Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by pain and stiffness, primarily affecting the shoulders, neck, and hips. It commonly affects adults over the age of 50, and symptoms can appear suddenly. Whether PMR qualifies as a legal disability depends entirely on the severity of the symptoms and the specific functional limitations the condition imposes on an individual’s ability to work, rather than the diagnosis itself.
Understanding PMR and Functional Limitations
PMR causes bilateral aching and stiffness in the proximal muscle groups, such as the upper arms and thighs. This stiffness is worst in the mornings or after periods of inactivity, often lasting longer than 45 minutes. The inflammation affects the surrounding joints, tendons, and bursae in the shoulder and hip girdles, not the muscle tissue itself.
These symptoms translate into functional limitations that can prevent a person from performing daily and work-related tasks. Individuals may find it difficult to raise their arms above the shoulders, making it impossible to reach, lift, or perform fine motor tasks required for many jobs. Simple actions like getting dressed or rising from a low seat become painful struggles.
The inability to sustain sitting or standing for long periods, combined with profound fatigue, further impacts a person’s Residual Functional Capacity (RFC). Objective evidence of reduced function—such as the documented inability to lift, walk, or maintain concentration—is what determines disability status.
Defining Disability Under Legal Standards
The Social Security Administration (SSA) uses a strict definition of disability, providing benefits only for a “total disability.” This means the impairment must prevent the individual from engaging in Substantial Gainful Activity (SGA). SGA is an earnings threshold, set at $1,620 per month in 2025 for non-blind individuals; earning above this level generally disqualifies an applicant.
To qualify, the medical condition must have lasted or be expected to last for a continuous period of at least 12 months or result in death. The SSA follows a five-step process to evaluate a claim, with the first step being the SGA determination. If the claimant is not working above the SGA level, the claim moves to a medical review.
PMR is not listed as a distinct condition in the SSA’s official Listing of Impairments. It is instead evaluated under the criteria for inflammatory arthritis, specifically Listing 14.09. Meeting this listing requires showing extreme limitations in daily activities, social functioning, or concentration and task completion, often combined with constitutional symptoms like severe fatigue or involuntary weight loss. If the condition does not meet a specific listing, the SSA assesses the person’s RFC to determine if they can perform any past work or adjust to other work.
Required Medical Evidence and the Application Process
A successful application for disability benefits relies on comprehensive and objective medical evidence. This documentation must clearly establish the severity of the inflammatory process and its resulting functional limitations. Required objective findings include blood tests showing elevated inflammatory markers, specifically the Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP).
While the presence of high ESR and CRP levels confirms inflammation, the SSA also requires detailed clinical documentation of physical exam findings, such as reduced range of motion and tenderness in the shoulder and hip girdles. Imaging reports, such as ultrasound or MRI, can further support the claim by showing inflammation in the bursae and tendons.
The most important document for an application that does not meet a Listing of Impairments is the Residual Functional Capacity (RFC) form. This form, ideally completed by the treating physician, must translate the medical data into specific, work-related limitations. A strong RFC form details the maximum amount of time the claimant can sit, stand, walk, lift, and carry, and must explain the medical rationale for these limits. Simple letters stating the patient is “disabled” are not sufficient; the form must specify why the person is prevented from working full-time.
Key Factors that Influence Claim Approval
The response of PMR to treatment is a significant factor in the SSA’s evaluation, as the condition is responsive to low-dose corticosteroids, such as prednisone. If a claimant’s symptoms are completely controlled by medication, and they can perform work-related activities, proving total disability is difficult. The SSA will consider the side effects of long-term steroid use, such as osteoporosis, cataracts, or weight gain, as additional impairments contributing to the overall functional limitation.
A co-morbid condition, particularly Giant Cell Arteritis (GCA), can substantially strengthen a PMR disability claim. GCA involves the inflammation of blood vessels, which carries a risk of serious complications like irreversible vision loss or stroke. If the PMR is secondary to GCA, the claim is often evaluated as a more severe systemic vasculitis under Listing 14.03, acknowledging the potential for multi-organ involvement.
A longitudinal medical history is important, especially when the condition flares and remits. Documentation must show persistent limitations over time, despite the prescribed treatment plan, detailing the frequency and severity of relapses when steroid dosage is tapered. The SSA evaluates the condition based on the claimant’s function while on medication, making the detailed record of ongoing limitations crucial for a successful claim.