Getting Social Security Disability or SSI for Joint Pain Problems

Joint pain is common as we get older; as many as one-third of adults suffer from joint pain at any given time. Typical places for joint pain include the knees, shoulders, neck, hips, elbows, wrists, and ankles. The severity of joint pain ranges from mild soreness to immobilizing pain, and it can last a few weeks (acute) or for months or years (chronic). Because you use your joints (the place where two bones meet) any time you move any part of your body, severe joint pain can be disabling.

Joint pain and stiffness have many causes, including injury, inflammation, age, infection, and cancer. Medical diagnoses associated with joint pain include osteoporosis, arthritis, post-traumatic arthritis, chondromalacia of the kneecap, fibromyalgia, bursitis, lupus, gout, and pigmented villonodular synovitis (PVNS).

Can You Get Social Security Disability or SSI for Joint Pain?

While it's possible to qualify for Social Security disability insurance or Supplemental Security Income (SSI) as a result of bad knees, bad hips, or other chronic joint pain, it's rarely easy.

To qualify for disability benefits, you must first show the Social Security Administration that you are not doing substantial work and that you have a "medically determinable" impairment (MDI) that will last for a year or more. Your first step, therefore, is to seek a diagnosis and treatment from medical professionals and establish that you have an ongoing impairment. If you apply for disability because of severe pain in a joint, you won't be considered for benefits unless you have x-rays, MRIs, or lab tests showing that you have a physical impairment that could reasonably be expected to produce your symptoms.

If you have met these initial requirements, Social Security will then assess whether your impairment is severe enough to qualify for disability benefits. You can qualify for benefits in one of two ways: (1) by showing that your impairment is so severe that it "meets" or "equals" the requirements in Social Security's listing of impairments, which automatically qualify for benefits; or (2) by showing that your impairment causes such severe physical and/or mental limitations that you can't work full time at any job.

Generally, those who qualify for benefits because of joint problems are those who can't walk without an assistive device like a walker or two canes—or those who have such difficulty that they can't use standard public transportation, can't shop or run other errands without someone's help, or can't climb a few steps with the use of a handrail.

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 (leg, hip, knee, ankle/foot, shoulder, elbow, or wrist/hand) must cause chronic joint pain or stiffness, known as arthraglia (or polyarthraglia when multiple joints are affected). 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 (such as an x-ray or MRI) 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 (partial dislocation), contracture (tightening), or bony or fibrous ankylosis (stiffness due to fused bone or adhesions).

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. (Note, during the COVID pandemic, Social Security has changed this time period to one year.)

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:

• osteoarthritis, nerve compression, or narrowing of the spine
• inflammatory or rheumatoid arthritis
• lupus, or
• hip surgery.

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 (90%) 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:

• degenerative joint disease, or arthritis
• fibromyalgia
• bursitis
• hip problems
• neck problems
• shoulder problems
• chronic fatigue syndrome, or
• gout.

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 (your "functional limitations"):

• 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.

Social Security determines whether your impairment prevents you from working full time by including these types of limitations in a "residual functional capacity," or "RFC," form. The RFC is a measure of your ability to work, after taking into account your physical (and possibly mental) impairments.

For information about qualifying for disability benefits under an RFC assessment, visit the link above that's most related to your joint pain.

How to Apply for Disability for Joint Pain

If you're applying for Social Security disability insurance (SSDI), you can file your entire claim online on Social Security's website. (For SSDI, you must have enough work credits to qualify.) If you're not comfortable filling out forms online, you can call Social Security at 800-772-1213 to start your claim.

If you don't have enough work credits, and you have low income, you can apply for SSI. Most individuals filing for SSI only cannot file the whole application online, but they can get started on Social Security's website. For more information, see our article on applying for Social Security disability benefits.

If you'd like help with your application, consider working with an SSDI expert. According to a survey of our readers, applicants who filed an initial application without expert help were denied 80% of the time. Click for a free case evaluation with a legal professional to determine whether your knee replacement complications are severe enough to qualify for benefits.

_{Updated September 24, 2021}