Does knee osteoarthritis qualify for disability?

Knee osteoarthritis is a common cause of disability, especially among older adults. Osteoarthritis of the knee can make it difficult to walk, climb stairs, and perform other daily activities. For some people with severe knee osteoarthritis, the condition may qualify them for disability benefits through private insurance, Social Security Disability Insurance (SSDI), or Supplemental Security Income (SSI).

Table of Contents

What is knee osteoarthritis?

Osteoarthritis (OA) is the most common form of arthritis and occurs when the cartilage that cushions the ends of bones progressively breaks down. This results in bones rubbing directly against each other, causing pain, swelling, and loss of motion in the joint.

The knees are one of the most commonly affected joints, with knee OA being a leading cause of disability in the U.S. Factors that increase the risk for knee OA include:

Older age
Female sex

Obesity
Joint injuries
Intense physical activity involving the knees (such as sports or manual labor)

Genetic factors

As the cartilage breaks down in knee OA, symptoms develop gradually over time. Common symptoms include:

Pain with walking, climbing stairs, or other use of the knee

Stiffness after periods of inactivity
Swelling
Feeling that the knee may “give out”

Decreased range of motion
Tenderness
Bone spurs or loose pieces of cartilage in the joint

How can knee osteoarthritis impact your ability to work?

For many people with knee OA, the condition causes functional limitations that can interfere with the ability to work, especially in jobs involving physical demands. Specific ways knee OA may impact your ability to work include:

Difficulty with standing or walking for prolonged periods – For jobs that require considerable time standing or walking, knee OA pain and stiffness can make it challenging to fulfill job duties.
Problems using stairs – Going up and down stairs can be extremely painful and difficult with knee OA. This can impact both mobility within the workplace and commuting.

Difficulty kneeling or squatting – Kneeling and squatting down are frequently painful or impossible with knee OA. This limits the ability to perform job tasks involving these positions.
Interference with lifting and carrying – Carrying heavy objects causes increased stress on the knees that most people with knee OA have difficulty tolerating.
Decreased stamina – The pain and loss of mobility associated with knee OA can result in greater fatigue and problems with sustained activity over a workday or week.

Challenges commuting – Long commutes involving walking, driving, or use of public transportation may be hindered by OA knee problems.
Time off for medical care – Doctor appointments, physical therapy, imaging studies, injections, knee braces, and even knee replacement surgery may be needed, requiring time away from work.

What are the disability criteria for knee osteoarthritis?

To qualify for government disability benefits through SSDI and SSI, or through private long-term disability insurance, there are strict medical criteria related to functional impairment that must be met. Some key criteria include:

Imaging evidence of knee joint damage – X-rays, CT scans or MRI scans must show structural changes consistent with osteoarthritis, such as loss of cartilage, bone spurs, bone-on-bone contact, and cysts.
Loss of range of motion – There must be reduced flexion, extension, or mobility of the knee joint documented on physical exam by a certain number of degrees.
Difficulty with weight-bearing activities – Problems with the ability to stand, walk, climb, balance, kneel, squat etc. must be documented during the physical disability evaluation.

Significant pain – The level of pain caused by knee OA should limit function and require regular use of prescription medications, injections, braces, physical therapy, or other treatments.
Duration requirement – The disability is expected to last for 12 months or longer.

In addition, approval for disability benefits depends on the condition resulting in significant work limitations and inability to perform either your past job (for SSDI) or any type of substantial gainful employment (for SSI).

How is disability determined for knee osteoarthritis?

Both public and private disability programs use an extensive process to evaluate knee OA disability claims. This typically involves:

Review of medical records – Records from your doctors, therapists, test results, and treatments will be obtained to document the progression of knee OA.
Assessment of ADLs – How knee problems limit activities of daily living, like dressing, bathing, chores, and self-care will be considered.

Evaluation of past work – Your specific job duties and physical demands will be analyzed to determine your ability to perform past work (for SSDI claims).
Analysis of transferable job skills – Your training, education, and work experience will be reviewed to identify any jobs you could still perform despite knee OA limitations (for SSI and private claims).
Functional capacity evaluation – A physical therapist may assess your current capacity for sitting, standing, walking, lifting, bending, etc.

Independent medical exam – An insurance company or Social Security Administration appointed doctor will perform an exam focusing on range of motion, strength, pain, assistive devices needed, and work-related limitations.

All the evidence in your claim will then be weighed to reach a determination regarding whether your condition qualifies as being disabling under program guidelines.

How severe must knee osteoarthritis be to qualify for disability benefits?

While any degree of knee OA can potentially cause difficulties functioning, there are some general severity criteria that increase the likelihood of being approved for disability:

Radiographic evidence of advanced joint degeneration (grade 3 or 4 changes)
Range of motion limited to less than 60 degrees flexion or less than 5 degrees extension
Inability to walk more than 1-2 blocks without severe pain

Use of a cane or wheelchair for mobility
Little to no relief from at least 3 months of conservative treatment measures
Falls or giving way of the knee

Knee replacement recommended, but not yet performed

Meeting the full disability criteria requires having objective test results and exam findings consistent with extreme, long-term functional loss.

What conditions must be met for SSDI eligibility based on knee osteoarthritis?

For Social Security Disability Insurance benefits based on knee OA, you must:

Be considered fully disabled and unable to perform substantial gainful work activity
Meet the required work credits through prior FICA payroll taxes (generally 40 credits, 20 earned in the last 10 years)
Have 12 continuous months of disability or an impairment expected to result in death

Be unable to perform past relevant work or adjusted work activities

Essentially, SSDI is based on your entire recent work history and requires total disability. Approval is most likely if knee problems prevent you from any occupations you have done in the past 15 years.

