Social security disability arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Many people who have arthritis are curious about whether they are eligible for disability insurance through Social Security.

The following is a discussion that addresses the issue. This is not meant to provide or serve as legal advice. An attorney experienced in disability law should be consulted.

From Allsup, Inc., a legal representation company

First, a distinction needs to made between SSDI and SSI.

Social Security Disability Insurance (SSDI) is a program based upon contributions made by individuals working and paying into Social Security.

Federal Insurance Contributions Act (FICA) taxes are withheld by Social Security on wages paid to an individual. If a person earns enough work credits he becomes insured for a disability benefit. A person can earn up to four credits per year. The number of work credits needed for disability benefits depends on a person’s age when he becomes disabled. The amount of a person's benefit depends on how much he earned and how much he paid into Social Security. The disability benefit monthly average in 1999 is $733 per month.

Supplemental Security Income (SSI) is a separate program administered by Social Security and funded by general federal tax revenues. It pays monthly benefits to the elderly, the blind and people with disabilities who have low income and few material assets. For example, one cannot collect SSI benefits if one’s assets (not including a single home and automobile) exceed $2000 for a single person or $3000 for a couple. The maximum SSI benefit in 1999 is $500 per month.

SSDI and SSI share the same definition of disability. It’s the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a period of not less than 12 months.

If a disease or medical condition is not listed in the listing of impairments, Social Security will assess how that condition reduces a person’s capacity to work. Social Security will make an assessment as to a person’s residual functional capacity. If a person’s residual functional capacity is not compatible with work, the person will be awarded disability benefits.

For SSDI a person must have paid enough work credits (be insured) and meet the definition of disability. For SSI a person must be income eligible and meet the definition of disability.

The first step in the application process is called initial application and requires a set of forms to be completed and submitted to Social Security.

At the outset, a person will only need to provide the original or certified copy of one’s birth certificate or other proof of citizenship to apply for disability benefits.

As the application process progresses, a person may be asked to provide copies of military discharge, birth certificates of eligible children, wage statements, copies of worker compensation award information, a voided check for direct deposit, etc.

In addition to actual copies of the above, a person will have to provide a great deal of information on family history, work history, earnings history and medical history (including names, addresses, dates tested by all health care providers, medications and, of course, medical symptoms). Applicants will also be asked to provide personal information about daily activities and interests. Completion of all initial application forms can take 45 minutes to over an hour.

Whether or not a person is asked to see another doctor for evaluation depends on the medical condition and the availability and completeness of that person’s medical records. Social Security requires that a treating physician’s opinion of severity is supported by objective medical findings such as laboratory tests and X-ray results.

Processing times for disability applications vary from state to state. A reasonable, general answer is that an initial application will take about three-five months before a decision. Reconsideration (first appeal) will take about three months more. A hearing (second appeal) will take an additional 12 months or more.

Most people that apply for disability social security are turned down on the initial and the reconsideration application. Of those who persevere and request an Administrative Law Hearing, more than half will win.

A person who is denied has 60 days to appeal, which is called reconsideration. If a person is denied again at reconsideration, he has 60 days to appeal and ask for a hearing before an administrative law judge. A person who’s denied by an administrative law judge has sixty days to appeal to an appeals council. If denied by the appeals council, the person can then file outside the Social Security Administration at the Federal District Court.

A person does not need a lawyer or disability representative in order to file a claim. However, a potential claimant should consider representation before filing a claim for Social Security disability benefits. It’s crucial to complete all forms in the most advantageous way.

Preparing for a hearing is a fairly complex process.

According to the federal government, Social Security Administration denies about 70 percent of applicants filing an initial claim for disability benefits.

A person who’s receiving SSDI benefits may be entitled to a trial work period depending on his medical condition. That trial work period may allow a person to test her ability to work for nine months while still drawing the full SSDI monthly benefit. After nine months of trial work, she will lose her SSDI cash benefit if she is earning over $500 per month from this work. Since SSI benefits have an income qualifying provision, SSI recipients may have benefits reduced by work wages.

