Social Security & SSI Disability & Rheumatoid Arthritis (RA)

Winning Your Rheumatoid Arthritis Case

You can be awarded Social Security disability and SSI benefits with rheumatoid arthritis (RA) if you satisfy the following –

1. Non-Medical Criteria, and
2. Disability Criteria.

Satisfying the disability criteria means –

1. You understand how Social Security evaluates rheumatoid arthritis (RA) (reviewed below),
2. You satisfy a RA Social Security Listing (also reviewed below) or you have disabling Functional Limitations, and
3. You Submit Winning Evidence.

Social Security’s Analysis Of Your Rheumatoid Arthritis Medical File

Social Security frequently hears rheumatoid arthritis cases. Rheumatoid arthritis is an immune system impairment where the immune system attacks the synovial lining of your joints. The disease process begins with the presence of abnormal levels of anti-CCP antibodies and rheumatoid factor antibodies (RF) in the blood. These abnormal levels are often not detected when they first appear because the individual is not yet symptomatic. Then, inflammation of the synovial lining occurs (synovitis) which causes typical symptoms of joint swelling, stiffness, pain, numbness, and reduced range of motion. RA suffers commonly refer to “flares” where symptoms are periodically worse. It is common that once these symptoms occur, the individual obtains medical care, blood tests are done, and the abnormal levels of anti-CCP and rheumatoid factor are detected. Once synovitis has occurred, blood testing commonly shows the presence of C-reactive protein and a high sedimentation rate which are markers for inflammation (though these markers are not specific to rheumatoid arthritis but rather to inflammation in general). When suspecting RA, doctors will review blood tests for anti-CCP antibodies, rheumatoid factor antibodies, C-reactive protein levels, and a sedimentation rate. All four are very common findings in a person with rheumatoid arthritis, and therefore, indicators of rheumatoid arthritis. In severe cases, nodules or deformities of the cartilage and bones will occur, and clinical evaluations, x-rays, ultrasounds, and MRIs are used to determine the presence and severity of nodules and tissue, cartilage, and bone damage.

Social Security will need evidence of your rheumatoid arthritis diagnosis whether it be by a blood test, x-ray, ultrasound, or MRI. However, diagnosis is also done by clinical observation (visual observation by your doctor) of the aforementioned common symptoms. Therefore, it is important you read your medical records to determine if your symptoms and physical abnormalities are being properly reported by your doctor.

Social Security will need evidence of your ongoing medical treatment which is usually limited to medications – nonsteroidal anti-inflammatory drugs (NSAIDs), steroids (the most common is prednisone), and disease-modifying antirheumatic drugs (DMARDs and the most common are methotrexate, Humira, Remicade, and Plaquenil). There is no cure for rheumatoid arthritis. Surgeries are very rare and may include a synovectomy (removing the inflamed knee, elbow, wrist, finger, and hip tissues), tendon repair, and joint replacement.

Social Security will determine the severity of your rheumatoid arthritis primarily by objective testing. If you report symptoms but do not have abnormal objective testing, it will be difficult to win a disability claim. Social Security may find your rheumatoid arthritis disabling with abnormal blood tests only, but the more severe symptoms of swelling; nodules; and tissue, cartilage, and bone damage will more commonly result in Social Security finding you disabled.

Tip. If you suffer nodules, you would do well to take and submit photos of your nodules. Photos can help Social Security see the severity of your rheumatoid arthritis – Pictures And What Social Security Looks For In A Disability Case.

Rheumatoid Arthritis: The Social Security & SSI Listing

The Adult Listing 14.09 is satisfied by an adult if point 1, 2, 3, or 4 is met. The Child Listing 114.05 is satisfied by a child if point 1, 2, or 3 is met.

