Standards Needed For Claim Approval
Unfortunately, the Social Security Administration does not approve most initial claims for arthritis. To be approved, it is important to submit all the supporting evidence you have. During an initial assessment, the Disability Examiner will determine:
- Does your disease prevent you from working?
- Is your condition expected to last for at least one year from when it caused you to either stop working or reduce your work so that after payment of impairment-related work expenses , your gross wages or net self-employment is not at the level of substantial gainful activity ?
- Have you been getting treatment for at least 3 months? And if so, how are you responding to treatment?
- If you are currently working and earned at the SGA level, did you have impairment-related work expenses that dropped your earnings below that amount.
- Is the disease causing chronic pain and swelling and joint motion that makes it painful or restricted to a degree that based on your age, skills, previous jobs, mental capacity, and education are you incapable of working at a Heavy, Medium, Light, or Sedentary level?
- Are you incapable of performing work?
If all those questions show you have severe arthritis by Social Securitys standards and that you cannot work in any occupations that you could do if you didnt have medical limitation, you should be approved for benefits.
Applying Specific Medical Tests To Your Case For Disability
Several medical tests are used to show the severity of osteoarthritis. Those tests include x-rays and MRIs. Blood work may also be used to show the amount of inflammation in the body. You should provide as many medical records and as much documentation as possible to prove your case.
But there are some instances when the SSA will order an evaluation at their expense to confirm the severity of your case.
You may be denied for benefits twice and you can appeal those decisions before asking for a hearing before an administrative law judge . The ALJ will sort through all the documentation, medical records, RFCs, and statements to determine if you do meet the vocational-medical allowance for approval for benefits.
Your age, educational background, skills level, and past work history are taken into consideration and the ALJ will determine if you can transfer your skills over to a less physical position.
You have a lot to gain from a successful Social Security disability claim. A successful claim wouldnt just mean consistent financial support for your ailmentit would also grant you the kind of stability that you may have been missing out on for years now.
Unfortunately, winning a claim isnt a cakewalk, which is why you should consider consulting a Social Security disability attorney or advocate. Your attorney will use his or her knowledge and experience to fight on your behalf and help you get the benefits you needand you dont even need to pay your lawyer unless you win.
Suggested Mechanisms Of Ptoa After Acl Injury
Although accumulating evidence demonstrates that patients with ACL injury are predisposed to PTOA, the precise mechanism remains unclear . Structural, biological, mechanical, and neuromuscular factors are thought to be involved in this process. The involvement of ACL injury in the development of OA may be associated with the mechanisms described in this section .
Suggested mechanisms of PTOA after ACL injury. An up arrow indicates an increase and a down arrow indicates a decrease
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How Joint Pain Can Qualify Under A Blue Book Listing
Social Security has recently updated its listing for joint dysfunction and given it a new number: listing 1.18. To meet the listing, a joint in one of your extremities must cause chronic joint pain or stiffness, known as arthraglia . Your pain or stiffness must be associated with an abnormality in a joint that causes problems with motion or stability.
Your medical records need to show evidence of an anatomical abnormality in one of the following ways:
- medical imaging must show either joint space narrowing, ankylosis, or the destruction of bone, OR
- your doctor must have found an abnormality on a physical exam, like subluxation , contracture , or bony or fibrous ankylosis .
In addition, you need medical documentation that you:
- need to use a walker, two canes or crutches, or a wheelchair or scooter that requires both hands, OR
- can’t use one hand, and you need the other to operate a one-handed wheelchair, cane, crutch, or other device, OR
- can’t use either arm or hand to begin, sustain, and finish work.
All of the above criteria must occur within a consecutive four-month period. For instance, you can’t have an MRI from last year showing an abnormal joint coupled with a need for a walker starting this month.
Social Security’s listing of impairments also includes others listings that are associated with chronic joint pain. To learn more about meeting the requirements under these listings, see our articles about these impairments:
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Residual Functional Capacity Analysis
The SSA also looks at how your arthritis is preventing you from carrying out daily activities that would be required in a work environment. Actions such as your ability to stand and walk for long periods, lift heavy objects, bend, or kneel are assessed by the SSA from your medical records and RFC form. Read more in our story How to File for Residual Functional Capacity.