When a person files for SSDI, she can not be working for than $500 per month. If she is earning more than $500 per month from working, her application for disability benefits will denied regardless of her medical condition. Blindness has slightly different rules regarding working.Since doing this chat the earnings limit has been raised to $780).

Monthly SSDI benefits depend upon an individual’s earnings and amount of taxes paid into Social Security. The agency has a complicated formula to determine what a person’s actual monthly benefit will be. Generally, the more a person pays in, the more he receives in a monthly disability benefit. The maximum monthly Social Security disability benefit for an individual is about $1300. The national average is about $730.

Fifty percent of SSDI benefits are taxable if annual adjusted gross income is $25,000-$34,000 for an individual, $32,000-$44,000 if married and filing jointly. Eighty five percent of SSDI benefits are taxable on annual income exceeding $34,000 for an individual, $44,000 if married and filing jointly.

Children up to age 18 or who have not graduated from high school are entitled to benefits if a parent is deceased, retired or disabled. Generally, dependent children of a disabled parent will receive about 50 percent of the disabled parent’s monthly benefit.

At age 65 (or retirement age), a person’s disability benefit automatically converts to a retirement benefit. The recipient will not notice the change but the check will no longer be drawn from the Social Security disability trust fund, but will be drawn from the Social Security retirement trust fund.

A person who’s found disabled and is eligible for disability benefits must wait two years (from the date eligible for cash benefits) before that person is eligible for Medicare benefits. A person has to wait five months after the established onset date of disability before he’s eligible for cash benefits. Therefore, Medicare benefits do not start until 29 months from the established onset of disability.

Disability benefits may be stopped if Social Security proves within its rules that the medical condition has improved and no longer prevents work activity. At the time a person is awarded disability benefits, a medical reexamination date is established based upon medical condition and expectation of improvement. Those conditions clearly expected to improve are scheduled for review in one year or 18 months. Chronic or progressive conditions are scheduled for review in three or seven years. At the time of review, a continuing disability review is conducted and an evaluation is made regarding medical improvement or lack thereof.

Since the initial denial rate is so high, there is no clear way to insure a favorable decision, unless of course, the medical condition is terminal. It is recommended that a patient get representation so that the best chance for an award at every level is enhanced. The rule of thumb: get good representation and stay in the process. Even if you’re initially denied, don’t give up.

After age 65 (retirement age), you can not draw additional benefits due to disability. Many attorneys charge nothing unless you are awarded benefits. Once you are awarded, they will charge you a percentage of your retroactive benefits. A one-time fee only--usually 25%

Rheumatoid arthritis is one of the impairments covered by "The Listings". The Listings are a group of conditions which are commonly considered by Social Security to be disabling when the claimant's condition meets the severity criteria given in the particular listing.

1.02 Active rheumatoid arthritis and other inflammatory arthritis.

With both A and B.

A. History of persistent joint pain, swelling, and tenderness involving multiple major joints (see 1.00D) and with signs of joint inflammation (swelling and tenderness) on current physical examination despite prescribed therapy for at least 3 months, resulting in significant restriction of function of the affected joints, and clinical activity expected to last at least 12 months;


B. Corroboration of diagnosis at some point in time by either:
1. Positive serologic test for rheumatoid factor; or
2. Antinuclear antibodies; or
3. Elevated sedimentation rate; or
4. Characteristic histologic changes in biopsy of synovial membrane or subcutaneous nodule (obtained independent of Social Security disability evaluation).

Part A is the disabling problems with Part B being the corroboration. To meet the listing each and every part must be met and be documented by a medical doctor.

The catch is the word "significant" in part A of the listing. The judge can say "yes" the claimant has severe RA but the restrictions are not really that significant because the claimant still does many of the activities of daily living.

We are going to assume the judge said the restrictions were not that significant, because if he found that you met all of the criteria of the listing you win and that the end of the hearing.

