Gout is a chronic condition that causes recurrent episodes of acute inflammatory arthritis. Gout involves redness, tenderness, stiffness and swelling of the affected joints. If the big toes become infected, it is sometimes called podagra.
If you have chronic gout and it affects your ability to work, you may be eligible for Social Security disability benefits if your gout meets the requirements of the Social Security Administration (SSA) inflammatory arthritis list.
The SSA oversees the Social Security Disability Insurance (SSDI) program, which provides monthly benefits to workers who become disabled due to medical conditions or serious accidents. To qualify for SSDI benefits, you had to work to earn enough credits and pay enough taxes for the SSA.
What are the symptoms of gout?
Gout is caused by high levels of uric acid in the bloodstream, resulting in crystallized deposits in joints and tendons. Sometimes your gout can cause additional problems or symptoms, including:
- Growths caused by uric acid crystals near joints
- Rapid deterioration of kidney function
- kidney stones
- painful and swollen joints
Your gout can be treated with a variety of options. The most common treatment options used for the condition include:
- steroids
- Febuxostate
- probenecida
- Nonsteroidal anti-inflammatory drugs
- colchine
- alopurinol
- diet changes
- Life style changes
Who has gout?
At some point in their lives, around 4% of the total population will have gout. Symptoms can vary greatly, from very mild to severely debilitating. People of all ages can suffer from gout. And while many may suffer from a mild case occasionally, you could be one of those who suffer from a chronic condition that affects your life day in and day out.
The cost of gout treatment
The Gout and Uric Acid Education Society reports that treatment-resistant or elderly patients can pay between $16,925 and $18,362 per person to manage gout. The 2016 study indicated that hospitalizations for gout doubled from 4.4 to 8.8 patients per 100,000 from 1993 to 2011.
An additional study published in Seminars in Arthritis and Rheumatism in February 2015 reported that these numbers are expected to increase. However, new drugs are being developed to treat the disease so they can reduce the financial burden and help improve the outcome for those who have the disease.
The SSA Assessment and Medical Qualifications for Gout
The SSA has a medical guide calledBlue Book, which has specific requirements established for specific medical conditions for an individual to be considered disabled and eligible forBenefits of SSDI.
While there is no specific list for gout, there is a list for inflammatory arthritis, to which gout is closely related.
Listing 14.09 is forinflammatory arthritis. If you meet any of the following conditions related to inflammatory arthritis, you will meet eligibility requirements for Social Security disability benefits.
- Two or more systems in your body are significantly affected by gout.
- You have at least two of the following symptoms: chronic fever, weight loss, malaise, or fatigue.
- Any of the major peripheral joints of the upper extremity, including the hands, shoulders, elbows, and wrists, make fine or gross motor movements impossible.
- Any of the weight bearing joints like ankles, hips and knees are affected to the point where you are unable to walk efficiently.
Another way you may qualify for gout disability benefits is if you have chronic inflammatory arthritis gout that causes malaise, fever, weight loss, or severe fatigue, if you can show that your condition results in severe limitations in any way. one of the following:
- social functioning
- Daily life activities
- difficulty concentrating
- Difficulty completing tasks on time
To qualify for disability benefits using theBlue Book, you must be able to provide medical records indicating that your condition meets the criteria despite your attempts at therapy and treatment. During the benefit consideration process, you should continue to consult with your physician and carefully follow your physician's instructions.
No benefits are provided for those who are only partially disabled. Benefits are only available to those who aretotally disabledand will be deactivated for a minimum period of one year. The first six months of disability is a waiting period for which you are not entitled to receive monthly benefits.
What happens if my gout doesn't meet the SSA guidelines?
If you do not meet the Blue Book listing requirements, you may still be eligible for Social Security disability benefits if you prove the severity of your symptoms and condition using aresidual work capacity (RFC)and the medical-professional subsidy.
SSA's Disability Determination Services will review all of your medical and mental conditions to determine whether it is reasonable to expect you to do any type of work. If you can't do your old job, they'll check to see if you can do light sedentary work.
Using themedical-professional subsidyThey will take into account your previous work experience, any training you have received and whether it can transfer to another job, your educational background and your age. If they determine that you have demonstrated that your condition or combined conditions are so severe that you are unable to carry out any type of work, you will bedisability approved.
Your doctor fills out the RFC and specifies your conditions, your symptoms and side effects, and your limitations. For example, if your gout is so severe that you cannot stand for more than an hour, this should be noted. If your gout prevents you from walking significant distances, this should also be taken into account.
Also indicate any limitations on lifting objects and if you cannot bend down often. The RFC is given important consideration when the Disability Determination Services team decides whether to grant benefits for your case. As mentioned above, please provide as much documentation as possible as evidence for your case.
What other benefits can I get?
At the Veterans Administration's (VA) mission center, Americans injured while serving their country may qualify for compensation if they are found to be disabled.
One of the most common types of disability for US veterans is arthritis, which can significantly limit mobility. As a form of arthritis, gout can become a very painful and mobility-limiting medical condition.
If you have gout and are a US veteran, you can get a VA disability benefit for gout if you tie your development of gout to your service in the US military.
The maximum amount of financial assistance a veteran can receive with a VA fall disability is 100 percent. However, most veterans receive a lower percentage of compensation because they cannot prove that developing gout symptoms is 100% related to their military service.
The percentage of money you are incapacitated for gout mainly depends on the number of flare-ups you experience over the course of a year.
If you have flare-ups no more than twice a year, you'll get a 20% VA rating. Three or more shoots per year guarantee a 40% rating.
Bouts that leave you unable to get up and move can reach a 60% rating if you experience the debilitating flare-ups four or more times a year.
Another important point to make involves associating gout symptoms with military service. The VA disability for gout requires that you receive a medical diagnosis during or shortly after completing your US military service.
How can I prove that I have gout?
There are several medical tests used to diagnose gout, including blood tests, urinalysis, x-rays, CT scans, and more. The results of these tests must be included in your disability claim. The SSA may request a medical evaluation and mental evaluation from the doctors it chooses at its expense. These reviews are for informational purposes only and not for medical treatment.
The more information that is provided and collected, the stronger your case will be. Please provide as much information as possible so I can expedite your case. The process can be time consuming and your claim may bebenefits deniedtwice. You can make one call at a time. The final step is to request a hearing before an administrative law judge who will decide your case.