Other Ways Your Arthritis Can Qualify As A Disability
If you do not qualify for benefits from the impairment listings for back problems, you may be eligible under a broader classification of a major dysfunction of a joint. To succeed with this category, you must have an obvious joint distortion. Such a distortion would be visible by using medical imaging techniques, such as an MRI. Examples of such impairments are the joint being fused or a compression of the space in a joint has occurred. Coupled with this would be a history of the loss of a range of motion, along with stiffness and pain in the joint.
A further requirement is the dysfunction must be occurring on both arms. It must exist in at least one hand, a wrist, an elbow, or a shoulder in each arm. Because of this stringent requirement, you must have a great difficulty in performing daily tasks such as preparing meals, performing daily hygiene, or completing simple house cleaning jobs without another persons assistance.
A second option would be if your dysfunction existed in an ankle, a knee, or a hip causing much difficulty in walking. Illustrations would be if you were unable to climb a set of stairs at a reasonable speed even using a handrail if you were required to use a walker, two canes, or two crutches or needed another persons help in the workplace, around the home, , or in activities such as shopping for groceries.
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How Does The Va Rate Arthritis
The VA rates arthritis differently, depending on whether the veteran has been diagnosed with the degenerative form of the disease that often results from overuse or traumatic injury and is the most common form of arthritis to affect veterans, or rheumatoid arthritis, which is an inflammatory condition that is the result of an autoimmune disorder. While autoimmune disorders are generally not service-related, the difference with a diagnosis of rheumatoid arthritis is that the cartilage breakdown associated with the rheumatoid form of this disease tends to happen suddenly within a year or two post-injury.
The VA considers rheumatoid arthritis to be a disabling condition. If you are diagnosed with this disease and are incapacitated as a result, you are generally provided with 100 percent disability, regardless of how many joints are affected. If you have experienced at least 2 episodes of incapacitation in a year, you will receive at least 20 percent disability. Three or more incapacitating episodes in a year will result in at least 40 percent disability, and four or more episodes or evidence of other symptoms of rheumatoid arthritis, such as loss of appetite or anemia, will result in 60 percent disability.
- Functional loss of the joint
How The Ssa Determines Disability With Arthritis
In the case of arthritis, you must receive medical treatment for at least three months before the SSA will make a determination regarding the extent and severity of your condition and whether or not it qualifies you for Social Security Disability benefits.
No matter where you develop arthritis, whether in your hands, feet, knees or back, if you have medical evidence to support your claim, you may be eligible for disability benefits. You will also need to meet financial requirements to qualify for disability benefits.
Follow the steps below to find out if you qualify for Social Security disability benefits due to your arthritis.
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The Ssa Evaluation And Medical Qualifications
The Social Security Administration has its own medical guide, known as the Blue Book, which determines the requirements to be approved for disability. Osteoarthritis falls under Section 1.00, which is the Musculoskeletal System.
In order to be approved for SSDI benefits, your documentation and medical records will need to show that you meet one or more of the listing requirements and that the pain you suffer from osteoarthritis is severe enough to keep you from working and it impacts your ability to perform your routine daily tasks.
Section 1.02 addresses joint dysfunction, which says your joints must be characterized by gross anatomical deformity, stiffness, loss of range of motion, and pain. You will need to provide imaging that shows stiffness or fusion, bony destruction, or narrowing of the joint space of the joints that are affected.
In addition, you will have to show that at least one your hip, knee, or ankle is impacted to the extent that:
- You are impaired to walk without using an assistive device and sustaining a reasonable pace while walking a sufficient distance in order to carry out your daily activities such as going to and from school or work.
- Your hand, wrist, elbow, or shoulder are impaired so severely they cant perform gross or fine movements like sorting files, pulling, pushing, preparing meals, or reaching.
Section 1.04 addresses disorders of the spine, including osteoarthritis, resulting in:
Winning Social Security Disability Benefits For Joint Dysfunction By Meeting A Listing
To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will consider whether your joint problems are severe enough to meet or equal the listing for joint dysfunction. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that Social Security Administration presumes would prevent a person from performing substantial work. If your joint pain or immobility is severe enough to meet or equal the listing, you will be considered disabled.
The listing for major dysfunction of a joint is 1.02. It has 2 parts: A and B. You will meet the listing and be eligible for Social Security disability benefits if you meet either of the two parts.
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Arthritis And The Americans With Disabilities Act
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act .
What Is An Equivalent Va Disability
An Equivalent VA disability is a general term for conditions that have multiple names. Listed below are some of the most common conditions that go by other names.
- Adrenal cortical hypofunction is the same as Addisons disease, code 7911.
- Aminoaciduria is a renal tubular disorder, code 7532.