Restricted use of the hands is a common problem associated with RA. One not only cannot play the violin anymore, but have problems typing, tying shoe laces, buttoning a shirt, writing, etc. If this is one of your problems, stress it. Many jobs require good bilateral manual dexterity. You cannot put the bolts in the box and pass it to be next guy on the assembly, if you have significant problems with your hands.

Claimant's over age 55 have an easier time getting disability benefits because Social Security's policy is that if a person over 55 cannot do his "past relevant work" or have "transferable skill" then the person is disabled.

It becomes obvious that good medical reports are necessary to obtain disability benefits at any age or step of the process. "What doctor are you seeing?" is one of the first questions asked of a potential client. If the answer is vague, or if the person is not seeing a doctor regularly, the interview is over.

Whether or not you are accepted will probably depend upon your ability to get your doctors to provide the information SSA requires for a favorable decision.

Your doctors must tell the truth and that truth must include extensive details from your medical records. You will need to give Social Security the name and address of every doctor who has information on your disabling condition.

It is in your best interest to contact your doctors ahead of time and discuss what you are doing.

Unsubstantiated opinions from your doctor won't do. Social Security isn't interested in the idea that your doctor/s believe you are disabled and unable to work.

Social Security requires a mountain of facts to substantiate your claim. The facts should set forth in very strong, detailed reports. The doctors must make SSA understand your situation through what they write.

SSA wants to hear about lab findings and test results. They want to know exactly how your problem limits your ability to work.

They want to know precisely what it is that you are unable to do. Doctors should remember that it is SSA that makes the "legal decision" as to whether or not you are disabled (not the doctors) and SSA makes this determination, in part, based on specific information provided by your doctors. It is up to your doctors to show how you are disabled.

Examples of facts needed are:

What are the numeric degrees of range of motion of involved joints?
On what dates were specific treatments started and stopped?
What X-rays and further studies need to be referenced to illustrate details of your case?
Exactly how much of a certain activity can you do before wearing out?
How much weight can you lift or carry?
How long can you stand and/or walk?
How long can you sit?
How are you at climbing, balancing, stooping, kneeling, crouching, crawling, reaching, pushing?
How can your doctors demonstrate your pain?
What are your other limitations?
How are you at handling objects, fingering, feeling?
How is your eyesight, your hearing?
What environmental restrictions do you experience, such as reactions to temperature extremes, dust, fumes?
Specifically how do the limitations you have affect what you do?
How long have you had these impairments and how long are they expected to last?
What are your medications and have you had side effects from medication?

The doctor's report should definitely comment on pain. If a person has to lie down or recline several times during the day to keep the pain at a tolerable level, this should be emphasized.

It’s recommended that patients keep and retain a copy of all their medical reports, records, diagnostic test results [radiological and chemical). Patients have the right to access and obtain their records and should keep them organized. Everyone should keep a desk calendar or daily planning dated book, with each medical appointment, test appointment, and treatment appointment. Most doctors have forms called "Residual Function Capacity " which will allow them to answer a great many of the above questions quickly.

Residual Functional Capacity means what is the MOST that you are able to do. Remember if you are able to do sedentary work, you are not disabled.

Few of us actually know how long we can sit, stand, walk, etc. How many pounds of weight can you lift or carry? It is a good idea to time yourself or better have someone else observe you and discuss you actual physical capacity.

Social Security will ask questions about your daily life. If you have substantial pain, you must let them know what the pain prevents you from doing on a daily basis. Do not exaggerate or minimize your problems.

Mental health counseling is good for your case because it furnishes documentation of your frustrations etc.

One has a right to see and obtain copies of their social security file. The problem is that the file will only be at the local "district office" for a short time between appeal steps. Once an Administrative Hearing is requested the file will be at the Office of Hearings and Appeals. The claimant and/or the attorney should inspect the claims file prior to a hearing to make sure all of the pertinent medical is in the file. If it's not there, you should obtain the medical file and get it to the office of Hearings and Appeals at least a week before the hearing.

You, your doctor, and your attorney must prove that you meet the criteria. Judges appreciate seeing a case prepared and well documented. It makes their job easier.

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