Inflammatory Arthritis and Social Security Disability Insurance: What does it Mean to “Meet a Listing”

May 2017 is Arthritis Awareness Month.  As I have written before, arthritis remains the primary cause of disability in the United States.  The Arthritis Foundation (naturally) is active in raising awarement and funds for research in arthritic conditions.  Of particular interest to residents of Dallas Fort Worth and North Texas, the Arthritis Foundation Texas is sponsoring the”2017 Walk to Cure Arthritis” on May 13, 2017 in Plano Texas. Our firm plans to participate.

In this blog post let’s explore what it means to “meet a listing” for approval of social security disability benefits based upon an inflammatory arthritis.  (Last year we explored this subject as it pertains to Lupus.  As I set out in that post, the so-called “Listings” are set out criterion for given illnesses that social security agrees if present entitle a person to disability benefits.  They are criteria that medical experts have agreed are disabling.  As you might imagine, they represent the severest forms of given illnesses, and the failure to meet a listing does NOT mean the disability claim will be denied.  I like to think of the Listings as a short cut to a favorable decision, but they are not the only path to victory.

The Listing for “Inflammatory arthritis”  can be broken down to the follow 4 “paths”:

PATH 1PATH 2PATH 3PATH 4
Persistent inflammation or persistent deformity of:

1. One or more major peripheral weight-bearing joints resulting in the inability to ambulate effectively

OR

2. One or more major peripheral joints in each upper extremity resulting in the inability to perform fine and gross movements effectively.
Ankylosing spondylitis or other spondyloarthropathies, with:

1. Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 45° or more of flexion from the vertical position (zero degrees);

OR

2. Ankylosis (fixation) of the dorsolumbar or cervical spine as shown by appropriate medically acceptable imaging and measured on physical examination at 30° or more of flexion (but less than 45°) measured from the vertical position (zero degrees), and involvement of two or more organs/body systems with one of the organs/body systems involved to at least a moderate level of severity.
Inflammation or deformity in one or more major peripheral joints with:

1. Involvement of two or more organs/body systems with one of the organs/body systems involved to at least a moderate level of severity;

AND

2. At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).
Repeated manifestations of inflammatory arthritis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:

1. Limitation of activities of daily living

2. Limitation in maintaining social functioning.

3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

I have highlighted terms in red that are further defined in the regulations that are extremely important. The definition of “Inability to ambulate effectively” is defined in the regulations in some 250 words (we are dealing with the government, after all) but here is the essence: you must have “an extreme limitation of the ability to walk; i.e., an impairment(s) that interferes very seriously with the individual’s ability to independently initiate, sustain, or complete activities”.

The “Inability to perform fine and gross movements effectively” is defined as “an extreme loss of function of both upper extremities; i.e., an impairment(s) that interferes very seriously with the individual’s ability to independently initiate, sustain, or complete activities.”

And finally, a “marked level”  of the limitations in path 4 is defined as follows:

“Marked limitation means that the signs and symptoms of your immune system disorder interfere seriously with your ability to function. Although we do not require the use of such a scale, “marked” would be the fourth point on a five-point scale consisting of no limitation, mild limitation, moderate limitation, marked limitation, and extreme limitation.”

Not exactly clear is it.  See why he need a lawyer? But thee take how lesson for looking at the listing for Inflammatory Arthritis is this: it generally takes a very severe and advanced disease to meeting this listing.  Modern competent rheumatological treatment has dramatically reduced the incidence of actual strucuture joint damage.  Path 4, with its emphasis on fatigue and malaise – symptoms that remain difficult for rheumatologists to alleviate – is the most typical listing based path to a favorable social security disability decision based upon Inflammatory Arthritis.

 

Social Security Disability & Arthritis

The Centers for Disease Control (CDC) reports that arthritis is the leading cause of disability in the United States.  In recognition of  Arthritis Awareness Month for the month of May 2012 I will focus several blog posts on arthritis and social security disability this month.

In considering arthritis and social security disability it is helpful to understand just what arthritis is.  We often associate arthritis with aging, perhaps remembering grandparents that complained of “rheumatism”.  Osteoarthritis (OA) is  characterized by the breakdown of cartilage in the joints – commonly the knees, feet, hips, and hands.  OA is a predictable and normal result of the aging process, and is typically present to some degree with all persons over the age of 50.

Inflammatory arthritis is a large family of diseases that are minimally related to aging, and are the result of a disease process that can strike young and old alike. More common inflammatory arthritis’ include rheumatoid arthritis, ankylosing spondylitis, psoratic arthritis, gouty arthritis, systemic lupus erythematosus, and spondyloarthropathies.  Fibromyalgia is considered to be a member of the arthritis family, but not considered to be an inflammatory arthritis.

While each of the inflammatory arthritis diseases and OA are unique, and therefore involve different strategies for purposes of securing social security disability benefits, there are many commonalities:

  • Limitations in function – the ability to stand, walk,and sit, and duration of those actvities – is critical.
  • Arthritis is often accompanied by pain even if relatively inactive, which affects the ability to sustain work activity.
  • Arthritis suffers often suffer from depression and anxiety, further eroding the ability to sustain attention and concentration.

In the coming weeks I will focus more specifically on some of the more common forms of arthritis and their treatment under the social security disability process.

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stanley@disabilityapproved.com

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