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Lyme Disease Social Security Disability Benefits Due to Joint Pain

Wilkinson & Magruder

Lyme Disease Social Security Disability

The Social Security Administration (SSA) has a list of impairments that qualify as “disabling.” This document is commonly referred to as the Social Security “Blue Book.” The book also includes information about what criteria is used to determine if given symptoms qualify for Social Security Disability (SSD) benefits. It’s not enough that you have been diagnosed with a disabling impairment, you must also meet the symptom standards outlined in the Disability Evaluation Under Social Security document. The application of the criteria found in the Blue Book is only one step in a multistep process. You may qualify for Lyme Disease Social Security Disability Benefits Due to Joint Pain, or under a number of other avenues.

Symptoms of Lyme Disease

Lyme disease that is not treated quickly or is not diagnosed early can become chronic. This can also happen if initial treatment of the disease is incomplete or inadequate to address the issue. Lyme disease can affect more than one body system. Symptoms may include joint and muscle pain as well as heart damage and arthritis.

Joint and Muscle Pain and Lyme Disease

If your Lyme disease has resulted in joint or muscle pain, you may qualify for SSD benefits. Joints which, if impacted, can qualify for SSD benefits include your shoulders, elbows, hips, knees, and your wrist-hand and ankle-foot, both of which are considered a single joint for evaluative purposes. The Blue Book calls for an evaluation of loss of function. Loss of function for musculoskeletal impairments is defined generally as “an inability to ambulate effectively on a sustained basis.”  This can be attributed to any reason, including an inability to effectively perform gross and fine movements, as well as pain associated with musculoskeletal impairment. To qualify, these symptoms must have either be expected to last 12 or more months, or actually have lasted for at least 12 months.

An Inability to Ambulate Effectively, Defined

An inability to ambulate effectively is defined as an impairment that very seriously interferes with your ability to initiate, sustain, or complete activities independently. It can also mean that you have an extreme limitation on your ability to walk. You can be deemed unable to ambulate effectively if you have lower extremity functioning that is insufficient to allow you to move about without crutches, two canes, or a walker. Other examples of an inability to ambulate effectively include the inability to:

You are deemed able to “ambulate effectively” if one can sustain a reasonable walking pace to the extent that they can execute the basics of daily living. Traveling without assistance to and from school or work is also considered “ambulating effectively.” However, the mere ability to move about your own home without the use of crutches, two canes, or a walker, is not, in and of itself, evidence of “effective ambulation.”

Performance of Fine and Gross Movements Effectively

While ambulating focuses on the use of the legs, performing fine and gross movements focuses on the “upper extremities” also known as “the arms.” Examples of an inability to perform gross movements and fine movements include an inability to take care of your own personal hygiene. Similarly, if you are unable to prepare a simple meal, or unable to feed yourself is considered a qualifying condition. Other conditions which are specifically identified in the Blue Book include an inability to put files in a file cabinet that is at or above waist level, and an inability to handle or sort files or other papers. This is not an exhaustive list, but gives a general idea of the types of symptoms or conditions which will qualify under the category of effective performance of fine and gross movements.

Things that could be considered effective performance of fine and gross movements, according to the Blue Book, include sustaining functions such as the following:

Pain or Other Symptoms

The Social Security Administration recognizes that pain can cause limitations and result in impairment. In evaluating how pain may result in impairment, the questions are:

These questions will be carefully evaluated to determine the overall impact pain has on one’s ability to function.

Diagnosis of Musculoskeletal Impairments

Musculoskeletal impairments can vary. Consequently, the documentation required to support your diagnosis may vary. However, in general, the diagnosis should be supported by documented ranges of motion, detailed descriptions of the affected joints, whether the musculature at issue is atrophying or weak, circulatory deficits, reflex or sensory changes, as well as laboratory findings. Laboratory findings could include X-rays, or other medically acceptable imaging, as appropriate. This could include CAT scans, MRIs, radio nuclear bone scans, or myelography.

Because of the expense of CAT scans and MRIs, the SSA will not routinely order such a test. Further, myelograms, an invasive procedure, can involve significant risk. Consequently, the SSA will not generally order such tests. However, in many cases, the test results are already part of the existing medical record. In such a case, SSA will consider this record, along with all other relevant evidence.

Physical examinations must include detailed descriptions of the impairments.   Your self report symptoms is not considered sufficient. Rather, there must be documentation of objective observations by the physician. Where impairment appears evident with one test, another test will be performed to confirm the findings. A specific example of this is a supine straight leg raising test along with a seated straight leg raising test. SSA recognizes that symptoms can vary, and occur intermittently. Consequently, ongoing management and evaluation is critical.