Was Your Va Disability Claim For Back Arthritis Denied
If your VA disability claim for back arthritis is denied, it can be quite frustrating. Having to navigate the system in order to gain access to VA disability benefits can be overwhelming, but an experienced attorney can help you make sure that you are putting the most thorough and accurate case forward. From assuring that the appropriate medical examinations have been done to helping service members launch official challenges to a VA disability claim denial, there are options available.
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Arthritis is the swelling and tenderness of one or more joints caused by the deterioration of cartilage. Fractures or breaks in the bone, obesity, age, autoimmune disorders, bacterial or viral infections, and normal wear and tear can all cause arthritis.
Arthritis can cause significant pain, redness, and swelling of the joints and often limits one’s ability to perform everyday activities.
Meeting Social Security Administration Listing 104c For Disorders Of The Spine
You will meet listing 1.04C if you have:
- A disorder of the spine ,
- With lumbar spinal stenosis resulting in pseudoclaudication ,
- Established by findings on appropriate medically acceptable imaging,
- Manifested by chronic nonradicular pain and weakness,
- Resulting in inability to ambulate effectively.
Inability to ambulate effectively means an extreme limitation of the ability to walk. Ineffective ambulation is defined generally as having insufficient lower extremity functioning to permit independent ambulation without the use of a hand-held assistive device that limits the functioning of both upper extremities. To ambulate effectively, you must be capable of sustaining a reasonable walking pace over a sufficient distance to be able to carry out activities of daily living. You must have the ability to travel without companion assistance to and from a place of employment or school. Therefore, examples of ineffective ambulation include, but are not limited to:
- The inability to walk without the use of a walker, two crutches or two canes,
- The inability to walk a block at a reasonable pace on rough or uneven surfaces,
- The inability to use standard public transportation,
- The inability to carry out routine ambulatory activities, such as shopping and banking, and
- The inability to climb a few steps at a reasonable pace with the use of a single hand rail.
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Qualifying For Disability Under The Listings For Back Problems
It’s fairly common for osteoarthritis to occur in the facet joints in between the vertebrae of the spine, but osteoarthritis in the spine qualifies for disability benefits only under certain conditions. To meet the requirements of the listing for spinal disorders, you must have a diagnosis of osteoarthritis in your spine and one of the following:
- compression of a spinal nerve root that limits the motion of your spine and makes it extremely difficult to walk and/or use your hands, or
- narrowing of the spinal canal in the lower lumbar region that affects your nerve roots and makes it extremely difficult to walk and/or use your hands.
For the specific disability criteria for each of these back problems, see our individual articles on getting disability for them by visiting the links above.
Other Disability Data Sources
Arthritis Conditions Health Effects Survey
In 20052006, CDCs Arthritis Program conducted the first national survey dedicated to arthritis, the Arthritis Conditions Health Effects Survey . ACHES is a national random-digit-dialed telephone survey of noninstitutionalized US adults aged 45 years or older, designed to generate a more comprehensive picture of the impact of arthritis or joint symptoms on peoples lives.
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How Does The Va Rate Back Arthritis
As with any service-related injury, the VA has a formula for determining if benefits will be awarded and in what amount. The VA assigns each applicant a disability rating based on the severity of the service-related condition. These ratings will be based on evidence from medical professionals, a VA claim exam, and information collected from other sources including federal agencies. If an individual has more than one service-related injury, the ratings can be combined to determine an overall rating for assigning benefits on a combined ratings scale.
In addition, the VA accounts for aggravating factors of a service-related incident. This means that if an individual had an existing condition before entering into service that would have been rated a 10% disability but the act of service aggravated the condition to increase it to a 20% disability, the VA would determine it to be a 10% disability for their rating system.
Back arthritis can certainly be a service-related injury that qualifies for VA disability benefits. The VA will assign a rating based on the severity of the condition. In general, the flexion measurements) of the affected area and the x-ray evidence showing the number of impacted joints will determine the rating.
Listing 115 Spinal Disorders With Compromise Of A Nerve Root
To qualify under Listing 1.15 for back problems resulting in a spinal “nerve root” being compromised, you must have evidence of all of the following:
- indications that a nerve root is compressed
- neurological signs such as muscle weakness, signs of nerve root irritation, and decreased sensation or decreased deep tendon reflexes
- X-rays or MRI results consistent with compromise of a nerve root, and
- an inability to use your hands for work because:
- you need an assistive device for walking that requires both hands
- you need a device that requires use of one hand, but you’re unable to use the other hand for work-related tasks, or
- you aren’t able to use either hand for work-related tasks.
