Can You Get SSDI Disability or SSI for Osteoarthritis?

Osteoarthritis, the most common type of arthritis, occurs when the cartilage that covers the ends of your bones wears down. This deterioration can cause pain and stiffness in the joints, swelling, muscle weakness, and a reduced range of motion in the affected joints. Osteoarthritis can occur in any joint, but is most often found in the hands, hips, knees, or spine.

When Can Osteoarthritis Qualify You for Disability?

Osteoarthritis causes pain and stiffness in the joints for many people as they get older; it's sometimes called degenerative arthritis or degenerative joint disease. Few people qualify for disability for arthritic pain and stiffness alone, but as arthritis symptoms continue to grow worse, the symptoms can limit walking, requiring knee or hip replacements, or using your hands and wrists. Arthritis in the neck can make it difficult to work at a computer, and arthritis in the lumbar spine (lower back) can make it impossible to work at a job that requires lifting, carrying, crouching, bending, or stooping.

Since osteoarthritis can be found in multiple joints, causing different limitations, Social Security evaluates the various joint problems in several different ways. First, Social Security has several "impairment listings" under which you may be evaluated: two listings for spine problems and two for major joint problems. If you meet the requirements of any one of these impairment listings, you will automatically be approved for benefits.

If you don't meet the requirements of a listing, you can still be approved for disability if you can show that your arthritis limits your ability to function so much that you can't do the physical activity required by most jobs, such as walking, standing, or sitting for periods of time; pushing, pulling, lifting, or grasping items; or occasionally bending or stooping.

Qualifying for Disability Under the Listings for Back Problems

It's fairly common for osteoarthritis to occur in the facet joints in between the vertebrae of the spine, but osteoarthritis in the spine qualifies for disability benefits only under certain conditions. To meet the requirements of the listing for spinal disorders, you must have a diagnosis of osteoarthritis in your spine and one of the following:

• compression of a spinal nerve root that limits the motion of your spine and makes it extremely difficult to walk and/or use your hands, or
• narrowing of the spinal canal in the lower lumbar region that affects your nerve roots and makes it extremely difficult to walk and/or use your hands.

For the specific disability criteria for each of these back problems, see our individual articles on getting disability for them by visiting the links above.

Qualifying for Disability Under the Listings for Joint Dysfunction

If you have osteoarthritis in your hips, knees, ankles, shoulders, elbows, wrists, or hands, you might meet the listing for having an abnormality of a major joint. In order to meet this listing, you must have an obvious deformity in a joint: medical imaging (such as an MRI) must show joint space narrowing, ankylosis (fused joints or bones), or the destruction of bone. You must also have a history of joint pain or stiffness, and a loss of motion or instability in the joint. In addition, you need medical documentation that:

• you need to use a walker, two canes or two crutches, or a wheelchair or scooter that requires both hands, OR
• you can't use one hand due to arthritis, and you need the other to operate a one-handed wheelchair, cane, crutch, or other device, OR
• you can't use either arm or hand to begin, sustain, and finish work.

If you've had surgery to help restore your joint, there's another listing you can qualify under. Listing 1.17 is for reconstructive surgery or "surgical arthrodesis" (fusion) of a major weight-bearing joint. Your major weight-bearing joints include your hips, knees, ankles, and feet. To meet the listing, you must have:

• documentation of reconstructive surgery or fusion
• evidence that you have difficulty moving that has lasted (or is expected to last) for 12 months, and
• proof that you need a walker, two canes or two crutches, or a wheelchair or scooter that requires the use of both hands.

Qualifying for Disability Based on Your Limitations

If you have osteoarthritis but you don't meet the criteria under any of the listings discussed above, the Social Security Administration (SSA) will look at your "residual functional capacity," or "RFC." Your RFC assessment is used by the SSA to determine what kind of work you're still capable of doing despite the limitations that your arthritis causes.

Lower extremity arthritis. If your arthritis affects your legs or your spine, you're probably limited in walking on uneven surfaces, climbing, and/or squatting. In this case, your RFC assessment may limit you to no more than sedentary work. Sedentary work is mostly sit-down work—work where you don't need to lift more than ten pounds at a time and the work is done mostly seated. However, up to two hours a day of walking or standing may be required for sedentary work, so if you have severe enough trouble with walking because of your arthritis, you may not be able to perform even sedentary work.

Upper extremity arthritis. If you have osteoarthritis in your shoulders, arms, or hands, your RFC assessment may restrict you from doing work that involves lifting, reaching, typing, writing, or grabbing. This would make it difficult to do many jobs, even sedentary jobs.

If you can't many types of sedentary work, the SSA should find you disabled. For more information, see our article on proving you can't do a full range of sedentary work.

Types of RFCs. Your RFC assessment can be for medium, light, or sedentary work. The SSA will compare RFC level with your prior job skills and education to see if there are any jobs you know how to do, or could easily learn to do, at that work level. If you're older than age 50, the SSA is less likely to expect you to learn to do a new job. For more information on how the SSA decides whether your RFC, skills, education, and age combine to make you disabled, see our section on disability determinations based on RFCs.

Obesity. If you're overweight, in determining your physical limitations, the SSA must look at how the combined effect of your extra weight and arthritis limit your functioning. For example, if you're medically obese and also have arthritis in both knees, you might have more pain and be limited more than someone with arthritis alone. For more information, read our article on getting disability when you are overweight.

Medical Evidence Required to Prove Disability Due to Osteoarthritis

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

For claims involving arthritis, Social Security will look for:

• physical exam reports with detailed descriptions of orthopedic or neurologic problems
• treatment notes with reports of your subjective symptoms, such as the frequency and severity of your pain and/or inability to perform activities of daily living
• documented need for an assistive device, such as a cane or walker
• imaging and diagnostic tests showing evidence of physical abnormalities
• operative reports for any surgical procedures, and
• history of any treatments tried and what the results were.

Increasing Your Chances of Being Approved

Even if you have severe osteoarthritis that causes difficulty walking or using your hands, 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. Social Security will compare your doctor's treatment notes and what you claim on your application to see if they match.
• 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, Social Security has a reason to deny you, because you could get better.
• Include other medical conditions. It's not uncommon for people with osteoarthritis, or any other condition causing chronic pain, to also experience depression or anxiety. Social Security has to consider how all of your impairments affect your ability to work when evaluating your claim, so it's important to list all of the serious conditions you experience on your application, even if you'd rather not admit to them.
• Work 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 knows how to present a case in the most favorable light.

Applying for Social Security Disability Due to Osteoarthritis

You can apply for Social Security disability in person at your local SSA office (after the COVID-19 pandemic ends), by calling Social Security at 800-772-1213, or online at www.ssa.gov/applyfordisability. 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.

If you have questions or you'd like help with your application, try contacting a disability lawyer or advocate, who may be willing to give you a free case evaluation. Working with a disability expert can help you get the evidence you need to convince the SSA that you are disabled enough to qualify for benefits.

After You Apply for Benefits

After you submit your application, Social Security sends your file to your state's Disability Determination Services (DDS) office. Next, a claims examiner will request and review your medical records and may call you for an interview or send you additional paperwork. When the claims examiner has enough information, Social Security will make the decision and notify you by mail. This normally takes three to four months, but it 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 20, 2021}