Social Security has combined several impairments under the generalized heading of “Inflammatory Arthritis” and continued to make the requirements for proving total disability more challenging.
Inflammatory arthritis conditions include a variety of diagnoses including: Rheumatoid Arthritis, Lyme Disease, Psoriatic Arthritis, Reiter’s syndrome, Ankylosing Spondylitis, Inflammatory Bowel Disease, Sjogren’s Syndrome and others. These are all lumped together because of the similarity of the symptoms involving inflammation of major peripheral joints.
Important, however,(though not a focus in the Listing), is recognition that in addition to the joint damage, these conditions often include “constitutional symptoms” such as severe fatigue, fever, malaise and involuntary weight loss. These symptoms must be emphasized during treatment to make it more challenging for Social Security to deny an application.
As in any Social Security Disability application the focus is on the medical charts, the clinical findings and the patient’s description at each doctor visit of day-to-day limitations and problems. The Listings actually direct focus on the “Primer on the Rheumatic Diseases” published by the Arthritis Foundation.
Listing 14.09 describes the required medical findings to meet SSA’s requirement for presumption of total disability. This Listing is broken down into 4 subparts and covers the symptoms associated with arthritis, including inflammation, deformity and involvement of other organs or body systems. The complete description can be found at www.ssa.gov and searching for Listing 14.09.
These are all clinical and functional problems which must be consistently documented in the notes of the treating rheumatologist. The requirements, though technical, clearly state that documentation of the disease is NOT the focus, it is documentation of the symptoms and their impact on function.
If this listing cannot be met, an application can still be approved if the “constitutional symptoms” such as severe fatigue, make it impossible for a Claimant to sustain full time work activity. Also, if SSA can be persuaded that use of the peripheral joints, such as hands and fingers, causes such a severe aggravation of symptoms such as pain and swelling, that they cannot be used on a sustained basis, benefits may be approved. These types of severe limitations must be well documented on a consistent basis throughout the medical charts.
The impact of new medications makes many of these applications more challenging. The success of the new biologics such as Humira, Enbrel and Remicade often ameliorate the symptoms sufficiently to allow for some work activity. Claimants need to be educated that just having the disease is not the focus of a Social Security Disability application and if the medications are working – even with possible long-term side effects – they may not have a viable claim.
This grouping of conditions may cause severe symptoms and limitations for claimants. Proving entitlement to Social Security Disability bene ts may be challenging but the earlier an experienced representative can get involved to explain the SSA requirements and focus, the more likely that appropriate claimants will get this assistance.
Please let us know. As your local source for support on Social Security disability issues, we can provide the information to help you assist clients, families and friends. We would be glad to come to your office or community group to talk about these issues. Calls and emails are welcome.
We continue to conduct our trainings at agencies throughout our community. If you would like us to come meet with your staff to discuss Social Security’s programs and operations, and how to more effectively help clients, please give us a call and we would be happy to schedule in-service trainings for no fees.
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