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Determining If You Can Work
When the SSA receives your application, they first determine whether you’re currently working and how much youre earning from your work. If you are earning $1,220 per month or more as stated in the 2019 COLA, you cant qualify for benefits because the SSA will determine that youre able to perform substantial gainful activity.
Qualifying For Benefits Under The Medical Listing For Ra
The SSA sets forth specific criteria for disability applicants with rheumatoid arthritisin its Listing of Impairments. Socials Securitys medical listing for inflammatory arthritis is lengthy and relatively complicated andoffers multiple ways that a disability applicant with RA can qualifyunder the listing. Overall, you must experience significant limitationsin your abilities due to your RA to qualify for benefits under thismedical listing. Specifically, to qualify for benefits under the listing for RA, youmust satisfy one of the following requirements:
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Arthritis In The Lower Back
The most prevalent type of spine arthritis is osteoarthritis . It mainly affects the lower back and develops over time as a result of normal wear and tear. Inflammation and pain result from the gradual breakdown of cartilage between the joints. The pain is usually more noticeable when you bend or twist your back because it is caused by mechanical injury.
What Spine Disorders Qualify
Spine disorders are conditions that are taken seriously as they can lead to permanent disability, including loss of mobility and severe pain. Because of this, spine disorders have their own section in the Social Security Administration Blue Book. Some of the spine disorders specifically listed in the Blue Book include:
- Degenerative Disc Disease
- Vertebra Fractures
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Working With A Disability Lawyer
If you are considering applying for SSD benefits for a spine disorder, it is important to understand that most applications for this condition are initially denied. Spine disorders require that you meet a very specific list of requirements based on the specific spine disorder you are claiming. Because of this, it is important to work with someone that knows exactly what documents, medical files and supporting evidence should be included your application. An experienced disability attorney can help you with your application process and also help you appeal your case if your initial application is denied. Complete our free case evaluation to be connected with a local disability attorney to discuss your application and your condition today.
Work With A Disability Lawyer Or Advocate
Because the rules and regulations for applying for Social Security disability benefits have become more and more complex over the years, it makes sense to have an attorney or experienced advocate assist you with your application and throughout the process, Dr. Smith says.
Local attorneys and advocates also usually know the judges and adjudicators in the system, which can often improve your chances of having your claim accepted, he explains.
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Back Pain Is One Of The Most Common Impairments For Which People Apply For Social Security Disability Benefits And Degenerative Disc Disease Is Listed As An Impairment In Social Securitys Blue Book Under Section :
1.04 Disorders of the spine , resulting in compromise of a nerve root or the spinal cord.
But qualifying for Social Security with spondylosis can be very difficult.
Almost everyone experiences back pain at some time in their life, but that will not make them eligible for SSDI. The Social Security Administration expects people who perform a job at a certain level of exertion who are injured will return to their same job after a period of time and grant benefits only to those applicants whose condition is so severe they are unable to sit or stand for long periods of time.
An applicant must be able to meet the following criteria:
A Social Security examiner will want to see:
What Back Conditions Automatically Qualify For Disability
There are many different spine disorders that can qualify for disability benefits, but the disability insurance company and/or Social Security Administration will have to evaluate the medical evidence to see if your condition is severe enough to be approved. There may be specific medical evidence that is required in order to be approved for disability benefits for certain disorders. For example, with arachnoiditis, the Social Security Administration requires surgical notes and tissue biopsy reports.
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Can I Qualify For Disability With Osteoarthritis
If you have been diagnosed with osteoarthritis and it has impacted your ability to work, you may qualify for Social Security Disability benefits. Osteoarthritis results in the gradual loss of cartilage from your joints. A tough tissue that provides the cushioning between the bones that form the joints, it is needed.
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How To Get Disability For Back Pain
Back pain is an incredibly common condition, with as many as 80% of all people expected to experience back pain at some point in their lifetimes, according to the American Chiropractic Association . Additionally, the ACA notes that back pain accounts for over 265 million lost hours of work every year. It is one of the top reasons people miss work, and it is the single leading cause of disability. All this to say, if youâre currently experiencing debilitating back pain or have been unable to work in the past due to back pain, youâre not alone!
But, do you qualify for disability for your back pain? And, if you do, how do you actually get your Social Security disability benefits?
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After You Apply For Benefits
After you submit your application, Social Security sends your file to your state’s Disability Determination Services office. Next, a claims examiner will request and review your medical records and may call you for an interview or send you additional paperwork. When the claims examiner has enough information, Social Security will make the decision and notify you by mail. This normally takes three to four months, but it could take longer.
