Arthritis & Disability: Meeting the Criteria

(Editor’s Note: On Friday, June 30, 2000, had an exclusive interview with disability expert Scott E. Davis, Esq., in which we discussed meeting the criteria to qualify for disability insurance when suffering from arthritis. Here’s what he had to say.)

ArthritisSupport: Mr.Davis, how does someone with arthritis qualify for disability insurance?

Davis: The law governing disability as a result of arthritis has three separate categories of medical criteria, and to qualify under these categories is pretty difficult. In fact, most people DON’T meet the criteria because it’s so difficult. But that does not mean you can’t get disability. There are other ways you can qualify. Basically you need to show that you have so much pain that you can’t do any job as a result of it.

ArthritisSupport: What’s the first thing a person should do to get disability if s/he has arthritis?

Davis: Before you can get disability for any medical condition, a person should file an application with Social Security. This can be done by phone (800-772-1213 is the free number nation-wide) or at your local Social Security Office.

ArthritisSupport: Then what?

Davis: It’s important to understand you have to be unable to work for a minimum of 12 months. This means that either you haven’t worked for 12 months or that your doctor anticipates that you won’t be able to.

Now this doesn’t mean that a year has to go by before you file a claim. You can file the claim the day you stop working, but you ought to be reasonably sure you won’t be able to go back to work for 12 months. Essentially, it’s a waste of time to file unless you don’t work for a year.

ArthritisSupport: Okay, I’ve filed a claim with Social Security and I’m sure I won’t work for a whole year. Now what?

Davis: The next step is to be evaluated, diagnosed and treated by a Board Certified Rheumatologist. This is either a medical doctor (M.D.) or osteopath (O.D.) who specializes in rheumatology. This is extremely important to your case.

ArthritisSupport: You mean I can’t just go to my family doctor?

Davis: Well, Social Security specifically looks for a specialist’s expertise when evaluating a case. Federal law mandates that a medical specialist’s opinion is entitled to more weight than a non-specialist’s, so your family doctor’s opinion won’t count as much as the rheumatologist’s.

ArthritisSupport: What about a chiropractor?

Davis: A chiropractor can diagnose you, but his or her opinion will be given very little weight by Social Security. A Board Certified doctor has more credibility. The weight of the Board Certified physician’s opinion when deciding the case is simply much greater.

Remember that if there’s an issue about granting disability, you’ll want your own doctor examining you. Social Security will have a rheumatologist evaluating the case, and will demand that a likewise qualified physician examine you.

ArthritisSupport: What else needs to be done?

Davis: The third most important element you need to have to get disability is appropriate documentation of your case. This is where the doctor comes in. Your medical records need to precisely document the severity of your condition.

ArthritisSupport: What kind of records need to be involved?

Davis: Several areas need to be documented. First of all is the physical exam. This needs to show you are in so much pain that you can’t do your job (or any job). You’ll need to prove a history of persistent joint pain and stiffness. Your physical limitations also need to be documented. The degree of pain you suffer and how you respond (or don’t respond) to pain medications should also be included in this area.

It’s also important that x-rays showing what the law labels “gross anatomical deformity” be in your records. Any other tests, such as those demonstrating limited range of motion, should be done and included. Laboratory tests, if called for, are also good supporting documents.

ArthritisSupport: What does the law state?

Davis: Without getting too technical, you should know a few definitions. First of all, most people qualifying for arthritis disability fall under the category of “arthritis of a major weight-bearing joint due to any cause.” Weight-bearing joints are the hip, knee, ankle, shoulder, elbow or the combination of the wrist and hand.

A “gross anatomical deformity” of any of these joints needs to be evident in x-rays. This goes back to the documentation that we talked about.

ArthritisSupport: Any final words of advice?

Davis: Cases are won and lost on the basis of the severity and functional limitations. Basically, if your doctor agrees that you can’t work and documents the degree of your pain experience, you’re on your way.

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