ARTHRITIS: Inflammatory Arthritis and Social Security Disability – A Guide for Doctors

Dear Doctor:

As you are aware, your patient suffers from Inflammatory Arthritis. He or she is applying for disability benefits and needs your help to prove this claim.

The Social Security Administration (SSA) views the opinion of a treating doctor as extremely valuable in a disability claim. Your patient needs you to provide an opinion based on your understanding of your patient’s symptoms and limitations.

In this guide you will find: (1) a list of the disorders commonly associated with Inflammatory Arthritis; (2) an overview of the criteria considered by the SSA; (3) potential symptoms experienced by Inflammatory Arthritis patients; (4) limitations to consider for Inflammatory Arthritis patients; and (5) a sample opinion letter.

(1) Disorders associated with Inflammatory Arthritis:

Here are some common disorders associated with Inflammatory Arthritis patients. Be sure to include those that apply to your patient:

Disorders involving the axial spine:

  • Reiter’s syndrome;
  • Ankylosing spondylitis;
  • Psoriatic arthritis;
  • Whipple’s disease;
  • Behçet’s disease; and
  • Inflammatory bowel disease.
 Disorders involving peripheral joints:

  • Rheumatoid arthritis;
  • Sjögren’s syndrome;
  • Psoriatic arthritis;
  • Crystal deposition disorders (gout and pseudogout);
  • Lyme disease; and
  • Inflammatory bowel disease.

(2) Criteria for presumed disability under SSA’s listing of Impairment 14:09: Inflammatory Arthritis.

The SSA considers these four following sections to determine whether an individual’s Inflammatory Arthritis-related impairments are severe enough to qualify him or her as “disabled” under this particular listing.

Note, your patient only needs to prove ONE section, not all four.

Use this as a guide to help your patient determine whether he or she might qualify for benefits under SSA’s criteria for this particular listing:

Inflammatory Arthritis (listing 14.09), with one of the following:

A. Persistent inflammation or persistent deformity of:

1.     One or more major peripheral weight-bearing joints resulting in the inability to ambulate effectively; or

2.     One or more major peripheral joints in each upper extremity resulting in the inability to perform fine and gross movements effectively.

OR

B. Inflammation or deformity in one or more major peripheral joints with:

1.     Involvement of two or more organs/body systems with one of the organs/body systems involved to at least a moderate level of severity; and

2.     At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).

OR

C. Ankylosing spondylitis or other spondyloarthropathies, with:

1.     Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 45° or more of flexion from the vertical position (zero degrees); or

2.     Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 30° or more of flexion (but less than 45°) measured from the vertical position (zero degrees), and involvement of two or more organs/body systems with one of the organs/body systems involved to at least a moderate level of severity.

OR

D. Repeated manifestations of inflammatory arthritis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:

1.     Limitation of activities of daily living.

2.     Limitation in maintaining social functioning.

3.     Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

Your patient’s medical evidence should support your opinion.

(3) Potential Symptoms and Signs of Inflammatory Arthritis:

Here are some common symptoms of Inflammatory Arthritis patients. Be sure to include all that apply to your patient:

  • Pain, swelling, warmth and tenderness in the joints
  • Muscle stiffness
  • Back pain
  • Skin rashes
  • Eye inflammation
  • Malaise
  • Involuntary weight loss
  • Joint stiffness
  • Loss of joint function
  • Loss of appetite
  • Dry mouth
  • Fever
  • Chills
  • Severe fatigue
  • Headaches

Address the various combinations of complications of one or more major peripheral joints or other joints, such as inflammation or deformity, extra-articular features, repeated manifestations, and constitutional symptoms or signs experienced by your patient.

(4) Limitations – in an 8-hour workday.

What can your Inflammatory Arthritis patient still do and what can they no longer do? The SSA wants details.

Describe how physical, visual, and cognitive impairments impact your patient’s ability to participate in daily activities and work on a sustained basis. Reference restrictions on sitting, standing, walking, extremity use, concentration, memory, persistence, or pace.

For example:

  1. Is your patient’s fatigue complaint typical of INFLAMMATORY ARTHRITIS patients? Will your patient need to take unscheduled breaks during the day (to rest, because of pain, etc.)?
  2. How far (in city blocks) is your patient able to walk without having to rest or having severe pain? Does your patient need a cane or other device to assist with walking?
  3. How long (hours or minutes) can your patient sit at one time without getting up? Does your patient need to elevate his or her legs while sitting? How long can he or she stand without sitting or moving around? Does your patient need to be able to change positions (sit, stand, walk) at will?
  4. How many pounds can your patient lift and carry? Can your patient reach, twist, bend or squat? Does your patient have difficulty manipulating fingers, hands, or arms?
  5. Will your patient’s lack of attention and concentration interfere with his or her workday? How many times per day do you anticipate this happening? Does your patient’s emotional distress exacerbate symptoms? What level of work stress is your patient able to tolerate?
  6. How many days per month is your patient likely to miss work due to his or her symptoms or treatments?

Always report fatigue and its impact. Because fatigue is difficult to measure objectively, provide any supporting evidence you have.

(5) Please click here for a Sample Opinion Letter.

If you are a treating doctor for one of our disability clients, we will be happy to send you a medical opinion form to complete. Some doctors prefer to complete a form rather than write an opinion letter. If you have any questions or concerns regarding this guide, please call us at (501) 247-1830.

Does your patient need help with his or her SSDI/SSI appeal and hearing?

If so, please have him or her contact Deborah at The Hardin Law Firm, PLC, for help with their SSDI/SSI appeal and hearing. Call (501) 247-1830.

ATTORNEY: Learn more about our Attorneys and Staff.

SERVING: Cabot, Beebe, Ward, Searcy, Jacksonville, Lonoke County, White County, Faulkner County, and other central Arkansas areas.

DISCLAIMER: The information contained in this website is intended to convey general information. It should not be construed as legal advice or opinion. It is not an offer to represent you, nor is it intended to create an attorney-client relationship.

Originally published: February 21, 2017

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