Social Security Disability & SSI Benefits: Psoriatic Arthritis

Winning Your Case

Your Psoriatic Arthritis Disability Case - Medical Evidence

If your psoriatic arthritis keeps you from holding down full-time work, Social Security will adjudicate your disability case, and grant you benefits. Psoriatic arthritis is a type of rheumatologic disease/arthritis that sometimes occurs in patients who have psoriasis. Psoriatic arthritis is an autoimmune disease where the body's immune system attacks and destroys joint cartilage - any joint in the body can be affected. Cartilage is the padding in between your bones. When the cartilage is destroyed, your bones rub on one another causing pain, joint swelling, stiffness, and numbness. Psoriatic arthritis also causes rashes.

After you submit your medical information contacts to Social Security, it will order and review your medical records. Its review will start with looking for evidence of your diagnosis which is usually complex but consists of four criteria:

1. Skin and nail examination by your doctor to look for psoriasis;
2. Clinical examination by your doctor to identify swollen or tender joints;
3. Blood tests which are usually negative but rule out rheumatoid arthritis (RA); and
4. An x-ray, CT scan, and MRI to identify abnormal bone growth that isn't bone spurs.

The diagnosis is often difficult because identification of psoriasis alone does not mean you have psoriatic arthritis. Swollen and tender joints are often missed or reviewed too casually by the doctor. Blood tests, as stated above, are often done to rule out RA, not to confirm psoriatic arthritis. Objective imaging is often normal because abnormal bone growth is unusual. Most patients get treatment prior to suffering such bone abnormalities.

The most common diagnostic signs of psoriatic arthritis is psoriasis and affected joints. In your Social Security disability case, it is important you 1) have a diagnoses by a rheumatologist (not just a primary doctor) as specialists carrier significant evidentiary weight, and 2) you have a doctor who writes good treatment notes - especially about the status of your joints.

Social Security will also review your treatment which will demonstrate symptoms you report, your doctor's clinical assessments of your psoriatic arthritis severity, and what your doctor is doing to help you.

There is no cure for psoriatic arthritis, and treatment is limited to biologics, anti-inflammatory drugs (NSAIDS) and corticosteroids, anti-rheumatic drugs (DMARDs), TNF inhibitors, and pain medications. Surgeries are rare and usually limited to a joint replacement.

Psoriatic Arthritis: The Social Security & SSI Listing

An adult meets Adult Listing 14.09 by proving sections 1, 2, 3, or 4. A child meets Child Listing 114.05 by proving sections 1, 2, or 3.

1. Enlargement or alteration of -
1. One or more of the significant lower extremity joints causing severe problems walking, or
2. One or more joints in both the left and right upper extremity causing severe problems using your upper extremities; or
2. Enlargement or alteration of one or more of the significant lower extremity joints and -
1. Two or more organs affected to a moderate extent or more, and
2. Two or more of serious fatigue, high fever, general illness, or weight loss; or
3. Ankylosing spondylitis or like impairments, with -
1. Serious spine ankylosis (fused vertebrae),
2. Serious spine ankylosis and two or more organs affected to a moderate extent or more; or
4. Frequent exacerbations of arthritis and two or more of serious fatigue, high fever, general illness, or weight loss and also one of your normal aspects of life affected to a marked extent or more.

A Success Story - The Importance Of A Rheumatologist Statement

Ms. Bennett was affected by psoriasis at a young age. By the time she was 40, she developed psoriatic arthritis. By the time she was 47, she was unable to work. She had suffered mightily on the job for three years unable to perform necessary work duties and missing a significant amount of work. Her employer even accommodated her limitations by relieving her of some of her work duties. Nevertheless, Ms. Bennett was eventually fired. She had worked for 18 years as an insurance company case manager in Dallas, TX.

Her psoriatic arthritis primarily affected her fingers, hands, wrists, elbows, and hips. She suffered pain, joint swelling, and stiffness. She suffered psoriatic rashes most of the time.

She had a primary doctor, but she was primarily treated by a rheumatologist who documented her symptoms and noted regularly on clinical exam that Ms. Bennett suffered swollen and tender joints. Ms. Bennett underwent hand, wrist, and elbow x-rays that were normal. She did not undergo hip x-rays. Her blood tests were normal. For three years prior to losing her job and up until the time of her hearing, she had been on a variety of medications: Humira and Enbrel injections (biologics); Arava and Methotexate (DMARDs); Mobic, Relafen, and Celebrex (NSAIDs); and a long list of pain medications.

We had two main issues in her case. First, we needed a statement from her rheumatologist confirming the diagnosis as the most objective tests - x-ray and blood - were normal. Second, because she was under age 50, we needed to show she could not perform any work at all - an any-job standard. We needed to show she could not perform a sedentary (sit down) unskilled job. Because of the lack of strong medical evidence, we needed a residual functional capacity (RFC) statement from her rheumatologist.

Luckily for us, her rheumatologist was willing to address a RFC form; it did cost $250. The doctor offered a statement about the diagnosis and the basis of it - painful and swollen joints. It was too short, but it sufficed. The doctor also opined that Ms. Bennett could only use her upper extremities about 15% of the day and Ms. Bennett needed to lie down three hours a day. Both limitations eliminated sedentary work.

The case eventually went to hearing. This case was a very close call. Counsel stressed that the most important diagnostic criteria for psoriatic arthritis was swollen and tender joints, not x-ray and blood test findings. Counsel also stressed the treatment of the rheumatologist, and of course, the very helpful RFC assessment. Counsel also highlighted Ms. Bennett's good work record. We did not get a decision at the hearing. The decision came about three months later. In the decision, the ALJ agreed with the rheumatologist and award Social Security disability benefits: 20 months of back pay, monthly payments, an earnings freeze, and Medicare.

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