Arthritis occurs when there is inflammation of the joints. Fractures or breaks in the bone, obesity, age, autoimmune disorders, and bacterial or viral infections can all cause arthritis. Arthritis can cause significant pain, redness, and swelling of the joints and often limits one's ability to perform everyday activities.
To decide whether you should be approved for disability based on your arthritis, the Social Security Administration (SSA) goes through several steps. If you are working, the SSA will first determine whether you are working above the substantial gainful activity (SGA) level. For 2019, this amount was $1,220 or more a month. This means that if you earn $1,220 or more per month, the SSA will find that you are engaged in SGA, and your claim will be denied.
If the SSA determines you are not working at the SGA level, it will next determine whether your arthritis is expected to last at least 12 months and is a “severe” impairment. Under the SSA’s standards, a “severe” impairment is one that causes a significant impact on your ability to do work-related activities.
At the next step, the SSA must determine whether your arthritis meets (or "equals") one of the conditions established in the SSA's Listing of Impairments; if your arthritis meets the criteria under a condition in the Listing of Impairments, your claim for disability will be automatically approved. If it doesn't, you may still be able to get disability benefits another way (see below).
The SSA lays out the criteria needed for arthritis to be a qualifying medical condition under four separate listings in the SSA's impairment listings: Listing 1. 02, Listing 1.03, Listing 1.04, and Listing 14.09.
If your arthritis has caused major dysfunction of any of your joints, you may be automatically eligible for disability under Listing 1.02. To qualify under Listing 1.02 you must prove that your arthritis has caused some type of deformity, such as excess boniness, misalignment, or permanent shortening of a joint, with chronic pain and stiffness that prevents you from using your joint fully. You must have x-rays or other images of the joint that show the joint space narrowing, bony destruction, or ankylosis (crookedness) of the joints. In addition, you have to have arthritis in either:
If you suspect you would qualify under this listing, ask your doctor if your x-rays show a type of deformity mentioned above.
If you have undergone reconstructive surgery or surgical arthrodesis (fusion) of a major weight-bearing joint, such as a hip or knee, as a result of your arthritis and you can no longer walk on your own effectively (and are not expected to walk well on your own within a year), you could be approved automatically for disability under Listing 1.03.
If you suffer from arthritis of the spine (including osteoarthritis and facet arthritis), you may qualify for disability under Listing 1.04. In order to qualify for disability under Listing 1.04, you must show that you suffer from an arthritis-related disorder of the spine that compromises a nerve root or the spinal cord with one of the following complications:
Nerve root compression that causes wide-spread, nerve-related pain, limited flexibility, and weakened muscles, with a loss of reflex and sensation. If the lower back is involved, then you must have a positive straight-leg test.
Spinal arachnoiditis (inflammation of the protective membranes that surround the nerves of the spinal cord) that results in painful burning or other abnormal sensations and requires you to change positions more than once every two hours.
Lumbar spinal stenosis (narrowing of the spinal canal) that causes non-nerve related pain in the lower back, lower limbs, or buttocks, with weakness in the lower extremities that makes walking on your own difficult (that is, you need to use a walker or crutches or need assistance getting to work).
Because the listing criteria are complex, ask your doctor to determine whether your arthritis meets one of these listing requirements.
If you don't qualify for disability under any of the above listings, you may qualify under Listing 14.09, Inflammatory arthritis (this includes rheumatoid arthritis, psoriatic arthritis, and reactive arthritis). To meet Listing 14.09, you must provide objective medical evidence that your arthritis has resulted in the following: