Rheumatoid Arthritis: Information for Social Security Disability

Rheumatoid arthritis, or RA, is an autoimmune disorder that occurs when a person's immune system attacks the membranes surrounding their joints, causing painful swelling and inflammation. 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 RA; see our article on getting disability benefits for children with juvenile arthritis.)

Disabling Symptoms of Rheumatoid Arthritis

Rheumatoid arthritis usually starts in the joints of the hands and feet and later progresses to other areas, including the wrists, knees, hips, and shoulders. The main symptoms of RA are warm, stiff, swollen joints. Bumps of tissue, called rheumatoid nodules, sometimes appear. RA can also cause fatigue, fevers, and weight loss. Over time, RA can cause bone loss and joint deformity, but also inflammation in the lungs, heart, and blood vessels.

There is no one diagnostic test for RA, although certain blood tests can indicate a likelihood of its presence. RA does not yet have a cure, but treatments include physical therapy, "disease-modifying" medications, and in severe cases, surgery to repair damaged joints.

Getting Disability Benefits for Rheumatoid Arthritis

If you have a severe enough case of rheumatoid arthritis, you should be able to qualify for Social Security disability benefits. The federal government provides these cash payments through the Social Security Administration (SSA) to those who are unable to work due to long-term illness. To have your disability claim approved, you'll need to demonstrate to Social Security that you can't perform any type of work on a consistent basis.

Qualifying for Benefits Under the Medical Listing for RA

Social Security sets forth specific criteria for disability applicants with rheumatoid arthritis in its Listing of Impairments. Social Security's medical listing for "inflammatory arthritis" is long and relatively complicated, but it offers multiple ways 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 Listing 14.09, you must meet one of the following sets of requirements:

• Your RA is present in at least one joint in your legs (foot, ankle, knee, or hip) and you have a documented medical need for a walker, two canes or crutches, or a wheelchair requiring both hands.
• Your RA is present in at least one joint in your legs and you can't use one of your arms to complete work-related activities. You must have documentation that you need to use the other hand for a hand-held device (cane) or a wheelchair involving the use of one hand.
• Your RA affects joints in both of your arms or hands, preventing you from performing many types of tasks with your arms or hands (involving both large muscle movements and small manipulations).
• You have inflammation or permanent damage in one or more major joints (could be in an arm or a leg), along with moderately severe issues with two more organs or body systems, causing at least two symptoms out of these four: severe fatigue, fever, malaise (discomfort), and/or involuntary weight loss.
• You have ankylosing spondylitis (fusion of vertebrae) or a similar joint issue that causes fixation of your spine of at least 45 degrees.
• You have ankylosing spondylitis or a similar joint issue that causes fixation of your spine of at least 30 degrees, along with moderately severe issues with two more organs or body systems.
• You experience repeated flare-ups of RA with at least two symptoms (such as fever, severe fatigue, malaise, or involuntary weight loss) that cause significant 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 meet any of the strict criteria above from the listing for inflammatory arthritis, you could still qualify for disability benefits if Social Security finds you're unable to do consistent work.

Your 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 most intensive type of work that Social Security feels that you could perform. Your RFC should list all of your functional limitations, including restrictions from your doctor, such as "needs to change positions every two hours" or "can stand for no more than 30 minutes at a time."

A sedentary RFC. If you have a limitation on how long you can sit or stand because of inflamed and painful joints, Social Security will likely give you a sedentary RFC, which will significantly limit the types of jobs you can do. Social Security might include a restriction on sitting and/or standing in your RFC if your doctor has given you this restriction and Social Security finds your doctor to be credible. Or, Social Security might add this restriction if you say you have trouble standing and you had an MRI showing damage to your foot or ankle joints.

Limitations and restrictions from RA. Here are some other restrictions you might find in an RFC for rheumatoid arthritis. If you have chronic shoulder pain, you might not be able to reach overhead. If you have finger swelling and pain, you might not be able to do what's called "fine manipulation" (picking, pinching, touching, typing, or otherwise working with the fingers), which is required at most sedentary jobs. Needing to change your position or take rest breaks frequently would further limit the types of jobs you can do.

How Social Security uses your limitations. In Social Security terms, any of these limitations could "erode the occupational base" for sedentary work, meaning you could actually do only a limited range of sedentary work, not the whole range type of sedentary work. This would make it likely that Social Security would approve you for disability benefits.

Unfortunately, Social Security doesn't always agree that your limitations are as severe as you say they are. Here's an example of 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; should avoid climbing ropes, ladders, scaffolds; should only occasionally climb ramps or stairs, or bend; should avoid kneeling and crawling.

Applicants who can do a full range of sedentary work are less likely to get approved for benefits, because Social Security will say there are some jobs they can do. 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, because Social Security doesn't expect them to be able to switch to a new type of occupation. For more information, see our article on the medical-vocational rules.

Medical Evidence Required to Prove Disability Due to RA

The main way that Social Security evaluates your claim is based on your medical evidence—this includes doctors' and hospital records and laboratory test results and could include a questionnaire completed by your doctor, or even the results of an independent examination by a doctor of Social Security's choosing.

Social Security 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 x-rays or MRIs or those that measure the range of motion of the spine.

Increasing Your Chances of Being Approved

Even if you have a strong case based your rheumatoid arthritis, Social Security will still probably deny your initial application. Social Security only awards about 38% of applications at the initial level. But here are some tips to improve your chances of getting approved.

• Get on the same page as your doctor. It's important to have open and honest discussions with your doctor about your symptoms and limitations—not just for your disability claim, but for your health as well. Social Security will be looking at your doctor's treatment notes to see if your documented symptoms and tests match what you claim on your application.
• Comply with your treatment plan. Social Security wants to see that you're doing everything you can to improve your condition. If you don't follow your doctor's recommendations or take your medications as prescribed, you may face a denial.
• Acknowledge other medical conditions. It's not uncommon for people with severe arthritis, or any other condition causing chronic pain, to also experience depression or anxiety. Or, you may have another condition like heart disease, a digestive disorder, or diabetic neuropathy that also affects your ability to work. Social Security has to consider how all of your impairments affect your ability to work, so it's important to list all of the serious conditions you experience on your application, not just the one you think is the most severe.
• Working with an experienced advocate or attorney. Evidence shows that Social Security is more likely to approve a claim when the applicant is represented by a disability advocate or attorney. From the initial application, all the way up to a hearing in front of an administrative law judge (ALJ), a disability representative will know how to present your case in the most favorable light.

Applying for Social Security Disability Due to Rheumatoid Arthritis

You can apply for Social Security disability in person at your local SSA office (after the COVID pandemic ends), by calling Social Security at 800-772-1213, or online at www.ssa.gov. To complete the disability application, you'll 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 your employers in the last 15 years. For more information, see our article on applying for Social Security disability benefits.

After You Apply for Benefits

Once your application is complete, Social Security will send your file 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 your file has sufficient evidence to make a decision, Social Security will notify you by mail. This normally takes three to four months, but could take longer.

If you receive a denial letter and your condition has worsened, or you think your case is strong enough to win an appeal, consider contacting a disability lawyer. Applicants who go to an appeal hearing represented by a lawyer have a better approval rate than applicants who represent themselves.

_{Updated October 15, 2021}