Rheumatoid arthritis (RA) is an autoimmune disease. For reasons doctors still do not understand, the immune system attacks the body’s own tissues, especially the synovial joint.
The synovial joint consists of a clear lubricating fluid secreted by synovial membranes. The capsule formed by synovial membranes and fluid lines the joint allowing bones to move without friction or pain. RA involves an inflammatory response of the synovial joint, secondary to swelling of synovial cells, excess synovial fluid, and the development of fibrous tissue in the synovium.
RA typically affects the synovial joints of the hands and feet. It causes inflammation, swelling, pain and stiffness. Chronic inflamation can damage soft tissue and erode bones thereby causing deformity of the affected joint.
During the initial interview with an RA client, I inspect the hands and feet. Usually several joints of the fingers of both hands are swollen. Often several toes are crooked and sometimes have curled inward.
RA can affect larger joints such as the knees, spine and shoulders. RA can also produce inflammation in the membranes around the heart and lungs.
In addition to the chronic day to day pain caused by joint inflamation, individuals with RA also experience flares of the disease when the pain dramatically increases and affects many large joints. RA flares are terribly debilitating.
If you suspect you have RA, it is important to seek treatment from a Rheumatologist. Left untreated RA will destroy the soft tissue and bones of numerous joints. The deformed joint then become another pain generator. Moreover, there are numerous medicines available that can be effective in the management of this disease. There is no known cure.
From a legal standpoint, the Social Security Administration (SSA) analyses an RA case pursuant to Listing 14.09. Most of the time SSA ultimately decides the case pursuant to the Medical Vocational Guidelines, but Listing 14.09 should always be the starting point for case analysis.
I have been representing RA clients in their efforts to obtain disability benefits for 25 years. From this experience I have several observations.
- I have found disability Judges to be knowledgeable and understanding about RA. I attribute this favorable treatment to the fact that the impairment caused by RA can be seen because it results in physical deformities. I regularly take photographs of my clients’ deformed fingers and toes.
- Like most impairments, SSA usually only awards disability in the most severe RA cases. Most of my RA clients who are awarded disability benefits worked for several years with RA and stopped working only when the disease reached an advanced stage and the unpredictable flares became frequent occurrences.
- The type of job the individual has is an important factor in terms of disability. It is very difficult to perform manual labor very long with RA. Clients with education who have jobs that are primarily intellectual rather than manual have a much better chance of being able to perform their job duties despite the limitations caused by RA.
In summary, I offer the following advice to individuals with RA considering disability. First, seek treatment from a rheumatologist. Second, work as long as you possibly can. SSA responds better to advanced RA cases. Plus, being able to demonstrate a strong work ethic is helpful when a disability Judge is evaluating your case.