What is Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is a little less common than rheumatoid arthritis, affecting less than 1% of the population. The TV-personality Ed Sullivan had ankylosing spondylitis. It affects men three times more often than women, and it usually begins at an early age, between the ages of 15 and 30.
It is an inflammatory arthritis of the spine, often starting in the low back area and in the sacroiliac (SI) joints. It is associated with a “disease susceptibility” gene, called HLA-B27 antigen.
What are the Disabling Symptoms of Ankylosing Spondylitis?
AS primarily causes back pain and stiffness, leading to progressively increased restriction in the range of motion of the back and to decreased flexibility of the spine. The damage to the spine is caused by inflammation, which leads to bone spurs (called “syndesmophytes”), and eventually to bony fusion of the SI joints and parts of or even the entire spine.
The disabling features of AS are primary related to the chronic pain, stiffness, and permanently restricted range of motion of the spine. In addition to back pain, AS can also cause other joints, such as the hips, knees, and shoulders, to become arthritic. It can cause inflammation of the eyes (iritis or uveitis), and it can be associated with other HLA-B27 positive disorders, such as psoriatic arthritis and an arthritis related to colitis (ulcerative colitis and Crohn's disease).
What Causes Ankylosing Spondylitis?
The cause of AS has not been precisely defined, but it is felt by most medical researchers to be a combination of environmental (e.g., infectious) and genetic factors (inherited disease-susceptibility genes).
Confirming the Diagnosis of Ankylosing Spondylitis
To successfully qualify for a disability award, you must first show that you have a confirmed diagnosis of AS. This usually requires x-rays of your spine that show sacroiliitis (inflammation of the SI joints) and other radiographic findings, which may include syndesmophytes and/or elements of bony fusion.
Blood testing generally shows a positive HLA-B27 antigen in about 90% of cases of AS and helps to confirm the diagnosis. However, you can still be diagnosed with AS even if your HLA-B27 antigen is negative. Remember, that this is a “disease-susceptibility” test. It doesn't necessarily mean that you have AS if you are positive, or that you don't have it, if you are negative. A rheumatologist is typically an expert in the diagnosis and treatment of AS, and that's the kind of doctor that will be able to help you the most.
What Must You Show to be Eligible for Disability Benefits?
After your diagnosis of AS has been confirmed by your doctor, with objective evidence of the disease by x-rays and laboratory testing, then your doctor must document in your medical records that you have symptomssuch as chronic pain, stiffness, and decreased range of motion in your spine that prevent you from working by restricting your functional capacityto sit, stand, walk, lift or carry.
Confirming the diagnosis of AS and documenting its symptoms(back pain, stiffness, and restricted range of motion), while obviously important, is not enough to qualify for disability benefits.
Your doctor must also document the effect your symptoms have on your ability to work, by documenting the most weight you can lift/carry in an 8-hour work day, and how long you can walk/stand or sit.
Be a Proactive Patient: Describe Your Limitations to Your Doctor
A critical factor is: How does your condition affect you? Be specific. Social Security likes to “measure” an applicant's functional capacity by having your doctor document the most you can lift/carry and the longest you can sit/stand/walk. Be proactive to verify that your doctor is entering that information into your medical record.
Your medical record is the “heart and soul” of your disability case. You must keep after your doctor to make it complete. While doctors are generally pretty good at documenting a patient's diagnosis and symptoms, they may not be as good at documenting your functional impairments.
SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).
SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work.
SSA has its own forms that are used for Physical RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.