Social Security Disability Benefits and Arthritis

The Evaluation Process

Qualifying for Social Security Disability Benefits

Arthritis is one of the leading causes of disability. How does a person suffering from arthritis qualify for Social Security disability benefits? According to Jim Allsup, the Social Security Administration uses a process called sequential evaluation to determine who will receive disability benefits. Mr. Allsup is president and CEO of Allsup Inc. Since 1984, Allsup claims his company has:

  • successfully helped over 100,000 people nationwide receive their entitled disability benefits.
  • achieved a 97% award rate.

Patients who have been helped by Allsup often suffer from rheumatic conditions and musculoskeletal diseases such as:

5 Steps to Determine Disability Benefits

What is the evaluation process used to determine disability benefits? Mr. Allsup explains the five-step sequential evaluation process:

Step 1: Are You Working?

Step 1 simply determines if an individual is "working", according to the Social Security Administration definition. Earning more than the Substantial Gainful Activity amount a month as an employee is enough for disqualification from receiving Social Security disability benefits.

Step 2: Is Your Condition Severe?

Step 2 implies that the impairment must be severe enough to significantly limit your ability to perform basic work activity.

In addition, the impairment must last, or be expected to last, for a continuous period of not less than 12 months.

Step 3: Is Your Condition a Listed Impairment?

Step 3 asks if the impairment meets or equals a medical listing. Social Security Administration breaks the body down into 13 major systems or listings.

Included in these 13 systems are more than 150 categories of medical conditions that, according to Social Security Administration, are severe enough to prevent an individual from performing any work.

Arthritis is considered under the Musculoskeletal Body System and has several specific medical listings or categories.

Inflammatory Arthritis

To satisfy the listing criteria, a person with inflammatory arthritis (such as rheumatoid arthritis) must have persistent swelling, pain and limitation of joints such as the:

  • hips
  • knees
  • ankles
  • shoulders
  • elbows
  • wrists and hands

Degenerative Arthritis

People who have degenerative arthritis (osteoarthritis) satisfy the requirements if they have significant limitations using their arms/hands or have a significant problem standing and walking. Those who have significant back or neck problems due to degenerative processes must have persistent sensory, reflex and motor loss to satisfy the listed criteria.

Conditions Not Listed

However, if a person's arthritis does not satisfy a medical listing, Social Security Administration continues to the next two steps to see whether the person might still qualify for disability benefits. At the next two steps:

  • Social Security Administration looks primarily at how the actual limitations and symptoms imposed by arthritis affect a person's ability to perform work.
  • Social Security Administration looks more specifically at the work-related impact of having arthritis.

Step 4: Can You Do Work You Did Previously?

Step 4 explores the ability of an individual to perform work he has done in the past despite his impairment. If Social Security Administration finds that a person can do his past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.

Step 5: 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:

  • age
  • education
  • 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, 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.

Problems to Overcome With Social Security Disability Benefits

More than one million people file for disability benefits with the Social Security Administration each year.

  • The bad news is, nearly two out of three who apply for disability benefits will be denied.
  • The good news is, expert help is available to assist with the process and improve your odds of winning your case.

Social Security Disability Insurance

Social Security Disability is an insurance program paid by your FICA taxes.

All working Americans contribute 7.65 percent from every paycheck to Federal Insurance Contributions Act (FICA) taxes.

Under the Federal Insurance Contributions Act, FICA taxes total 15.3 percent of your earned income. A total of 12.4 percent of your earned income (up to an annual limit) is paid into Social Security, an additional 2.9 percent of your earned income (with no limit) is paid into Medicare. If you are an employee, you pay only half the FICA taxes (6.2 percent for Social Security + 1.45 percent for Medicare for a total of 7.65 percent), your employer pays in the other 7.65 percent. People who are self-employed pay in the entire 15.3 percent.)

Some of that payment goes toward disability insurance coverage by the Social Security Administration. However, bureaucratic problems plaguing Social Security Administration's Disability Insurance program often prevent fair and speedy distribution of disability benefits to people who are eligible.

Problems When Applying for Disability Benefits

If you choose to apply for disability benefits by yourself, there are several problems you will face such as:

  • backlogs of unprocessed disability claims.
  • an average five-month wait after filing a claim before receiving an answer on the initial claim, and almost a year of additional delays if the claim is appealed.
  • backlogs of disability cases awaiting review, with hundreds of thousands of cases coming up for review each year.

Do You Need Representation?

Though initially designed to make it easy for people to represent themselves, it did not take long for attorneys and representatives to become involved in the disability process. Representation in a Social Security Disability case can be valuable since:

  • learning the details of the system can be difficult.
  • rules are increasingly complex.
  • experts know the details of the process.
  • experts may improve your odds of winning disability benefits.

Why Should You Apply for Social Security Disability Benefits?

Why should I apply for Social Security disability benefits if my employer or insurance company is already paying benefits?

Those who do not know the answer to that question are shortchanging themselves. And so are employers who do not realize the lack of Social Security qualification is costing them a larger share of their employees disability benefits than necessary.

Sources:

Allsup Inc

IRS Publication 15; Social Security Administration

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