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Arthritis and Joint Injury

Doctor Treating Patient Ohio disability lawyer

How the Social Security Administration evaluates arthritis and joint damage

Arthritis and joint problems are the two skeletal impairments I see most often in my Ohio Social Security disability cases.

Unfortunately, the Social Security Administration, both in Ohio and nationally, does not treat osteoarthritis and degenerative joint disease as disabling … at least not in
the early stages when you might be suffering pain and some limitation of motion but may not have objective medical evidence of arthritis or other joint damage.

X-ray evidence of osteoarthritis and degenerative joint disease does not align well with symptoms. Some people with x-ray findings of severe osteoarthritis or degenerative joint disease may have no symptoms whatsoever. Others suffer excruciating pain even though they have x-ray findings characterized as mild. For those who are symptomatic, x-ray findings often seem to lag far behind symptoms. In the introductory comments to the musculoskeletal Listings, the Social Security Administration acknowledges that “there is a relative lack of correlation between findings on imaging and function of the joint.” Let’s take a closer look at those Listings.

Musculoskeletal system Listings

First off, you should note that when symptoms such as pain appear as an element in the musculoskeletal Listings, any pain will do. It is not necessary to quantify it, or to evaluate its intensity or functionally limiting effects to determine if the Listing is met unless the Listing itself states otherwise. The musculoskeletal Listings require nothing more than the presence of pain.

6 of the 13 musculoskeletal Listings focus on inability to ambulate effectively on a sustained basis. This is described in the introductory section of the musculoskeletal Listing, §1.00B2b, as follows:

b. What We Mean by Inability to Ambulate Effectively

(1) Definition. Inability to ambulate effectively means 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. Ineffective ambulation is defined generally as having insufficient lower extremity functioning (see § 1.00J) to permit independent ambulation without the use of a hand-held assistive device(s) that limits the functioning of both upper extremities.

(2) To ambulate effectively. Individuals must be capable of sustaining a reasonable walking pace over a sufficient distance to be able to carry out activities of daily living. They must have the ability to travel without companion assistance to and from a place of employment or school. Therefore, examples of ineffective ambulation include, but are not limited to, the inability to walk without the use of a walker, two crutches or two canes, the inability to walk a block at a reasonable pace on rough or uneven surfaces, the inability to use standard public transportation, the inability to carry out routine ambulatory activities, such as shopping and banking, and the inability to climb a few steps at a reasonable pace with the use of a single hand rail. The ability to walk independently about one’s home without the use of assistive devices does not, in and of itself, constitute effective ambulation.

Despite the language in (1) that appears at first glance to require a walker or two canes to meet the criteria, the Social Security Administration said “we recognize that individuals with extreme inability to ambulate do not necessarily use assistive devices. Furthermore, we recognize that an individual who uses a cane may be disabled.” 66 Fed. Reg. 58026-58027 (2001).

The Social Security Administration’s Office of Disability issued a series of questions and answers as part of a training program on the musculoskeletal Listings. One question was: “Can there be situations where there is ineffective ambulation that meets Listing §1.02A when only one extremity is involved and only one cane or crutch is used?” Answer: “The use of a cane(s) or crutch(es) is not a requirement to meet this listing …. It is important to remember that it is the medical inability to ambulate effectively, not the use of an assistive device(s), that establishes listing level severity. Therefore, when the listing criteria are met, a claimant’s impairment can meet §1.02A even if he or she is not using any assistive device.”

The key is whether you can walk a block at a reasonable pace on rough or uneven surfaces. If no, you are likely disabled in the Social Security Administration’s eyes.

Complete investigation of possibilities

I fully explore all factors, especially a high impact item like having difficulty walking, when I take on a Social Security disability case, whether the claim is due to a skeletal impairment or is triggered by some other health problem.

If you would like me to evaluate your disability claim, use the contact information below or the evaluation form to your right.

John Paul Oreh

Ohio disability lawyer

Phone 216-896-0935
Fax 216-896-7202

25550 Chagrin Blvd., Suite 320
Beachwood, OH 44122

Social Security Disability Library