If you receive a denial letter and your condition has worsened, or you think your case is strong enough to win an appeal, consider contacting a disability lawyer. Applicants who go to an appeal hearing represented by a lawyer have a better approval rate than applicants who represent themselves.
Qualifying For Disability Benefits
The medical requirements are typically the same for adults to qualify for Social Security or SSI. You will need to demonstrate that the disability makes you unable to sustain substantial, gainful employment.
You can apply as soon as PsA makes it difficult or impossible to perform a job. While theres no requirement for you to have a disability for a certain amount of time before you apply, you will need to show that PsA will prevent you from working for at least 12 months.
More information on qualifying for Social Security and SSI with a PsA disability can be found in the Immune System Disorders or the Musculoskeletal System sections of the governments Disability Evaluation Under Social Security guidelines.
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What Chronic Back Conditions Qualify Automatically For Disability
The SSA maintains a listing of impairments that can automatically qualify for disability. If your condition matches the requirements of any of the following listings, you could qualify automatically for disability. To learn about the criteria for each listing read our articles on the following types of back problems:
Applying For Social Security Disability Due To Osteoarthritis
You can apply for Social Security disability in person at your local SSA office , by calling Social Security at 800-772-1213, or online at www.ssa.gov/applyfordisability. To complete the disability application, you’ll need detailed information, including the contact information and dates of treatment for all of your medical providers, the dates of any medical tests, and the names, addresses, and dates of employment for all of your employers in the last 15 years. For more information, see our article on applying for Social Security disability benefits.
If you’d like help with your application, think about working with a legal professional. Click for a free case evaluation with an SSDI expert to determine whether your osteoarthritis is severe enough to qualify for benefits.
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Can You Do Any Other Type Of Work
Step 5 determines what other work if any, the person can perform. Social Security Administration looks at:
- Work experience
- Physical/mental condition
To determine disability, Social Security Administration enlists vocational rules, which vary according to age. For example, if a person is:
- Under age 50 and, as a result of the symptoms of arthritis, unable to perform what Social Security Administration calls sedentary work, then Social Security Administration will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.
- Age 50 or older and, due to his disability, limited to performing sedentary work but has no work-related skills that allow him to do so, Social Security Administration will reach a determination of disabled.
- Over age 60 and, due to his disability, unable to perform any of the jobs he performed in the last 15 years, the Social Security Administration will likely reach a determination of disabled.
- Any age and, because of arthritis, has a psychological impairment that prevents even simple, unskilled work, Social Security Administration will reach a determination of disabled.
Disability Benefits For Psoriatic Arthritis
Psoriatic arthritis is a type of arthritis that can become so painful that it can actually affect ones ability to continue working. Psoriatic arthritis is a condition that typically develops in people who have been suffering from psoriasis for a considerable amount of time.
Psoriasis itself results from the inflammation of parts of the skin, such as on the hands or fingers. Psoriatic arthritis develops when the psoriasis has become so pronounced that it causes inflammation of the joints, particularly the points where tendons and ligaments are connected to bones.
Because of the pain resulting from psoriatic arthritis, continued employment may be impossible. Ones working ability with psoriatic arthritis usually depends on where the arthritis occurs.
Arthritis in the fingers and hands, for example, will have a serious effect on people who handle anything with their hands in their jobseven those who operate a computer keyboard. Sufferers who are unable to keep working for at least the next 12 months, despite any treatment, may qualify for disability benefits for psoriatic arthritis.
The criteria for determining eligibility for disability benefits for psoriatic arthritis include:
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Do You Meet One Of The Disability Listings Applicable To Arthritis
The SSA has a Listing of Impairments that describe severe medical conditions that are so severe it will presume they prevent a person from performing gainful activity regardless of their age, education, or past work.
The listings do not include all possible medical conditions. But for those included the listings state the specific medical criteria an applicant must meet for the listing to apply.
If you satisfy the criteria, the SSA will find you disabled.
If you do not and many people do not the SSA will move to the next steps in the valuation. Indeed, only 10 percent of the people found disabled by a musculoskeletal disorder meet a listing. The other 90 percent are found disabled at a later step.
The following impairments might apply to your arthritis claim:
- 1.15: Disorders of the skeletal spine resulting in compromise of a nerve root
- 1.16: Lumbar spinal stenosis resulting in compromise of the cauda equina
- 1.17: Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint
- 1.18: Abnormality of a major joint in any extremity
- 14.09: Inflammatory arthritis
I recommend that you review these listings and their stated criteria when seeking disability benefits for arthritis. They provide an overview of the type of evidence you should develop and present.