the structure of the bony skeleton. The skeletal spine refers to the bony structures, ligaments, and discs making up the spine. We refer to the skeletal spine in some musculoskeletal listings to differentiate it from the neurological spine. Musculoskeletal disorders may be congenital or acquired, and may include deformities, amputations, or other abnormalities. These disorders may involve the bones or major joints; or the tendons, ligaments, muscles, or other soft tissues.
To qualify for disability benefits, your osteoarthritis must match the symptoms and limitations of a listed impairment.
Getting approved for SSDI under a diagnosis of any musculoskeletal disorder has become more restrictive since the Social Security revised its criteria for impairments listed under Section 1.00 Musculoskeletal Disorders last year. 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 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.
Also, if you have had reconstructive surgery of a major weight bearing joint such as a hip or a knee (See Section 1.17), you may also be eligible for disability benefits, 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.
Be prepared to submit complete medical records, including medications and side effects, physical therapy, and changes to your lifestyle as a result of osteoarthritis.
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. Follow your treatment plan; Social Security wants to know you are doing everything you can to manage your osteoarthritis.
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 work and if there is any job you are able to perform, taking into account whether or not you are able to drive, your age, and level of education. Additionally, if you have another impairment, for example, high blood pressure or diabetes, Social Security must consider how those health issues, combined together, limit your ability to hold a job and perform necessary daily tasks.
If you have been diagnosed with osteoarthritis and are unable to work, you may be eligible for Social Security Disability benefits.
Filing for SSDI is a complicated matter. Most applicants are denied initially, but if you have an attorney experienced in disability law to help you navigate the often confusing and lengthy process, you can avoid the common pitfalls that lead to the delay or rejection of your claim.
In order to qualify for Social Security Disability, you will need to satisfy a few specific requirements in two categories as determined by the Social Security Administration.
The first category is the Work Requirements which has two tests.
- The Duration of Work test. Whether you have worked long enough to be covered under SSDI.
- The Current Work Test. Whether you worked recently enough for the work to actually count toward coverage.
The second category is the Medical Eligibility Requirement.
- Are you working? Your disability must be “total”.
- Is your medical condition severe? Your disability must be “severe” enough to interfere with your ability to perform basic work-related activities, such as walking, sitting, and remembering.
- Is your medical condition on the List of Impairments? The SSA has a “List of Impairments” that automatically qualify as “severe” disabilities. If your disease is not listed this does not mean you cannot get disability, it means you must prove you cannot maintain employment due to your limitations.
- Can you do the work you did before? SSDI rules look at whether your medical condition prevents you from doing the work you did prior to developing the condition.
- Can you do any other type of work? If you cannot do your prior work, an evaluation is made as to whether you can perform any other kind of work.
More details can be found on our Qualifying for Disability page.
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.
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.
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