Disability for Arthritis: How to Qualify for Benefits
Applying for disability benefits for arthritis can be a long grueling process, but patience and persistence can pay off.
By Mary Anne Dunkin | Updated Oct. 9, 2022
When arthritis makes it impossible to keep up with the demands of a job, the loss of income and health benefits from an employer can be financially devastating. Social Security disability benefits can be a lifesaver but getting approved for benefits can be difficult. The more you know about the process — what to expect and how prepare along the way — the greater your likelihood of receiving the assistance you need. Here’s a step-by-step guide.
Understand the Programs
The Social Security Administration has two long-term disability benefit programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).
SSDI helps replace the wages of people who pay Federal Insurance Contributions Act (FICA) taxes and whose disability meets Social Security criteria. The program provides a monthly disability benefit that is based on one’s Social Security earnings, and the benefits continue as long as the disability does.
SSI, a much smaller program, provides cash to meet the basic needs of people who have low or no income and are blind, disabled or elderly. In general, SSI acts as an emergency program. It is available even to people who have never paid FICA taxes and its benefits are often a supplement to other forms of government assistance, such as subsidized housing or food stamps.
The application processes are similar for the two programs; however, most of the information provided here will refer primarily to SSDI. You can learn more about SSI at www.ssa.gov/ssi, at your local Social Security Administration (SSA) office or by calling 800-772-1213. To determine the best benefits for you, you can fill out this questionnaire at https://ssabest.benefits.gov.
Understand the Criteria — and Your Chances
A person may have exhausted their arthritis work rights options, such as special accommodations from employers, before applying for disability benefits. For others, workplace rights just aren’t adequate for their needs.
Of the estimated 2.5 million people who file for SSDI or SSI each year, fewer than half are awarded benefits — at least initially. But there are ways to appeal, and the chances of success increase for those who stick with it and successfully navigate the system.
Many factors predict your success. Foremost, you must meet the following criteria:
- You must have a diagnosis. The SSA has a list of disabling conditions, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, gout and pseudogout. Evaluation is based largely on how your condition impairs your ability to function, so you may be eligible even if your specific condition isn’t listed.
- For SSDI, you cannot currently be working full time, and if you are 31 or older, you generally must have worked five of the previous 10 years.
- For either program you must be unable to do your job — or in some cases, any job — for 12 months.
- If you are younger than 50, you must be able to prove that you are unable to do any readily available job.
- If you are 50 or older, you only have to prove that you cannot do a job similar to the one you have done for the previous 15 years. Criteria are less stringent for people 55 and older.
Begin the Application Process
If you think you meet the criteria, your next step is to make the initial application. You can apply for SSDI benefits online at ssa.gov, by phone at 800-772-1213 or in person at your local Social Security office. (Schedule an appointment by phone or online first.)
If you apply by phone or in person, be prepared for a wait — waiting rooms can be crowded and phone hold times long — hours even.
The initial application will consist of several forms requesting basic demographic information; your daily activities; work history, including job duties and pay; and physicians who are treating you or treated you in the year prior to your becoming disabled. If you have questions about the forms and how to fill them out, ask an SSA representative.
Disability psychologist Rhoda Olkin, PhD, an associate professor of clinical psychology at California School of Professional Psychology, recommends creating a filing system for copies of any documents you submit to the SSA as well as any correspondence you receive from it. You’ll want easy access to these documents as the process goes forward.
Supply Proof of Disability
Once you have submitted your application, the SSA will begin gathering information to support your claim. This will include contacting all of the doctors you have listed on your application to determine whether your functioning levels allow you to work.
Proving disability will require determining your level of functioning and ability to meet the physical and mental demands of work.
- Physical demands may include the ability to stand, sit, lift, carry, walk, climb, stoop, bend, balance, crouch, reach, see, hear, grip, pinch and feel.
- Emotional demands include the ability to reason; learn, process, retain and express information; make appropriate decisions; behave in an appropriate manner; maintain emotional control; and understand and carry out instructions.
Be proactive in gathering information and making sure your rheumatologist and other doctors and health professionals are in agreement about your disability. Let them know the importance of submitting required information and follow up to make sure they have received and submitted the necessary forms and supporting materials.
Getting your doctors’ support is paramount, says Randy Wolfe of Phillips Law Firm in Seattle. Information your doctor should provide includes X-rays, MRIs, lab tests and the results of specific treatments (medications or joint replacement surgery, for example). It may also help your case if your doctor includes color photographs showing how your arthritis affects you. Photographs of red, swollen joints or hands disfigured by arthritis can have more of an impact that simply saying, “My joints are painful,” or “Arthritis makes it difficult for me to use my hands.”
In addition to supplying your medical records, your doctors will fill out forms about your disability, including their opinion about your ability to work and whether your condition may worsen, affecting your ability to work. Experts advise getting an additional evaluation by a vocational specialist or physical therapist, who can measure and document your ability (or inability) to meet demands of your work or work you might be able to do. And get a psychological evaluation by a psychotherapist, particularly if depression, anxiety, fatigue or trouble concentrating affect your ability to work. (If you are awarded benefits and your condition is expected to improve, the SSA will re-evaluate your case within a certain number of months. If your condition is not expected to improve, the re-evaluation is done after about seven years.)
Be Prepared to Wait – and Try Again
After you file your application, it typically takes three to five months to receive an answer, which in most cases is “no.” Only 21% of those who applied for disability between 2010 and 2019 were approved on their first try, according to the Social Security Administration.
If you are denied, you need to file an appeal. During the appeals process (called reconsideration) you may be required to see a doctor contracted by the SSA to perform an exam and make a decision about your disability. You will also receive more forms to fill out.
Because the appeals process can be complicated, many experts recommend hiring a lawyer or a licensed Social Security advocate at this point to answer your questions, work with your doctors to get proper records, represent you at hearings and improve your chances of getting benefits.
The services of an advocate will cost you nothing if your application is not successful. If you are awarded benefits, the SSA limits advocates’ fees to 25% of your first disability check, not to exceed $6,000. As a result, it will be in your advocate’s best interest to help you get benefits.
And Try Again
If your reconsideration appeal is denied — as about one-half are, says Wolfe — and you haven’t yet secured the services of an attorney or advocate, now is the time to do so. Your next, and usually final, step in the process will be to go before an administrative law judge. Your advocate can help you prepare for that meeting and represent you. (In rare cases, applicants take their case further, to an Appeals Council and then a Federal District Court.)
The time from initial application to the time you see a judge can be a year and a half or more, says Wolfe. If you are awarded benefits at this point, they can be retroactive up to 12 months. Although the process can be grueling, persistence and patience can pay off and help you pay your bills when you can no longer do your job.
Emotional Survival
The road to Social Security benefits can be emotionally draining at a time when you least feel like making the journey, says Olkin, who specializes in coping with disability and helping people apply for benefits.
“To start, you have to sign something that says you are incapable of working, and that is a huge psychological step,” she says. But don’t think of it as signing something that means forever. “Realize that no matter what you sign, all you are really saying is, ‘I can’t right now,’” she says.
While the disability is “right now,” the process to prove it and receive payments can take many months. Knowing that and knowing what the whole process looks like can help with the stress that comes with uncertainty, she adds. “It’s a series of steps, and it’s going to take time. Just know that going in.”
