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Getting Disability Benefits for Rheumatoid Arthritis

Updated on May 27, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Annie Keller
Article written by
Sarah Winfrey

Joint pain, mobility problems, and other symptoms of rheumatoid arthritis (RA) can make full- or part-time work challenging. When people with RA can no longer work, many in the United States seek Social Security disability benefits. Disability benefits help replace lost income when people with RA have to leave their jobs.

Many people with rheumatoid arthritis work for decades before applying for disability benefits. One myRAteam member wrote, “I have decided after 30 years of medication and pain and trying to keep working, I can’t take it anymore. I am applying for disability.”

You’re not alone if you share these sentiments. The Centers for Disease Control and Prevention (CDC) found that 19 percent of those who qualified for disability benefits between 2011 and 2013 reported “arthritis/rheumatism” as their main problem.

Leaving a job or considering leaving because of disability can cause significant financial stress. “I worry about the future financially, as we still have mortgage payments and [I have an] inability to work in the future,” a myRAteam member commented.

The process of applying for a disability claim can feel intimidating, especially if you are newly diagnosed with RA. Knowing ahead of time what is needed to get Social Security disability benefits can help. Here’s what the Social Security Administration (SSA) uses to determine disability and how to go through the application process to receive benefits.

Types of Disability Benefits in the United States

There are two federal disability programs in the United States, Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both share one requirement: The person who receives the funds has to have a disability that affects their ability to work. However, the programs differ in other ways.

Social Security Disability Insurance gives disability benefits to those who have previously worked for a required time period in the recent past. SSDI benefits are funded through payroll taxes. If you are approved, you can receive benefits starting six months after you become disabled. If you have been disabled for at least a year, you can get back payments of disability benefits from that year. You will be eligible for Medicare 24 months after your SSDI benefits began.

Supplemental Security Income gives disability benefits to those who have not worked for the required time period and have limited funds. If you are approved, you can receive benefits in the next month. You may also be eligible for back payments of SSI if you became disabled before your SSI approval.

In most states, SSI eligibility qualifies you for Medicaid. In Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah, and the Northern Mariana Islands, you have to apply for Medicaid separately from SSI to receive it, but the qualifying criteria are the same. Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Oklahoma, and Virginia all use different criteria to determine who is eligible for Medicaid, even if you already receive SSI.

Almost all states provide additional benefit supplements for SSI recipients, but Arizona, Mississippi, North Dakota, and West Virginia do not. Many of the states that offer an SSI supplement have their own eligibility rules.

SSI has an asset cap. If an individual has more than $2,000 of assets or a couple has more than $3,000 of assets, they stop being eligible. The Social Security Administration has a list of SSI resources considered to be assets.

It’s possible to get both SSDI and SSI if you have very limited funds and also have a work history.

How Does One Qualify for Disability Benefits?

There are several criteria used to determine whether someone qualifies as disabled and is determined eligible to receive Social Security benefits. The following criteria will be evaluated when you apply for Social Security disability benefits:

  • If you are making at least $1,350 a month, you are most likely not eligible for disability benefits. (If you are making some money but less than that amount, you may still be eligible. The amount of benefits you receive may be reduced.)
  • You cannot do the basic tasks most jobs require. These include standing, walking, lifting, sitting, and memory tasks. In addition, you must not have been able to do these tasks for at least 12 months.
  • You have a diagnosed disability. The Social Security Administration provides a list of conditions that are considered so disabling that they prevent working. Rheumatoid arthritis is one of the types of arthritis included under the category of inflammatory arthritis. You can still be eligible for benefits even if your specific condition isn’t listed.
  • You are unable to do the type of work you did previously. (If you’re applying for SSI, it’s not necessary to have a work history, so this isn’t always applied.)
  • You must be unable to do any other form of sustainable work. Your diagnosis, age, medical history, and education will be examined, as well as any other work history or skills that might be applied to work.

Applying for Disability Benefits

There’s a lot of paperwork needed to apply for disability benefits for rheumatoid arthritis. The Social Security Administration provides a checklist of the necessary information. Here is a basic rundown of what you might need to provide for a disability application.

Information About Yourself and Your Family

  • Your full legal name, date of birth, and Social Security number
  • The full names and dates of birth of current or previous spouses and dates of marriage, divorce, or death
  • The full names and birth dates of your children
  • Bank account information

Medical Evidence of Your Condition

  • The name and contact information for your rheumatologist and other health care providers who can discuss your medical condition
  • A complete list of present and past medications, and a list of any medical tests you have had for RA (such as X-rays, blood tests, and MRI scans)
  • A description of how RA symptoms impact your ability to do tasks like shopping, cooking, cleaning, and other activities of daily life

Total Work History

  • Earnings from the past year
  • Contact information for your current employers or any you have worked for in the past two years
  • A complete work history from the last 15 years, including any jobs from before you became disabled
  • Whether you are getting or intend to get any form of workers’ compensation
  • Any military service, including branch and dates of service

Documents

  • Birth certificate
  • Social Security card
  • Proof of U.S. citizenship
  • W-2 or other tax forms from the previous year
  • Any medical records or test results about your condition that you currently possess
  • Proof of any workers’ compensation you have received

If you haven’t been denied in the past 60 days and aren’t currently getting any benefits, you can apply for SSDI online. If you have never been married, you were born in the United States, and you are between the ages of 18 and 65, you can apply for SSI online. If you don’t meet those criteria, you can still apply at a local Social Security office or over the phone.

