WHAT IS OSTEOARTHRITIS (OA) OR DEGENERATIVE JOINT DISEASE (DJD)?
Osteoarthritis (OA), also known as Degenerative Joint Disease (DJD), is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone.
Primary OA is a chronic degenerative disorder related to but not caused by aging. As a person ages, the water content of the cartilage decreases as a result of a reduced proteoglycan content, thus causing the cartilage to be less resilient. The water content of healthy cartilage is finely balanced by compressive force driving water out & swelling pressure drawing water in. Collagen fibers exert the compressive force, whereas the Gibbs-Donnan effect & cartilage proteoglycans create osmotic pressure which tends to draw water in. However, during the onset of OA, there is an increase in cartilage water content. This increase occurs because while there is an overall loss of proteoglycans, it is outweighed by a loss of collagen. Without the protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur, though often mild (compared to what occurs in rheumatoid arthritis). This can happen as breakdown products from the cartilage are released into the synovial space, and the cells lining the joint attempt to remove them. New bone outgrowths, called “spurs” or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces. These bone changes, together with the inflammation, can be both painful and debilitating.
OA/DJD symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. The main symptom is pain, causing loss of ability and often stiffness. “Pain” is generally described as a sharp ache or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called “crepitus”) when the affected joint is moved or touched and people may experience muscle spasms and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Some people report increased pain associated with cold temperature, high humidity, and/or a drop in barometric pressure.
OA/DJD commonly affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees, although, in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel better with gentle use but worse with excessive or prolonged use, as distinguished from rheumatoid arthritis.
In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) and/or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen. Some people notice these physical changes before they experience any pain. OA is the most common cause of a joint effusion of the knee.
CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS FOR OSTEOARTHRITIS/DEGENERATIVE JOINT DISEASE?
Osteoarthritis/Degenerative Joint Disease can cause pain and other symptoms that can impact your ability to work. Social Security Disability benefits may be available to you if you are diagnosed with OA/DJD.
If you are not engaging in gainful activity due to OA or DJD, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the sequential evaluation process.
Generally, to establish Degenerative Joint Disease as a medically determinable severe impairment, you must show:
- Objective medical imaging establishing osteoarthritis/degenerative joint disease;
- Consistent complaints of pain or other symptoms for a period of time and which is not controlled through conservative treatment modalities
At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. For OA/DJD, SSA will determine if your condition meets any of the Listing 1.02 – Major Dysfunction of a Joint or 1.04 – Disorders of the Spine.
- 1.02 can be met if your OA/DJD is
- Characterized by gross anatomical deformity (e.g., subluxation, contracture, bony or fibrous ankylosis, instability) and chronic joint pain and stiffness with signs of limitation of motion or other abnormal motion of the affected joint(s), and findings on appropriate medically acceptable imaging of joint space narrowing, bony destruction, or ankylosis of the affected joint(s), and
- There is involvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle), resulting in inability to ambulate effectively, OR
- There is involvement of one major peripheral joint in each upper extremity (i.e., shoulder, elbow, or wrist-hand), resulting in the inability to perform fine and gross movements effectively.
- 1.04A can be met if your OA/DJD affects the spine and
- Results in compromise of a nerve root (including the cauda equina) or the spinal cord
- There is evidence of nerve root compression characterized by–
- if there is involvement of the lower back, positive straight-leg raising test (sitting and supine).
- motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss, and
- limitation of motion of the spine,
- neuro-anatomic distribution of pain,
- 1.04B can be met if your OA/DJD affects the spine and
- Causes spinal arachnoiditis confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, and
- Is manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours.
- 1.04C can be met if your OA/DJD affects the spine and
- Causes lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, and
- Is manifested by chronic nonradicular pain and weakness, resulting in inability to ambulate effectively.
The key to meeting the listing is to have the appropriate objective medical testing and a longitudinal medical history that addresses each of the requirements. In most cases, in my experience, the medical listing will not be met, but having a good knowledge of what you have to prove can help you discuss your case with your doctor.
If your related symptoms do not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your OA/DJD and pain), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.
TIPS FOR APPLYING FOR SSDI WITH OSTEOARTHRITIS/DEGENERATIVE JOINT DISEASE IN LOUISIANA
- Make sure an imaging report (MRI, CT, X-ray) diagnosing OA/DJD is in your medical records. It is important that you “know your medical records.”
- Make sure your medical records document ALL of your symptoms and limitations. Your medical records should not just document your pain. Let your doctor how often you feel the symptoms, how severe each symptom is and how long each episode lasts. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
- See a specialist. Treatment of OA/DJD by an orthopedist or neurologist or rheumatologist or a chronic pain specialist will carry more weight than the same diagnosis from a family physician or internist professional.
- Comply with your doctor’s orders and try various modes of conservative or less invasive treatment, if recommended.
- See a mental health professional. If you are suffering from depression or anxiety as a result of the chronic pain and inability to participate in life, see a mental health professional to diagnose, treat, and document these conditions. Pain is often accompanied by or is the cause of mental health conditions. Treatment of the depression can help with the pain.
- See your doctor regularly and keep your appointments.
- If you can, provide evidence of a long work history.
- Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity.
- Include information from non-medical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
- Keep a journal. Make regular notes about your impairment, level of function, and treatments.
- If you need assistance with your claim, contact an attorney who is knowledgeable in the requirements for obtaining Social Security Disability for degenerative joint disease. At Louisiana Disability Law, we have experience obtaining disability benefits for clients with degenerative joint disease. To discuss the details of your case, call disability attorney Loyd J. Bourgeois at 985-240-9773.