• walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
• seeing, hearing and speaking
• understanding/carrying out and remembering simple instructions
  use of judgment
• responding appropriately to supervision, co-workers and usual work situations
• dealing with changes in a routine work setting

Are Your Medical Records Sufficient? In an arthritis case, your medical file may look like this: your medical records may consist of 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 presume to derive 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.

The best way to approach this problem is by studying your medical record, then creating a checklist form (called a “functional capacity” form) that tracks most of your symptoms, Our 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.

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.

STEP THREE asks if the arthritis disability meets or equals a medical listing. Arthritis is considered under the musculoskeletal body system and has several specific medical listings or categories. To satisfy the listing criteria, a person with inflammatory arthritis (such as rheumatoid arthritis) must have:

• persistent swelling
• pain
• limitation of joints (hip, knee, ankle, shoulder, elbow, or wrist and hands)

People who have degenerative arthritis (osteoarthritis) satisfy the requirements if they have:

• significant limitations using their arms/hands
• have a significant problem standing and walking

Those who have significant back or neck problems due to degenerative arthritis must have:

• persistent sensory, reflex and motor loss

Getting Cooperation from your Doctor
Your doctor may truly feel that you cannot work, but if he is not familiar with Social Security practice and procedure, he 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.

You need to be aware that many claimants - perhaps as many as half the claims filed - involve complaints of arthritis. Mild 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.

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.

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.

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.

However, if a person’s arthritis disability does not satisfy a medical listing, SSA continues to the next two steps to see whether the person might still qualify for disability benefits. At the next two steps, SSA looks primarily at how the actual limitations and symptoms imposed by arthritis affect a person’s ability to perform work. Thus, at Steps 4 and 5, Social Security looks more specifically at the work-related impact of arthritis.

STEP FOUR explores the ability of an individual to perform work he has done in the past despite his arthritis. If SSA finds that a person can do his past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.

STEP FIVE looks at age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine disability, SSA enlists vocational rules, which vary according to age.

For example, if a person is:

Under age 50 and, as a result of the symptoms of arthritis, unable to perform what SSA calls sedentary work, then SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.

Age 50 or older and, due to his disability, limited to performing sedentary work but has no work-related skills that allow him to do so, SSA will reach a determination of disabled.

Over age 60 and, due to his disability, unable to perform any of the jobs he performed in the last 15 years, SSA will likely reach a determination of disabled.

Any age and, because of arthritis, has a psychological impairment that prevents even simple, unskilled work, SSA will reach a determination of disabled.