This column will examine how the
Social Security Administration evaluates Disability Insurance
Claims for people who suffer from Arthritis. The Social Security
Administration (SSA) has a set of criteria that it uses called
Listings to determine whether a person is eligible for monthly
disability insurance payments.
To obtain disability insurance
benefit payments from the SSA a person must in general have a
health problem that can be expected to last at least one year or
to result in death and be unable to perform any type of
substantial gainful employment.
To better understand how the SSA
reviews claims that involve persons who suffer from arthritis it
is helpful to take a brief look at what arthritis is and how it is
Arthritis comes from the term arthro
which means a joint, and the suffix itis which means inflammation.
Thus arthritis is a term that describes inflammation of a joint.
Where two or more bones come together in a joint is called an articulation.
Most joints allow flexibility such as the hip joint or the
Movable joints are called synovial
joints. Some joints such as vertebra in the spine allow a
limited range of motion. Some joints such as the suture joints
in a personís skull do not allow any movement at all as they are
A typical movable joint has the
bones separated from each other by a joint capsule which consists
of cartilage. Ligaments which are strong bands of
connective tissue which usually hold the joints together.
The end of the bone that faces
the joint is covered by articular cartilage which is a
smooth cartilage that allows the joint to move freely. There is a synovial
membrane which lines the inside of the joint and contains
fluid which serves as a lubricant between the bones, like oil
lubricates a car engineís moving parts.
There are a number of different
types of arthritis. Two of the more frequently occurring types of
arthritis are discussed below. Osteoarthritis is a very
common form of arthritis. It is a disease in which there is a
progressive degenerative joint disease in which the articular
cartilage that covers the ends of the bones facing the joint wears
The end of the bone in the joint
will hypertrophy which means it increases in size and
thickness. This hypertrophy of the ends of the bone is why a
person with arthritis may have swollen knuckles. Osteoarthritis is
also called degenerative joint disease. It tends to occur
in people as they age.
Rheumatoid arthritis is a
form of arthritis in which the joints become inflamed and very
painful. Women tend to get rheumatoid arthritis more than men. The
synovial membranes that surrounds the joint becomes inflamed and
becomes thicker. These changes make it more difficult to move the
joint. It can lead to the formation of tissue that can harden and
form a bony ankylosis which is a fusion of the joint that
prevents any movement of the joint.
Rheumatoid arthritis is
accompanied by pain and swelling of the affected joint and can
also create a fever. Rheumatoid arthritis can be diagnosed by a
blood test that reveals a rheumatoid factor (antibodies) in
the blood. X-rays are also used to determine if there is swelling
of the effected joints.
The SSA uses the following test
to determine if a person with rheumatoid arthritis meets the
criteria for awarding Disability Insurance Benefits. The person
must have each of the following:
- A history of persistent joint
pain, swelling and tenderness involving multiple major joints
which are defined as hip, knee, ankle, shoulder, elbow, or
wrist and hand. The person must also have signs of joint inflammation
such as swelling and tenderness on a current medical exam
despite at least three months of prescribed therapy. The
person must have significant restriction of the functioning of
the affected joints and it must be expected that this
condition will last at least twelve months.
- The diagnosis must also be
corroborated by either a blood test that is positive for
rheumatoid factor, or positive for antinuclear antibodies, or
higher than usual sedimentation rate or characteristic changes
in the tissue in a biopsy of the synovial membrane.
For further information on
arthritis you can contact the Arthritis Foundation, Carolinas
Chapter, 1135 Kildaire Farm Road, Suite 311-7, Cary, N.C. 27511.
It should be kept in mind that a
person can still be found to be disabled by an Administrative Law
Judge even if he does not meet a particular listing if he has
health problems that in combination are the equivalent of a
listing. The Judge has the discretion to decide if a personís
health problems are serious enough to warrant an award of
disability benefits despite not meeting the specific technical
requirements of one of the SSA listings for disability.