Perseverance When Filing for Disability Benefits

On average, it takes three to five months to process an application for disability benefits. This delay can cause financial stress for members of myRAteam. As one member said, “Hoping I’m not living in a cardboard box before hearing a favorable decision.” Some members heard back sooner. “My case only took 23 days for an answer,” one myRAteam member shared.

Most people are not approved the first time they apply. An average of 21 percent of those who applied for disability benefits between 2010 and 2019 were approved on their first attempt, according to the SSA’s 2020 statistical report on the SSDI program. You can still receive benefits even if you’re denied the first time.

Requesting an Appeal

If your application for benefits was denied, you have the option to appeal the decision. To make an appeal you must apply for reconsideration, and your case will be evaluated by someone who did not take part in the first evaluation. Between 2010 and 2019, about 2 percent of those whose applications weren’t approved the first time were approved from an appeal.

There is a second step to appealing — a hearing by an administrative law judge. These judges are trained in disability laws and will hear all of the evidence in your disability case. You may have a lawyer or a disability attorney represent you at this hearing. A myRAteam member recommended this: “Make sure you have an attorney who specializes only in disability.” Some law firms even specialize in disability hearings.

If your appeal is denied, you can ask the Appeals Council to look at your case and make a decision on it. About 8 percent of successful SSDI claims between 2010 and 2019 were approved at the hearing or Appeals Council level. If you are denied at this level, the only remaining option is a federal court hearing.

The Family and Medical Leave Act

If you cannot get approved for disability benefits in the United States, you may qualify for short-term benefits under the Family and Medical Leave Act (FMLA). This act is best known for providing up to 12 weeks of leave to care for an ailing family member or to bond with a newborn or newly adopted child. However, people with serious medical conditions can also get benefits through this program.

If you qualify for this benefit, you can get up to 12 weeks of unpaid leave in a given year. While you will not get paid, your job will be protected so you have the option to go back to work if your health improves. In addition, you will retain your medical insurance coverage as if you had not taken leave.

Some states may have additional laws that offer paid leave, partially paid leave, or other options under this broader act. These laws often change or get updated, so it’s up to you to make sure you’re applying for a program that will work for you.

Applying for FMLA

To apply for FMLA leave, you will need to fill out an application form as well as forms to certify your medical condition. Your employer is allowed to use a qualified representative to clarify or authenticate the information on your certification form, though they may not do so. They may also request a second and, if necessary, a third opinion. Your employer is responsible for all costs associated with hiring representatives and getting additional opinions, and you are eligible for leave while these evaluations are ongoing.

Consider These International Resources

If you’d like to research more about disability benefits in countries outside of the United States, check out these resources, listed by country:

Talk With Others Who Understand

When you join myRAteam, you gain a community of more than 191,000 people who understand what it's like to live with rheumatoid arthritis. Members offer support and advice on a range of topics, including applying for disability benefits.

Have you applied for disability benefits for your RA? Are you looking to apply and need advice on getting approved? Comment below or start a conversation on myRAteam.

References
  1. Disability Benefits — Social Security Administration
  2. Arthritis Disabilities and Limitations — Centers for Disease Control and Prevention
  3. Supplemental Security Income (SSI) — Social Security Administration
  4. SSI vs. SSDI: The Differences, Benefits, and How To Apply — National Council On Aging
  5. How Is SSDI Back Pay Paid? — Disability Benefits Center
  6. Program Operations Manual System (POMS) — Social Security Administration
  7. What Is Medicaid? — Social Security Administration
  8. Who Is Eligible for SSI? — AARP
  9. Understanding Supplemental Security Income (SSI) Eligibility Requirements — Social Security Administration
  10. How You Qualify — Social Security Administration
  11. Part III — Listing of Impairments — Social Security Administration
  12. Disability Evaluation Under Social Security: 14.00 Immune System Disorders — Adult — Social Security Administration
  13. Adult Disability Starter Kit — Social Security Administration
  14. Apply for Benefits — Social Security Administration
  15. Supplemental Security Income — Social Security Administration
  16. What You Should Know Before You Apply for Social Security Disability Benefits — Social Security Administration
  17. Annual Statistical Report on the Social Security Disability Insurance Program, 2020 — Social Security Administration
  18. Disability Benefits | Appeal a Decision — Social Security Administration
  19. Hearings and Appeals: What Do I Need To Know About Requesting a Hearing Before an Administrative Law Judge — Social Security Administration
  20. Hearings and Appeals: Information About Requesting Review of an Administrative Law Judge's Hearing Decision — Social Security Administration
  21. Hearings and Appeals: Federal Court Review Process — Social Security Administration
  22. Family and Medical Leave Act — U.S. Department of Labor
  23. FMLA: Forms — U.S. Department of Labor
  24. Fact Sheet #28G: Certification of a Serious Health Condition Under the Family and Medical Leave Act — U.S. Department of Labor
All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Annie Keller specializes in writing about medicine, medical devices, and biotech. Learn more about her here.
Sarah Winfrey is a writer at MyHealthTeam. Learn more about her here.

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