The main issue in your rheumatoid or inflammatory arthritis Social Security disability case is whether or not you are able to work even a simple, entry-level job. Although all forms of arthritis are medical conditions that can be diagnosed using medical imaging tools (x-ray, CT scan, etc.) you will not win if you focus solely on the details of your arthritis. Instead, your focus must be the specific ways in which arthritis prevents you from performing activities in a work environment.
Are Your Medical Records Sufficient?
In an arthritis case, I typically see medical records like this: your medical records may consist twenty pages of office notes describing thirty office visits over a three year period of time. In each day’s entry, your doctor may write down how you reported feeling, his impressions as to redness, stiffness, or swelling. Your doctor also may note what medications you are taking, how well they seem to be working and whether he intends to refer you to a specialist for more tests.
What is missing here? These notes are perfectly good as documentation of your illness and your treatment. However, they may not help you in your Social Security case.
Social Security, remember, focuses on work activity limitations. There is nothing in these records about how much you can lift, how much you can carry, or how long you can sit. There is also no analysis of your pain in terms of the extent to which your pain interferes with concentration, or causes irritability that might cause tension with co-workers.
A Social Security adjudicator would not give these notes a second look as they do not even begin to suggest limitations on your functioning. Even an experienced Social Security Judge will not assume specific work limitations from this type of office note. Some judges may, however, recognize the significance of a long treatment history, and might be more inclined to accept limitations set out in your testimony. Other judges, however, are less inclined to believe anything unless it is in your record.
Using Social Security’s Special Language
As your attorney, I would approach this problem by studying your medical record, then creating a checklist form (called a “functional capacity” form) that tracks most of your symptoms, My forms (which are based on the official Social Security forms) also include the specific functional limitations set forth in the judge’s handbook used by your Social Security Judge. Further, after representing claimants at hundreds of hearings, we know which vocational factors carry the most weight with judges.
For example, a pain limitation that causes interference with concentration such that you would not be able to understand and carry out complex job instructions is not particularly limiting, since many jobs exist that only require you to understand and carry out simple job instructions.
On the other hand a sitting and standing limitation that says you can stand only 5 minutes at a time and that you must lie down for 30 minutes every three hours is extremely significant since there are no jobs that would permit an unscheduled 30 minute break every three hours.
Getting Cooperation from your Doctor
Your doctor may truly feel that you cannot work, but if he or she is not familiar with Social Security practice and procedure, he or she may not think to complete the most important questions contained in a functional capacity form. Every case is different, however, there are certain activity limitations that seem especially important to Social Security judges. As you might expect, these “threshold” activities relate to job reliability and minimal physical activities.
Over the years, we have run into some situations in which a client’s doctor “does not want to get involved.” Often this is the result of a bad experience with a legal case in the past – perhaps the doctor was forced to wait around the courthouse for hours, only to be brutally cross-examined by an aggressive lawyer. If your doctor expresses concern about getting involved in a Social Security case, you should explain to him that Social Security judges follow relaxed rules of evidence. Written reports or letters are almost always accepted. Live testimony by the doctor is extremely rare. Further, there is no cross-examination by a hostile lawyer – at the Administrative Law Judge level, there is no “government lawyer” on the other side.
In addition, if you are approved for Disability (Title II) benefits, you will become eligible for Medicare 24 months after your first date of Title II entitlement. Medicare, of course, can be a source of payment for your doctor, and may result in more cooperation.
As attorney representatives, our experience has been that most caring physicians will agree to spend ten or fifteen minutes to complete a form that can dramatically better your life. If your doctor refuses to cooperate or if he wants to charge you more than $50 to complete a functional capacity form, you may want to think about finding a more cooperative doctor.
Hearing Issues Unique to Arthritis cases
Arthritis cases often involve issues that may not reflect your particular case, but have to do with other arthritis cases the judge has seen. To put this another way, you need to be aware that many claimants – perhaps as many as half the claims filed – involve complaints of arthritis. Osteoarthritis arthritis is a common ailment in most of the population over the age of 40. As a result, your Social Security Judge has seen a lot of claimants who complain of arthritis pain. Because of this experience, many judges tend to play down arthritis as a disabling condition.
Because osteoarthritis is so common, you will have an uphill battle trying to convince a judge that your osteoarthritis leaves you without the capacity to perform all types of work. I am much more inclined to accept a case for representation if my potential client suffers from both osteoarthritis and some other significant medical condition. I could then argue that your arthritis prevents you from certain categories of work, such as jobs requiring extensive standing and walking, or the use of ladders, ropes and scaffolds, and I could argue that your other medical condition or conditions further limits your capacity for work.
