How to Qualify for Social Security Benefits With Osteoporosis
Medically reviewed by Anju Goel, MD, MPHFact checked by Nick Blackmer
Osteoporosis can be a debilitating disease that significantly impacts your quality of life. The weakening of the bones over time can lead to complications that affect your ability to work and care for yourself. Someone with osteoporosis who cannot work because of associated complications like repeat fractures may consider applying for disability benefits.
The Social Security Disability Insurance (SSDI) program provides disability benefits to qualifying individuals. The Social Security Administration (SSA) uses a series of steps to determine if someone’s medical condition makes them eligible for disability benefits.
While osteoporosis is not a qualifying condition on its own, someone with osteoporosis may be eligible through associated qualifying conditions or under a medical-vocational allowance.
This article will discuss what SSA looks at to determine eligibility for disability benefits if you have osteoporosis, the medical evidence required, and what to expect in the application.
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Is Osteoporosis a Disability?
Osteoporosis is characterized by porous bones and low bone mass due to thinning of the bones over time. The gradual breakdown of bones makes them more prone to fracture, making work and daily activities challenging or impossible.
For example, the wrist is especially prone to fracture from osteoporosis. With a fractured wrist, desk work will become much more difficult or undoable. In that case, osteoporosis is disabling.
If you have osteoporosis, knowing how and when you would be eligible for disability benefits is important for your peace of mind and your health, both from a financial and mental health perspective.
The SSA uses a medical guide called Disability Evaluation Under Social Security (or, commonly, the Blue Book) to determine if a condition qualifies as a disability. This then makes the person eligible for disability benefits through SSDI.
The Blue Book does not define osteoporosis as a disability on its own. Still, it may be considered one if it is accompanied by debilitating symptoms or associated health conditions that affect your ability to work. In addition, if osteoporosis is caused by a health condition that is considered a disability in the Blue Book, then you may qualify for benefits that way.
For example, inflammatory bowel disease (IBD, which includes Crohn’s disease and ulcerative colitis) is a potential cause of osteoporosis. It results in malabsorption of important nutrients like vitamin D and calcium, increasing bone loss risk. A person with IBD may qualify for disability benefits under section 5.00, Digestive System, of the Blue Book.
Social Security 5-Step Process for Determining Eligibility
Only by applying for benefits with the SSA can you know if you will receive disability benefit payments. However, you can follow the steps to help determine if you are eligible. Here are five factors the SSA looks at to decide if you have a qualifying disability.
Whether You've Worked Since Developing a Disability
The SSA looks at your earnings to help determine if you’ve been able to perform “substantial gainful activity” (SGA), a term the SSA uses to describe work that involves doing significant physical or mental activities for pay or profit.
Generally, if you’ve worked at some point in the calendar year and have earned above a certain amount each month, the SGA level, then you will not be considered to have a qualifying disability.
For example, if you have osteoporosis and worked in 2022, earning more than $1,350 per month on average, you likely won’t be eligible for disability payments. For 2023, the SGA level is $1,470 per month.
If you are not working or are working but not engaging in SGA, the SSA will send your application to the Disability Determination Services (DDS). The DDS will decide whether your medical condition, such as osteoporosis, is a qualifying disability.
Severe Medical Impairments
A condition must be considered severe to move on to the next step. Severity is determined by whether the condition keeps you from doing basic activities at work for at least 12 months. For osteoporosis, significant limitations in lifting, sitting, standing, or walking may mean it is considered a severe medical impairment.
Meeting a Medical Listing
At this point in the process, if a condition is found on the SSA’s list of medical conditions or is considered as severe as a medical condition that is on the list, it is considered a qualifying disability. The list is broken up by body systems.
Osteoporosis itself is not listed under Section 1 (Musculoskeletal Disorders), but it is mentioned in relation to pathological fractures, which are fractures due to the weakening of the bones.
These fractures would have to happen on three separate occasions within 12 months, limit physical functioning for at least 12 months, and be accompanied by medical documentation of the limitation to be considered a qualifying disability.
Another way to look at it is that osteoporosis can be associated with many other conditions, like rheumatoid arthritis, which is listed under Section 14 (Immune System Disorders). In that case, osteoporosis may not be the qualifying condition, but depending on the severity and effects, the associated condition may be.