- Anaphylaxis is the same as angioneurotic edema, code 7118.
- Angioedema is the same as angioneurotic edema, code 7118.
- Anthracosis is the same as pneumoconiosis, code 6832.
- Antheroembolic renal disease is the same as atherosclerotic renal disease, code 7534.
- Atherosclerotic heart disease is the same as arteriosclerotic heart disease, code 7005.
- Bartters syndrome is a renal tubular disorder, code 7532.
- Benign chronic familial pemphigus is a type of bullous disorder, code 7815.
- Birmingham Hip Resurfacing is a type of hip replacement surgery, code 5054.
- Buergers Disease is the same as thrombo-angiitis obliterans, code 7115.
- Bullous pemphigoid is a type of bullous disorder, code 7815.
- Calcinosis cutis is a type of collagen-vascular disease, code 7821.
- Cardiospasms are the same as spasms of the esophagus, code 7204.
- Choroidal nevus is a type of benign neoplasm of the eye, code 6015.
- Choroiditis is a form of choroidopathy, code 6000.
- Coronary artery disease is the same as arteriosclerotic heart disease, code 7005.
- Cyclitis is a form of choroidopathy, code 6000.
- Dacryocystitis is a disorder of the lacrimal apparatus, code 6025.
- Dariers disease is a disease of keratinization, code 7824.
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Predictive Markers For Chronic Pta
Despite the knowledge of the potential, pathogenic mechanisms occurring in the injured joint have increased in the past years, whereas clinical and biochemical features that predict or correlate with the risk and progression of chronic PTA have to be still identified.
Given the high number of molecules involved in the processes during the acute injury phase, molecular biomarkers could be more useful to indicate the risk for chronic evolution. Indeed, molecular biomarker profiles based on the identities, quantities and temporal pattern of expression in joint tissues and, in particular, in SF may provide important indications of the disease development. At present, an increasing number of reports suggest that potential candidates could be inflammatory mediators, even though their value for clinical purposes has not yet been confirmed.
Recently, studies in animals have indicated that specific genetic mutations that alter the synthesis of a variety of molecules may also be relevant as predictive biomarkers for the pathophysiology of chronic PTA. In particular, modifications in genes involved in cartilage matrix degradation, inflammation,or the differentiation and apoptosis of chondrocytes contribute to protect against the onset of PTOA.
Qualifying Based On Residual Functional Capacity
If you don’t meet listing 1.18 for a joint abnormality, or another listing discussed in the section above, you aren’t alone. Most people who qualify for disability based on a musculoskeletal problem don’t have an impairment that meets a listing. And in fact, many diagnoses associated with joint pain are not specifically listed in Social Security’s blue book. For example, there are no listings for the following specific joint-related problems:
But you can still try to show Social Security that your joint pain or stiffness limits your ability to function so much that you can’t work full time. You’ll need your doctor’s notes to include exactly how your joint problems limit you :
- If the deformity is in your hip, knee, or ankle joint, you may be unable to walk well enough to carry out many normal activities of daily life, even if you don’t need a walker or scooter, two crutches, or two canes. Or you may be unable to lift more than 30 pounds or be unable to stoop or crouch.
- If the deformity is in your shoulder, elbow, wrist, or hand, you may need someone else’s help for daily activities like preparing a meal, taking care of personal hygiene, or sorting and handling papers or files. Or you may be unable to reach overhead or write or type for more than two hours.
For information about qualifying for disability benefits under an RFC assessment, visit the link above that’s most related to your joint pain.
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Can Arthritis Make You Unable To Walk
Arthritis in certain parts of the body can make it more difficult to walk. Heres how to deal with these changes in your gait and remain mobile. Having arthritis in your hips, knees, ankles, or feet can making walking harder a side effect that can have consequences for your daily well-being and quality of life.
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Acl Reconstruction And Ptoa
Patients who wish to return to high-level activities commonly choose to undergo ACL reconstruction . It is believed that ACL-R helps to restrain the anterior translation of tibia, regain proper joint kinematics, restore knee stability, and prevent excessive torsional loading, thus resulting in pain relief, functional recovery, low complication rates, and highly predictable improvements . Notably, reconstruction methods, including graft choice, attachment point, fixation, and tension, as well as rotational stability, could affect the biomechanical load of the knee joint . Evidence shows that hamstring autografts demonstrate lower incidence, less knee pain, and better self-reported function than bone-patellar tendon-bone autografts .