Inflammatory arthritis, however, will be seen by a Social Security judge as a much more serious medical problem. If you have been diagnosed with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis, you have a much stronger case for disability as these conditions tend to be chronic in nature and degenerative, meaning that treatment will be focused on maintaining your functioning as opposed to “curing” your condition.
Often, when representing a client with inflammatory arthritis, I will focus both on your medication side effects as well as the actual symptoms of your arthritis. I am interested in any element of your arthritis and treatment that would negatively impact your ability to work. Spend a few minutes to learn about how to best describe your symptoms – this site, for example, contains links to several blogs published by arthritis sufferers – you may get some good ideas here about how to describe your symptoms.
If your case involves an unusually advanced case of osteoarthritis, or rheumatoid arthritis or inflammatory arthritis, or other rare forms of the disease, you may need to educate your Judge in order to win.
Preparing your Case File for a Hearing
It has been my experience that sometimes your doctor may simply use the term “arthritis” when he really should use a specific medical term that describes your specific diagnosis. Again, your doctor may not realize that someone else will be reading his office notes; thus terminology accuracy and specificity may not be a priority. Either you or your Social Security representative should review all office notes thoroughly ahead of time to insure that the medical records make sense.
Would you be surprised to know that most doctor’s notes are handwritten and difficult to read? In several instances, we have had to work with a doctor’s office to “translate” notes so that they could be understood.
None of this is to suggest that a doctor with sloppy handwriting or sketchy office notes is not a good, caring physician. To the contrary, your doctor’s main focus is his treatment of you. His notes are simply reminders for him to review prior to your visits. For Social Security purposes, however, your doctor’s office notes can make or break your case – thus we see our role as one whereby we “translate” medical findings into work limitations.
How You Should Prepare for your Hearing
As an attorney, I obviously feel that Social Security claimants are better off with lawyers than without. Since most cases do not involve up-front fees money should not be an issue. However, you are permitted to appear and argue your case on your own or with a non-attorney representative. If you proceed without an attorney, you will get the best results if you do the following:
- Review your file thoroughly – make sure that all records of medical treatment are present and up to date.
- Decide on a theory of disability – why are you unable to work. You should be able to boil this down to two or three sentences.
- Give the Judge specific information. Testimony that “it hurts a lot” or “I can’t walk very far” doesn’t say much. Testimony that “I can only stand and walk for 15 minutes every three hours” gives the Judge a specific vocational limitation.
Click on the link to read more about what a Social Security disability hearing room looks like and what actually happens during the hearing proceeding.
In my law office, I prepare for hearings by reviewing your claims file two to six weeks prior to the hearing and summarizing the claims information and medical records into a two or three page typewritten summary. By reviewing your file early, I have enough time to update records. Social Security has also approved me to review claims files electronically – this means that I can log on to SSA’s database to review your file in real time.
When I prepare for a hearing, I create a summary of your medical treatment in date order with references to the Exhibit page number. Thus, if I am discussing a particular medical record, I can identify it specifically for the judge. At your hearing, therefore, you will note that my hearing worksheet is a neat two or three page document rather than a bulky file. In many cases, I bring my laptop computer to the hearing and enter hearing notes directly. I use these annotated hearing notes to track the questions typically asked by a particular judge and the “hot buttons” that help me win cases.
Big Picture Approach to Arthritis Disability Cases
If you get the sense that presenting a disability case to an Administrative Law judge is kind of like putting together a giant jigsaw puzzle, you would be right. Our goal is to paint a picture of you as an honest, hardworking person who can no longer function reliably at even a simple, entry level job because of pain and other symptoms associated with your arthritis and other medical conditions. We can use your severe or even not so severe arthritis symptoms and medication side effects to paint this picture.
Rheumatoid Arthritis Disability Case Study #1: 47 year old female with a solid work history and well documented rheumatoid arthritis. The judge approved my client’s claim.
Rheumatoid Arthritis Disability Case Study #2: 36 year old female with rheumatoid arthritis, diabetes, DVT and a subsequent cancer diagnosis. This case was approved as the judge concluded that she would be off task at any job for up to 20% of the work day.
Rheumatoid Arthritis Disability Case Study #3: 53 year old female small business owner who alleges disability based on painful joints and medication side effects.
Rheumatoid Arthritis Disability Case Study #4: 48 year old female who retired from teaching because of rheumatoid arthritis related hip and leg pain, instability in walking, reduced grip strength and medication side effects.