If you suffer from osteoarthritis and it causes moderate to severe symptoms, you may be eligible to receive Social Security Disability benefits. The Social Security Administration (SSA) oversees the Social Security Disability Insurance (SSDI) program, which is for workers who have become unable to work because of medical conditions or an injury.
In order to be eligible to receive SSDI benefits, you have had to work enough to earn sufficient credits and to have paid in enough taxes to the SSA. If you are deemed eligible for benefits, you may have some dependents, such as minor children, who are also eligible for benefits. The SSDI process is detailed and complicated, so providing extensive documentation to back up your claim is essential.
Osteoarthritis is a form of arthritis that has a gradual loss of cartilage in the joints. Cartilage, a tough tissue that provides cushioning between the bones that makes up the joints, plays an important role in your functioning. Loss of cartilage causes bone spurs and cysts, allowing bones to rub against each other causing severe pain.
Load-bearing joints, such as the hands, hips, knees, spine, and feet are usually those that are affected. The condition usually begins in one joint then spreads to others. A degenerative disease, it can be either a primary or a secondary condition. Osteoarthritis can be aggravated by metabolic irregularities or excessive weight.
If you suffer from osteoarthritis, you may suffer from severe pain and mobility issues that limit your functioning. This form of arthritis is diagnosed with x-rays and diagnostic imaging. A physical exam can rule out other conditions, which may be indicated by a fever or a rash. The doctor will move and touch your different joints to determine which joints are involved, and x-rays will show narrowed joint spaces, bone spurs, or cysts.
Common symptoms of osteoarthritis are joint pain, stiffness, and enlarged joints. While your symptoms may initially be mild at first, they can develop into severe problems that leave you unable to perform your daily tasks. The pain can manifest into a severe ache that worsens throughout the day. Your joint stiffness may lessen throughout the day, but as the cartilage thins the joint may become unstable.
The Cost of Treating Osteoarthritis
According to the Centers for Disease Control (CDC), estimated costs due to hospital expenditures of total knee and hip joint replacements totaled, respectively, $28.5 billion and $13.7 billion in 2009. The average direct cost per patient, who has health insurance, is about $2,600 per year. On average, the cost is $5,700 per year.
Because osteoarthritis is an ongoing condition that worsens, you can expect to continue paying for treatment throughout the years ahead. Of course, if you have to have joint replacement surgery, your out-of-pocket expenses will be considerably higher than those who don’t undergo joint replacement surgery. Joint replacement surgery can cost $25,000 or more.
The SSA Evaluation and Medical Qualifications
Osteoarthritis is listed in the medical guide used by the SSA, which is called the Blue Book. Conditions in the Blue Book have specific criteria that must be met in order to qualify for disability benefits.
Section 1.00 of the Blue Book focuses on the Musculoskeletal System, which includes osteoarthritis. In order to meet the criteria for this listing, you have to show that the pain caused by your osteoarthritis is severe enough that it limits your ability to perform daily tasks, such as mobility issues. Your medical records need to indicate any treatment you have undergone and how you responded to those treatments.
Section 1.02 of the manual addresses Joint Dysfunction, which indicates your affected joints must be characterized by chronic pain, stiffness, loss of motion, or “gross anatomical deformity”. Your medical files need to include imaging that narrowing of spaces, fusion or stiffness, or bony destruction of the affected joint(s).
In addition, you have to be able to prove that one or more of your weight-bearing joints, such as the hip, knee, or ankle, is impacted to the extent that:
- You cannot walk independently without the aid of an assistive device that limits functioning of both arms, such as a walker or crutches, and in maintaining a reasonable pace when walking a sufficient distance.
- Your wrist, shoulder, elbow, or hand are impacted so severely you are unable to perform fine gross motor skills, such as pushing, pulling, or fingering – sorting files, preparing meals, or so forth.
OR
Meeting the Criteria for Disability with a Medical-Vocational Allowance
If you do not meet the criteria set forth in the Blue Book, you may still be considered disabled when using the medical-vocational allowance and the residual functioning capacity (RFC). The RFC is to be completed by your doctor and should clearly indicate any limitations, such as your inability to stand more than two hours without repositioning or your inability to lift more than 10 pounds.
This approach considers your age, medical condition and symptoms, work experience, education, and skills. It determines if you are able to do a lighter duty work, such as sedentary work which calls for sitting 6 hours and standing 2 hours during an 8-hour day and the ability to lift a maximum of 10 pounds. If your osteoarthritis impacts your ability to do those things, you may meet the criteria for disability approval per the medical-vocational allowance.
Applying Specific Medical Tests to Your Case
The SSA will consider test results when determining if eligible for SSDI benefits. Images, including x-rays, MRIs, and CAT scans may show the severity of the joint damage and deformities. Detailed test results and physician notes are imperative in proving your case.
The SSA may order a medical evaluation, at their expense, with the doctor they choose. This evaluation or consultation is for informative purposes only and can help determine the severity of your condition and symptoms and if you meet the criteria for disability. In some cases, a mental evaluation may be ordered to determine if the ongoing pain and discomfort has impacted your mental functioning by causing anxiety or depression which impact your ability to work.
Providing thorough documentation is the key to proving your disability case and winning your monthly benefits. The disability process is complex and can be a lengthy process depending upon the evidence that is presented and if your case can easily be approved based on the documentation that has been presented.