SSDI Approval Rates for Knee Osteoarthritis

Approval rates nationally for knee OA SSDI claims are around 37% on initial application and 68% after appeals and hearings. Allowance rates increase with age, with about a 43% approval rate for those aged 50-59 years old.

What conditions must be met for SSI eligibility based on knee osteoarthritis?

To potentially qualify for Supplemental Security Income based on disabling knee OA, you must:

Meet the Social Security Administration disability criteria
Have limited income and resources

Be unable to perform any past work or other jobs existing in significant numbers nationally
Have a qualifying impairment expected to last at least 12 months or result in death

SSI does not depend on your work history but does require full disability. Knee OA symptoms must prevent you from adjusting to other occupations besides past work.

SSI Approval Rates for Knee Osteoarthritis

Approval rates for SSI disability claims involving knee osteoarthritis average around 30% initially but increase to about 57% after appeals. Allowance rates are higher for individuals aged 50 or older.

What medical evidence is needed to support knee osteoarthritis disability?

Key medical documentation needed for knee OA disability claims includes:

Physician records – Notes should document symptoms, exam findings, test results, past treatments tried, and functional limitations.

Diagnostic imaging – X-rays, CT scans or MRI scans confirming joint degeneration.
Physical therapy records – Details response to PT and physical functioning.
Surgery consultations – Notes indicating knee replacement has been recommended help demonstrate severity.

Pain management records – If seeing a pain specialist, these details use of injections, pain medications, braces, ambulatory aids etc.

The more evidence of reduced functioning and work capacity, the stronger the disability case.

Does age affect qualification for osteoarthritis disability?

Age can impact disability qualification in a few important ways:

Prevalence of osteoarthritis increases substantially with age, making disability claims more common in older adults.
Severity of knee OA also typically worsens with advancing age as joint degeneration progresses.
Older individuals are less likely to be able to adapt to different occupations, improving chances of approval.

For SSDI claims, older workers have had a longer time paying into FICA taxes, making it easier to meet the required work credits.
Approval rates for those aged 50 and over are noticeably higher than younger claimants.

So while knee OA can cause disability at any age, older adults tend to have an easier time qualifying for benefits based on this condition.

Can I work while receiving disability for knee osteoarthritis?

You cannot engage in substantial gainful work activity while collecting Social Security disability benefits. However, some limited work activity is allowed during a trial work period.

For private long-term disability insurance, the policy language determines whether any work is permitted during disability. Some policies do allow a small percentage of prior earnings or part-time work.

So while monthly disability payments depend on the inability to work full-time, some partial earnings may be possible in many cases after initial qualification.

What are the possible durations for knee osteoarthritis disability benefits?

Potential benefit duration if approved for disability due to knee osteoarthritis includes:

12 months – SSI and private disability require at least 12 continuous months of disability, though most policies pay benefits until retirement age if unable to work.
24 months – Some private disability contracts limit payments for musculoskeletal conditions like OA to 2 years.

5-10 years – Disability can continue under SSDI until retirement age as long as you remain unable to perform substantial gainful employment.
Life – If approved for SSDI or SSI prior to age 60 and your condition won’t improve, benefits often continue for life.

The main factor determining duration is the prognosis and whether significant functional improvement allowing work is expected. Knee replacement surgery, for example, may allow for returning to work.

Does knee osteoarthritis automatically qualify you for disability benefits?

There are no conditions that automatically guarantee approval for disability. While knee osteoarthritis is a common impairment leading to disability claims, qualification depends on the severity and impact on functioning and work capacity.

Many applicants with knee OA are denied disability benefits on initial application if symptoms are not yet advanced. Milder cases failing to meet the full disability criteria may not qualify.

However, as knee arthritis worsens over time, your chances of meeting disability requirements increase. Supporting your claim with thorough medical documentation of functional limitations is key.

What jobs may still be possible with knee osteoarthritis disability?

While knee OA can prevent past occupations involving physical demands, some types of work may remain possible with appropriate accommodations. Jobs that may still be within limitations include:

Telecommuting office roles
Taxi or rideshare driver

Telephone customer service
Medical billing
Computer programmer

novelist
Accountant or financial analyst
Teacher

Employment involving primarily sitting, with flexibility to change positions, rest, or use assistive devices, is often attainable despite advanced knee OA.

Can knee osteoarthritis qualify you for social security disability?

Knee osteoarthritis can potentially qualify for Social Security disability benefits under either the SSDI or SSI programs, provided it results in inability to work. To meet Social Security’s definition of disability:

Your knee condition must prevent past work (SSDI) or any substantial gainful employment (SSI).

Evidence must confirm inability to function in a work setting 8 hours daily, 5 days per week.
Significant limitations in strength, range of motion, ambulation, and activities must be documented.
Symptoms have lasted or are expected to last at least 12 continuous months or result in death.

While approval is not guaranteed, advanced knee OA that interferes with occupational functioning can qualify you for Social Security disability benefits in many cases with proper medical documentation.

Conclusion

Knee osteoarthritis is a leading cause of disability, especially in older adults. Severe OA with imaging evidence of joint degeneration, loss of range of motion, pain, and inability to walk, stand, climb, squat, kneel, and lift can potentially qualify for disability benefits through SSDI, SSI, or private insurance.

However, approval is based on demonstrating extreme functional limitations and work capacity reductions through objective medical evidence. Supporting your claim with comprehensive records documenting your symptoms, treatments, and progression of knee OA is key to qualifying for disability due to this condition.