Joint pain is common and can be caused by a variety of conditions including arthritis, osteoarthritis, fibromyalgia, bursitis, gout, lupus, and rheumatoid arthritis. Whether the pain is present in the tendon surrounding the joint, the ligament, or the bursae, it is not uncommon for the pain and resulting debilitation to be so severe that an individual cannot work.
Recently on our disability forum a claimant asked, If I have severe joint pain and have joint redness, swelling, tenderness, and stiffness that makes it difficult to walk, can I qualify for Social Security Disability Insurance?
SSDI and proving disability for joint pain
Unfortunately, winning SSDI benefits for any type of pain, including joint pain, can be very difficult. To win benefits you will have to meet certain requirements. You will have to prove you have a medically determinable impairment, your condition will last at least 12 continuous months, you have enough work credits to qualify for SSDI benefits, and you are not currently working and earning too much money.
Additionally, the SSA will expect that you have received a diagnosis from a medical professional, followed their treatment plan (and still cannot work), and you have medical evidence of your impairment. Medical evidence can include x-rays, MRIs, or lab tests which could reasonably be expected to produce your physical symptoms.
How does the SSA make a disability determination for joint pain?
To determine whether or not your joint pain is severe enough to eliminate your ability to work the SSA will first determine if it meets or equals a listing in the SSA Listing of Impairments. Often referred to as the Blue Book, this listing outlines the conditions and their corresponding symptoms the SSA considers automatically disabling.
Joint pain is reviewed under 1.00 Musculoskeletal System, Section 1.02 Major dysfunction of a joint(s) (due to any cause). The language in the Blue Book can be a bit complicated to understand, but basically, the SSA will expect your joint pain to be associated with a deformity in a joint including either joint space narrowing, ankylosis (when your joints fuse) or the destruction of bones.
If the joint pain is present in your hip, ankle, or knee, the SSA will review your ability to ambulate effectively (i.e. do you have to use a walker, two crutches, or two canes). If the joint pain is in your wrists, hands, shoulders, or elbows, the SSA will review your ability to perform daily activities (i.e. can you cook your own food, bathe yourself, or take care of your own hygiene requirements).
If your joint pain is the result of different health conditions it may be evaluated under those specific listings. For instance lupus is evaluated under 14.00 Immune System Disorders.
Medical Vocational Allowance and Joint Pain
If a claimant does not have a condition which meets or equals a listing in the SSA Blue Book they may still be determined disabled if the SSA determines they do not have the residual capacity to work based on their age, work history, transferable work skills, and educational background. This disability determination process is called a medical vocational allowance.
Winning SSDI through a medical vocational allowance is very difficult, especially for younger claimants. Talk to a lawyer if you have questions about your joint pain.