Is Your Patient With Aching Joints Disabled Under The Social Security Listings?

This is the third in a series detailing how the Social Security “Listings” define certain types of disabling conditions. If your patient’s symptoms match or are equivalent to the criteria in the Listings, then your patient is “disabled” under Social Security law.

Under the Listings for the musculoskeletal system, there are three categories of arthritic conditions:

1) Active rheumatoid arthritis and other inflammatory arthritis;

2) Arthritis of a major weight-bearing joint (due to any cause); and

3) Arthritis of one mayor joint in each of the upper extremities (due to any cause).

Active rheumatoid arthritis calls for a history of persistent joint pain, swelling or tenderness involving multiple major joints. “Major joints” include hip, knee, ankle, shoulder, elbow and “wrist and hand” – which are considered together as one major joint.

The signs of joint inflammation (swelling and tenderness) must appear on current physical examination despite at least three months of prescribed therapy. The result must be significant restriction of the afflicted joints which is clinically expected to last at least 12 months.

In addition, the diagnosis must be corroborated by at least one of the following:

1) Positive serologic test for rheumatoid factor; or

2) Antinuclear antibodies; or

3) Elevated sedimentation rate; or

4) Characteristic histologic changes in biopsy of synovial membrane or subcutaneous nodule (obtained independent of Social Security disability evaluation.)

There are other conditions that may mimic these symptoms and have the same disabling effect, but may not match all the criteria. One such condition may be severe fibromyalgia. If your patient suffers a condition of the same severity of pain and limiting effects as active rheumatoid arthritis, he or she may be disabled for being equivalent to the Listings.

Symptoms may be migratory. They may appear in different parts of the body at different times or may at times be worse than at other times. In such cases, it is helpful to note the frequency of flare-ups and the migratory nature of such if relevant.

We have had clients who experience extreme tenderness and hyper-sensitivity to pain in one hand. This will render them incapable of using the hand and make them grimace in pain for a week or so. Then it will subside and there will be no complaint for several days. Similar symptoms may then occur in other joints.

Persons suffering physical disabilities are often restricted to only sedentary work. But sedentary work usually requires good use of the hands. Therefore, it is important for treating doctors to note any loss of use of hands such as the abilities to grip, handle objects and manipulate things.

Arthritis of a major weight-bearing joint may be degenerative or due to trauma. There must be persistent pain and stiffness shown on examination by marked limitation of motion or abnormal motion. There must also be 1) a gross anatomical deformity of the hip or knee shown by X-ray evidence; OR 2) reconstructive surgery or surgical arthrodesis of a major weight-bearing status within 12 months.

A gross anatomical deformity may be subluxation, contracture, bony or fibrous ankylosis, or even instability. The X-ray evidence must show either significant joint space narrowing or significant bony destruction, which markedly limits the ability to stand.

The third option, arthritis of one major joint in each of the upper extremities must be shown by marked limitation of motion and X-ray evidence of significant joint space narrowing or significant bony destruction, as well as a history of persistent pain and stiffness. This may be a bilateral condition, or one upper extremity may be afflicted in one major joint and the other in another. In addition, one of the following is required; A. The elevation of both arms at the shoulders, including scapular motion, must be limited to 90 degrees; OR B. There must be gross anatomical deformity (which may include ulnar deviation, in addition to examples above) and enlargement or effusion of the affected joints.

We, of course, hope to see people – your patients and our clients – recover from these conditions. The legal issue, however, is whether the condition persists for 12 or more months. If so, they are entitled to Social Security disability benefits for the period they were afflicted with arthritis or an arthritis-like condition which met — or was equivalent to — the above criteria.

This article was prepared by Arthur W. Stevens, III