Arthritis And SSA Disability Claims
This column will examine how the Social Security Administration evaluates Disability Insurance Claims for people who suffer from Arthritis. The Social Security Administration (SSA) has a set of criteria that it uses called Listings to determine whether a person is eligible for monthly disability insurance payments. To obtain disability insurance benefit payments from the SSA a person must in general have a health problem that can be expected to last at least one year or to result in death and be unable to perform any type of substantial gainful employment.
To better understand how the SSA reviews claims that involve persons who suffer from arthritis it is helpful to take a brief look at what arthritis is and how it is diagnosed.
Arthritis comes from the term arthro which means a joint, and the suffix itis which means inflammation. Thus arthritis is a term that describes inflammation of a joint. Where two or more bones come together in a joint is called an articulation. Most joints allow flexibility such as the hip joint or the elbow. Movable joints are called synovial joints. Some joints such as vertebra in the spine allow a limited range of motion. Some joints such as the suture joints in a person’s skull do not allow any movement at all as they are fused together.
A typical movable joint has the bones separated from each other by a joint capsule which consists of cartilage. Ligaments which are strong bands of connective tissue which usually hold the joints together. The end of the bone that faces the joint is covered by articular cartilage which is a smooth cartilage that allows the joint to move freely. There is a synovial membrane which lines the inside of the joint and contains fluid which serves as a lubricant between the bones, like oil lubricates a car engine’s moving parts.
There are a number of different types of arthritis. Two of the more frequently occurring types of arthritis are discussed below. Osteoarthritis is a very common form of arthritis. It is a disease in which there is a progressive degenerative joint disease in which the articular cartilage that covers the ends of the bones facing the joint wears out. The end of the bone in the joint will hypertrophy which means it increases in size and thickness. This hypertrophy of the ends of the bone is why a person with arthritis may have swollen knuckles. Osteoarthritis is also called degenerative joint disease. It tends to occur in people as they age.
Rheumatoid arthritis is a form of arthritis in which the joints become inflamed and very painful. Women tend to get rheumatoid arthritis more than men. The synovial membranes that surrounds the joint becomes inflamed and becomes thicker. These changes make it more difficult to move the joint. It can lead to the formation of tissue that can harden and form a bony ankylosis which is a fusion of the joint that prevents any movement of the joint. Rheumatoid arthritis is accompanied by pain and swelling of the affected joint and can also create a fever. Rheumatoid arthritis can be diagnosed by a blood test that reveals a rheumatoid factor (antibodies) in the blood. Xrays are also used to determine if there is swelling of the effected joints.
The SSA uses the following test to determine if a person with rheumatoid arthritis meets the criteria for awarding Disability Insurance Benefits. The person must have each of the following:
A. A history of persistent joint pain, swelling and tenderness involving multiple major joints which are defined as hip, knee, ankle, shoulder, elbow, or wrist and hand. The person must also have signs of joint inflammation such as swelling and tenderness on a current medical exam despite at least three months of prescribed therapy. The person must have significant restriction of the functioning of the affected joints and it must be expected that this condition will last at least twelve months.
B. The diagnosis must also be corroborated by either a blood test that is positive for rheumatoid factor, or positive for antinuclear antibodies, or higher than usual sedimentation rate or characteristic changes in the tissue in a biopsy of the synovial membrane.
For further information on arthritis you can contact the Arthritis Foundation, Carolinas Chapter, 1135 Kildaire Farm Road, Suite 311-7, Cary, N.C. 27511. Telephone 919-388-0052.
It should be kept in mind that a person can still be found to be disabled by an Administrative Law Judge even if he does not meet a particular listing if he has health problems that in combination are the equivalent of a listing. The Judge has the discretion to decide if a person’s health problems are serious enough to warrant an award of disability benefits despite not meeting the specific technical requirements of one of the SSA listings for disability.
Pitt Dickey has practiced law in Fayetteville handling Social Security Disability claims since 1978.