Can You Get SSDI or SSI Disability for Gout?

Gout is an extremely painful type of arthritis caused by the buildup of excess uric acid in the body. Too much uric acid can cause monosodium urate crystals to form in the affected joint(s).

Gout is a type of inflammatory arthritis (IA), a group of diseases that cause pain and function loss in one or more joints. Other types of IA include:

• rheumatoid arthritis
• psoriatic arthritis
• ankylosing spondylitis, and
• some forms of osteoarthritis.

Gout, like other types of inflammatory arthritis, can cause symptoms that range from relatively mild to debilitating. If your gout symptoms prevent you from working, you might qualify for Social Security disability benefits.

Symptoms and Treatment for Gout

Joint pain is the most common symptom of gout. It's not uncommon for a gout flare to cause severe pain. But gout can cause other symptoms, such as:

• swelling
• redness
• heat, and
• stiffness.

Gout most commonly affects the big toe. But it can affect other joints in your foot and other body parts, like your ankle, knee, and fingers. Gout can either be chronic or acute.

Acute gout. Acute gout usually only affects one joint and is generally treatable with medications and lifestyle changes. Acute gout flares, though painful, generally get better within a week or two.

How often acute gout flares happen varies from person to person. They can be fairly frequent or happen only every few years. But if left untreated, gout can become chronic, causing more frequent, repeated episodes of pain and inflammation that might affect more than one joint.

Chronic gout. Chronic gout (sometimes referred to as "refractory gout" or "recalcitrant gout") is generally the result of "tophi" (needle-shaped urate crystals) building up in the affected joints. The crystal deposits can cause painful deformity and dysfunction of the affected joint. Chronic gout is less effectively treated.

Pseudogout. Another condition, calcium pyrophosphate deposition disease (CPPD), is called "pseudogout" because its symptoms are similar to gout symptoms. But CPPD is caused by a different type of crystal (calcium pyrophosphate dihydrate crystals). These crystals build up in the cartilage surrounding a joint, triggering inflammation and pain. Pseudogout can't be controlled or eased with lifestyle changes, and it can cause lasting arthritis symptoms.

Both chronic gout and pseudogout can cause frequent flares that can make it difficult to work a full-time job.

Can I Get Disability for Gout?

If you suffer from chronic gout, you might be able to get disability benefits if your gout severely impairs your ability to walk or use your hands for tasks like:

• tying your shoes
• preparing meals
• managing your personal hygiene
• holding a pen, or
• sorting papers.

To determine whether you're disabled, the Social Security Administration (SSA) will first check to see if your impairment meets the criteria of one of the disability listings in the Blue Book. If you meet the requirements of a listing, you'll automatically qualify as disabled.

Social Security will consider your gout symptoms using the listing requirements for inflammatory arthritis. You can meet the requirements of the listing if a rheumatologist has diagnosed you with gout and you experience one of the following due to chronic inflammation and tophi deposits:

• trouble with one or more major peripheral joints in both upper extremities (shoulder, elbow, or wrist/hand) that prevents you from being able to make fine or gross movements effectively, or
• trouble with one or more major peripheral weight-bearing joints (hip, knee, or ankle/foot) that makes it very difficult for you to walk without help from either:
• a handheld assistive device that takes two hands (like a walker or crutches), or
• a handheld assistive device that takes one hand (like a cane), and you can't use your other hand for other activities due to gout or another impairment.

You might want to review the criteria of the inflammatory arthritis listing (14.09) with your treating physician to determine if you meet the listing requirements.

Can I Get Disability If My Gout Comes and Goes?

To qualify for disability benefits, you must show that your disability has lasted (or is expected to last) at least one year. If you have acute gout, which usually responds well to medical treatment and lifestyle changes and often goes away within weeks, it will be hard to meet this duration requirement.

If your gout attack has lasted less than 12 months, Social Security will look at your medical evidence to determine if your gout is likely to last a whole year. The SSA will want to know how often your gout attacks happen and your treating doctors' opinions about your prognosis.

If Social Security finds that your gout is likely to last a year or more, you'll meet the durational requirement for disability, even if you have periods where your gout is in remission.

What Medical Evidence Do I Need to Prove My Gout is Disabling?

To qualify for Social Security disability benefits, you'll need medical evidence that proves that:

• you have a medically determinable condition, and
• your condition is severe.

For your evidence to carry weight, it must come from accepted medical sources, like licensed medical doctors (MDs) or osteopaths (DOs). When filing for disability based on an inflammatory condition like gout, the supporting opinion of a rheumatologist will be helpful—as long as it's based on objective medical evidence.

Social Security will look for objective medical evidence and treatment records like the following:

• lab results
• diagnostic imaging (like X-rays or CTs)
• treatments you've undergone (including any side effects), and
• information about any gout complications you've had (like heart trouble or kidney disease).

Learn more about the kind of medical evidence you need to qualify for disability benefits.

What If I Don't Meet the Listing Requirements?

If Social Security determines that your gout meets the durational requirement but not the requirements of a disability listing, you can still qualify for benefits. Social Security will next decide whether your symptoms prevent you from performing your old job.

At this point, Social Security will prepare a residual functional capacity assessment (RFC), which rates how your gout affects your ability to perform work-related activities. Social Security will use your RFC to determine whether gout interferes with your ability to do the tasks required at your old job.

If Social Security decides you can still do your past work, your claim will be denied. But if Social Security determines that your gout prevents you from performing your old job, the SSA must next decide if there are any other jobs you can be expected to do, given your limitations.

For example, people with gout often experience pain and swelling in multiple joints, especially the toes. If you've developed gout in your toes, you might have difficulty walking or standing for extended periods. That would prevent you from working some types of jobs.

If you've developed gout in your dominant hand, you might be unable to perform tasks requiring writing or typing. This limitation would also reduce the number of jobs you could do. If there aren't any jobs left that you can do, given your skill set and education, Social Security would likely consider you disabled.

The pain from gout can also interfere with your attendance, reliability, and job performance. If you have a 20% reduction in your productivity due to gout, Social Security is supposed to find you disabled. (Learn more about qualifying for disability due to reduced productivity.)

You should ask your treating physician to prepare an RFC or medical source statement detailing your limitations and explaining why your gout symptoms prevent you from working. Learn more about getting your doctor to complete an RFC form.

Standard Disability Requirements

In addition to the medical requirements discussed above, to be approved for Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits, you must meet certain eligibility requirements. For instance, you can't earn more than the maximum amount of about $1,600 per month. (The maximum allowed changes each year.)

SSI is a needs-based program for people with little employment history, and it has additional criteria. To be eligible for SSI, you can't exceed the income and asset limits set by the SSA. Learn more about SSI eligibility.

SSDI benefits are only available to people with a qualifying work history with employers who paid Social Security taxes. Learn more about SSDI eligibility.

Applying for Disability Based on Gout

You can apply for SSDI or SSI disability benefits by calling Social Security's national office at 800-772-1213 (TTY 800-325-0778) and making an appointment to apply by phone. You can also apply in person by contacting your local Social Security office for an appointment. If you apply by phone or in person, a Social Security representative will help you with the paperwork.

If you're comfortable completing the application yourself, you can apply for SSDI online. The advantage of the online application is that you can complete it from the comfort of your own home when it's convenient for you. Plus, you can stop and restart as often as necessary without losing your progress.

For SSI, you can start an application online, but you'll need to speak with a Social Security representative to complete your SSI application. After you complete the online portion, the SSA will contact you with an appointment to finish your application.

Learn more about applying for Social Security disability benefits.