Ability to Perform Past Work
This step only happens if the condition in question is not in the SSA’s medical listing and is not considered to be as severe as a medical condition that is on the list. This might be the case if you have osteoporosis but not an associated qualifying condition.
The SSA will then determine whether your osteoporosis keeps you from performing any of your past work activities. If it does, then they move on to the next step. If not, then you will be considered as not having a qualifying disability.
Ability to Perform Other Work
If you can’t do the work you did in the past, the SSA will see if there is other work you can do with your osteoporosis. Your age, work experience, and education are factors that the SSA may use to determine if you can do other work. If you can work, you won’t be eligible for disability benefits. If you can’t work, you will qualify.
Required Medical Evidence to Qualify for Benefits
Since osteoporosis is not a qualifying disability in and of itself, the medical evidence of your osteoporosis and how significantly it impacts your daily life or ability to work is crucial. The SSA will need a complete medical history of your osteoporosis, including records from your healthcare provider.
Your medical record should include the progression of your osteoporosis, your symptoms, your history of falls or fractures, and the results from your physical exam. Your healthcare provider should document any limitations you have, such as needing to use a walker, cane, or crutches or not having the ability to do some movements, like lifting or typing.
These notes are crucial to proving that osteoporosis prevents you from working.
Your medical record should also include your treatment plan and any medications you take for osteoporosis. Some osteoporosis medications have unwanted side effects that may limit your ability to work.
For example, some people report having joint, muscle, or bone pain as a side effect of bisphosphonates, a common medication used to treat osteoporosis, which may make physical labor or even desk work more difficult.
Using a Medical-Vocational Allowance
You may qualify for disability benefits through a medical-vocational allowance if you do not have a condition that meets a listing in the Blue Book but are unable to work because of the effects of osteoporosis.
In this process, the SSA will review your medical records and assess whether you can do other types of work with your condition and maintain that employment. If the SSA finds that you can’t maintain any work because of your osteoporosis, you may be approved for SSD benefits under a medical-vocational allowance.
Applying for Benefits
Before applying for benefits, it may be helpful to use the SSA’s BEST (Benefits Eligibility Screening Tool) questionnaire to see if you qualify for benefits. Generally, to apply for SSDI benefits, you must:
Have a long-term disability (it cannot be short-term or a partial disability)
Have a disability that meets the SSA definition of a disability
Be younger than your retirement age
Be unable to work for at least a year due to your medical condition, or that condition is expected to result in death
Be sure to collect information ahead of time to make the application process easier. Information that will be collected as part of the application process includes:
Date of birth and Social Security number
Medical information, such as your healthcare provider’s contact information and the medications you’re taking
Details about your work, including how much money you earned in the last year
You can apply online for disability benefits on the SSA’s website. You don’t need to fill out all the information at once. You can save your application and return to it later to fill in more information and submit it. You can also check your application status on the SSA’s website.
Related: How to Apply for SSDI
Summary
Osteoporosis is not considered a qualifying disability by itself, but it may be associated with conditions that do qualify, such as repeat fractures. If you apply for disability benefits, the SSA will use a five-step process to determine if your ability to work is significantly impacted by your osteoporosis and use medical records to help make that decision.
Even though osteoporosis isn’t considered a qualifying condition, if you are still unable to work because of your osteoporosis, you may be eligible for benefits under a medical-vocational allowance.
Frequently Asked Questions
Can you work if you have osteoporosis?
Osteoporosis progresses over time and some people may not know they have it until they sustain a fracture. That said, some people can still perform their work even with osteoporosis. However, some with more progressed osteoporosis may have other related conditions, like repeat fractures, that make work difficult or impossible.
How much will you receive monthly with SSDI?
The monthly amount of money you can receive from SSDI is modest. It is often not enough to fully support someone on its own. According to the SSA, the average monthly benefit is about $1,350 in 2023.
Is it difficult to qualify for disability benefits with osteoporosis?
Because osteoporosis is not a disability listed in the Blue Book, it isn’t as straightforward to qualify for disability based on osteoporosis alone. However, it is possible. The SSA will look at your medical history and work history to help determine if your condition as a result of osteoporosis makes you eligible for benefits through SSDI.
Read the original article on Verywell Health.
