Rheumatoid Arthritis: Information for Social Security Disability
You must experience significant limitations in your abilities due to your RA to qualify for disability benefits.
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Rheumatoid arthritis, or RA, is an autoimmune disorder that occurs when a person’s immune system attacks the membranes surrounding their joints, causing them to inflame. Although RA can affect anyone, it’s most common in women, people between the ages of 40-60, smokers, and those who have a family history of RA. (Children can also get rheumatoid arthritis; see our article on getting disability benefits for children with juvenile rheumatoid or idiopathic arthritis.)
Disabling Symptoms of Rheumatoid Arthritis
Rheumatoid arthritis usually starts in the joints of the hands and feet, later progressing to other areas including the knees, hips, and shoulders. The main RA symptoms are warm, stiff, swollen joints. Bumps of tissue, called rheumatoid nodules, sometimes appear, and RA can also cause fatigue, fevers, and weight loss. RA symptoms can range in severity, and often get better and worse. Over time, RA can cause the joints to become permanently deformed.
There is no one diagnostic test for RA, although there are blood tests that can indicate a likelihood of its presence. RA is a chronic condition and there is no cure. Treatments include lifestyle remedies, therapy, medications, and in severe cases, surgery.
Disability Benefits for Rheumatoid Arthritis
If you have a moderate to severe case of rheumatoid arthritis, you could qualify for Social Security disability benefits. Through the Social Security Administration (SSA), the federal government provides these cash payments to those who are unable to work due to an illness or injury for at least a year. To have your disability claim approved, you’ll need to demonstrate to the SSA that you are unable to perform any type of work on a consistent basis.
Qualifying for Benefits Under the Medical Listing for RA
The SSA sets forth specific criteria for disability applicants with RA in its Listing of Impairments. The medical listing for inflammatory or rheumatoid arthritis is lengthy and relatively complicated and offers multiple ways that a disability applicant with RA can qualify under the listing. Overall, you must experience significant limitations in your abilities due to your RA to qualify for benefits under this medical listing. Specifically, to qualify for benefits under the listing for RA, you must satisfy one of the following requirements:
- Your RA is present in a joint in your legs, causing you significant difficulties in walking (for example, needing to use a two canes, a walker, or a wheelchair).
- Your RA affects joints in both of your arms, preventing you from performing many types of tasks with your arms (involving both large muscle movements and small manipulations).
- You have inflammation or a permanent deformity in one or more major joints, along with moderate involvement of at least two more organs or body systems, causing at least two symptoms out of these four: severe fatigue, fever, malaise, and/or involuntary weight loss.
- You have ankylosing spondylitis or another spondyloarthropathy, with fixation of your spine of at least 45 degrees.
- You have ankylosing spondylitis or another spondyloarthropathy with fixation of your spine of at least 30 degrees, along with moderate involvement of at east two or more body systems, or
- You suffer repeated flare-ups of your RA with at least two of symptoms (such as fever, extreme fatigue, malaise, or weight loss) that cause limitations in your activities of daily living, social functioning, or ability to complete tasks.
Qualifying for Disability Using the Medical-Vocational Guidelines
If you have rheumatoid arthritis but don’t exactly meet the specifications in the medical listing for inflammatory arthritis, you could still qualify for Social Security disability benefits if the SSA determines that you are unable to perform consistent work.
RFC. One of the ways the agency evaluates your ability to work is by assigning you a “Residual Functional Capacity” (RFC). Your RFC – either sedentary, light, medium, or heavy – is the heaviest type of work that the SSA feels that you could perform. Your RFC also includes doctor's restrictions and functional limitations, such as "needs to change positions every two hours" or "can stand for no more than 30 minutes at a time."
A limitation on how long you can sit or stand because of inflamed and painful joints (if the SSA finds you or your doctor credible, or you have an MRI showing deformity) will likely give you a sedentary RFC, which will limit the types of jobs you can do. Needing to change your position or take rest breaks frequently will further limit the types of jobs you can do. If you have chronic shoulder pain, you may not be able to reach overhead. If you have finger swelling and pain, you won't be able to do what's called fine manipulation, which is required at most sedentary jobs. Any of these limitations could "erode the occupational base" for sedentary work, meaning you could actually do only a limited range of sedentary work.
Here's an RFC that Social Security developed for an actual applicant with rheumatoid arthritis: Applicant has the ability to perform a full range of sedentary work and a limited range of light work, including the ability to lift and/or carry and push and/or pull 20 pounds occasionally and 10 pounds frequently; to sit for one to two hours continuously for a total of eight hours in an eight-hour day; to walk and/or stand for 30 minutes continuously for a combined total of about two hours in an eight-hour day; but should avoid climbing ropes, ladders and scaffolds; should only occasionally climb ramps or stairs, or bend; and should avoid kneeling and crawling.
Medical-Vocational Grid. After developing your RFC, the claims examiner responsible for your file will consider your RFC along with your age, level of education, and the type of work you’ve done in the past. The results of these factors will classify you as either disabled or not disabled according to a set of "medical-vocational" rules.
In general, it’s easier for those who are older, less educated, and who have done unskilled work in the past to be approved for disability benefits under these rules. For instance, if you have done heavy physical labor all your life, and now you are 50 years old and you were given an RFC for sedentary work, if you have no transferable job skills and little education, the medical-vocational rules dictate that you should be found disabled. The theory behind this rule is that at your age, the law won't expect you to learn how to do a sedentary job with your limited education and skills. For more information, see our article on RFCs and the medical-vocational rules.
Medical Evidence Required When Proving Disability Due to Rheumatoid Arthritis
The main way that the SSA evaluates your claim is based on your medical evidence – this includes doctors and hospital records, laboratory test results, and could include a questionnaire completed by your doctor or even the results of an independent examination by a doctor of the SSA’s choosing.
The SSA uses the information contained in the most recent edition of the Primer on Rheumatoid Arthritis, published by the Arthritis Foundation, when evaluating rheumatoid arthritis disability claims. In general, to get approved for disability, your records must reflect the following:
- diagnosis of rheumatoid arthritis
- doctor’s notes reflecting the frequency and severity of your symptoms
- blood test results indicating the likelihood of RA (such as a positive rheumatoid factor and ANA findings)
- history of any treatments tried and what the results were, and
- other test results such as imaging studies or those that measure the range of motion of the spine.
Applying for Social Security Disability Due to Rheumatoid Arthritis
You can apply for Social Security disability in person at your local SSA office, by calling the SSA at 888-772-1213, or, for SSDI, online at www.ssa.gov. To complete the disability application, you will need detailed information, including the contact information and dates of treatment for all of your medical providers, the dates of any medical tests, and the names, addresses, and dates of employment for all of of your previous employers.
Once your application is complete, your file will be sent to your state’s Disability Determination Services (DDS) office. Here, a claims examiner will request and review your medical records and may call you for an interview or send you additional paperwork to complete. When the claims examiner feels that there is sufficient evidence to make a decision, you will be notified via mail. This normally takes 3-4 months but could take longer. If your claim for disability is denied, you will be able to file an appeal.