1. Ongoing swelling or changes of –
   1. At least one of your feet, ankle, knee, or hip joints culminating in profound walking limitations, or
   2. At least one or your shoulder, elbow, wrist, or hand joints culminating in profound use limitations;
2. Swelling of changes in at least one major joints (other than the fingers or toes) and –
   1. At least a moderate degree of impact on at least two body organs, and
   2. At least two of significant fatigue, fever, malaise, or weight loss;
3. Ankylosing spondylitis or other spondyloarthropathies, with –
   1. Significant spine ankylosis (fusion), or
   2. Moderate spine ankylosis, and at least a moderate degree of impact on at least two body organs; or
4. Ongoing arthritis, at least two of significant fatigue, fever, malaise, or weight loss, and a marked limitation in one of –
   1. Activities of day-to-day life,
   2. Community interactions, or
   3. Completing responsibilities.

A Success Story With An ALJ Deal And An Amended Onset Date

Ms. Johnston lived in Denver, CO. She contacted counsel about 60 days after her reconsideration level denial. She had applied for Social Security disability and SSI benefits. She was 51 years old, and her past relevant work consisted of working as a cashier, waitress, and a front desk clerk. She was first diagnosed with rheumatoid arthritis at age 45, but did not stop work until 49. From age 45 to 49, she had pain and swelling in her fingers, wrists, and hands. At age 49, she developed several nodules in four of her fingers. She was treated by a primary doctor and an orthopedist. Ms. Johnston had been prescribed prednisone, methotrexate, and pain medications.

After a reconsideration denial, a claimant has 65 days from the date of the denial to appeal a decision. So, we had to quickly get papers signed and the appeal submitted to Social Security. The case was then transferred to the Denver Social Security hearing office, and our 16-month wait for a hearing began. Her condition slightly deteriorated as we awaited our hearing.

Overall, we did five things for her case. First, we obtained her medical records. Second, counsel asked Ms. Johnston to take pictures of her finger nodules during our ongoing wait for a hearing which was then submitted when her hearing was scheduled. Third, counsel requested a physician statement (an RFC) from both her treating primary provider and her orthopedist, but neither would participate – a problem that is very common. Fourth, we obtained two lay statements from Ms. Johnston’s best friend who detailed Ms. Johnston’s problems carrying out activities of daily living and one from her past supervisor at work who detailed Ms. Johnston’s problems carrying out job duties and why such problems led to Ms. Johnston’s ultimate firing. Fifth, counsel obtained her medical records from her primary provider, orthopedist, local hospital, and her orthopedic surgeon consult.

At the hearing, the ALJ decided Ms. Johnston’s upper extremity use was limited to occasional frequency (1/3 of the workday). The vocational expert (commonly called a VE, and nearly all hearings have a VE in attendance) made three findings. First, the VE found that Ms. Johnston would be unable to perform her past relevant work since her upper extremity use was limited to occasional use as all of Ms. Johnston’s past work required frequent upper extremity use. Second, the VE testified that Ms. Johnston would be able to perform other unskilled work – unskilled sedentary jobs with occasional upper extremity use. Third, the VE testified that Ms. Johnston would not be able to perform other work with only occasional upper extremity use that utilized her work skills she learned from her past jobs.

Hence, Ms. Johnston satisfied Step 4 of Social Security’s 5-Step disability evaluation – she could not do her past work. However, the issue was Step 5 – other work. The VE stated she could do other work but not work wherein Ms. Johnston’s skills could transfer. Therefore, Ms. Johnston was not disabled under 50 (other work was available), but she was disabled over 50 (other work was not available that utilized her work skills). She had already met Step 1 (she was not engaging in substantial gainful activity) and Step 2 (she had a severe impairment), and she did not need to meet Step 3 (a listing).

Because Ms. Johnston could perform other unskilled jobs, but not other skilled jobs, this meant she did not meet Social Security’s disability rules before age 50, but she did meet them at age 50. At the hearing, the ALJ offered Ms. Johnston a deal to amend her onset date of disability. The ALJ agreed to find Ms. Johnston disabled as of her 50th birthday. Ms. Johnston’s original alleged disability date was about her 49th birthday. She accepted the deal and agreed she was disabled as of her 50th birthday. This meant she won her hearing at the hearing, was awarded Social Security disability and SSI benefits, but she gave up about one year of backpay.