Musculoskeletal System

• Author: Thomas E. Bush/David A. Morton III/David Traver/Sarah H. Bohr/Curtis J. Fisher/Kimberly V. Cheiken
• Pages: 22-133

Medical Issues In

Social Security Disability

David A. Morton III, M.D.

SOCIAL SECURITY DISABILITY COLLECTION

James’ Best Materials

1-23

Chapter 1

Musculoskeletal System and Growth Impairments

Part I – Adults

§1.00 Musculoskeletal System

§1.01 Category of Impairments, Musculoskeletal

§1.02 Major Dysfunction of a Joint

§1.03 Reconstructive Surgery or Arthrodesis of a Major Weight-Bearing Joint

§1.04 Disorders of the Spine

§1.05 Amputation (due to any cause)

§1.06 Fracture of Femur, Tibia, Pelvis, Tarsals

§1.07 Fracture of an Upper Extremity with Non-Union

§1.08 Soft Tissue Injury

Part II – Children

§100.00 Growth Impairments

§100.01 Category of Impairments, Growth

§100.02 Growth Impairment

§100.03 Growth Impairment

§101.00 Musculoskeletal System

§101.01 Category of Impairments, Musculoskeletal

§101.02 Major Dysfunction of a Joint

§101.03 Reconstructive Surgery or Arthrodesis of a Major Weight-Bearing Joint

§101.04 Disorders of the Spine

§101.05 Amputation (due to any cause)

§101.06 Fracture of Femur, Tibia, Pelvis, Tarsals

§101.07 Fracture of an Upper Extremity with Non-Union

§101.08 Soft Tissue Injury

Part III – Forms

§1.02F Major Dysfunction of Joints

§1.03F Reconstructive Joint Surgery

§1.04F Disorders of the Spine

§1.05F Amputation from Any Cause

§1.06F Pelvis and Lower Extremity Fractures

§1.07F Upper Extremity Fractures

§1.08F Soft Tissue Injuries

§100.02F Growth Impairments

Forms on Digital Access Only

§1.02F(L) Major Dysfunction of Joints

§1.04F(L) Disorders of the Spine

§1.05F(L) Amputation from Any Cause

§1.06F(L) Pelvis and Lower Extremity Fractures

§1.07F(L) Upper Extremity Fractures

§1.08F(L) Soft Tissue Injuries

§1.00 SOCIAL SECURITY DISABILITY COLLECTION 24

Form Reference:

Forms 1.02, 1.03, 1.04, 1.05, 1.06, 1.07, 1.08, and 100.02 can be

used to obtain optimal information from treating physicians regard-

ing the impairments discussed in this chapter.

General Legal Text Cross-References:

See Bohr’s Social Security Issues Annotated (James Publishing),

§307, regarding specific court cases involving fibromyalgia, and

§313 about other musculoskeletal impairments.

Part I – Adults

§1.00 Musculoskeletal System

[The applicable Listing of Impairments introduces each chapter

and is typeset in Helvetica. Author comments follow each Listing

subsection and are typeset in Times.]

SSA Listing of Impairments

A. Disorders of the musculoskeletal system may result from he-

reditary, congenital, or acquired pathologic processes. Impairments

may result from infectious, inflammatory, or degenerative processes,

traumatic or developmental events, or neoplastic, vascular, or toxic/

metabolic diseases.

B. Loss of function.

1. General. Under this section, loss of function may be due to bone or

joint deformity or destruction from any cause; miscellaneous disor-

ders of the spine with or without radiculopathy or other neurological

deficits; amputation; or fractures or soft tissue injuries, including

burns, requiring prolonged periods of immobility or convalescence.

For inflammatory arthritides that may result in loss of function be-

cause of inflammatory peripheral joint or axial arthritis or sequelae,

or because of extra-articular features, see §14.00B6. Impairments

with neurological causes are to be evaluated under §11.00ff.

2. How We Define Loss of Function in These Listings

Author’s Note

[Loss of function should include SSA evaluation of the

claimant’s activities of daily living (ADL’s), as well as the

formal medical evidence. While the SSA may provide forms

for the claimant or their representative to complete, it should

not be assumed that the SSA will fully develop functional

capacities if not given quality information. Many claimants

carelessly just write “No” or “None” in all the ADL form

blanks when the SSA requests information. Or the skimpy

and obscure answers are not revealing. It is in the best in-

terest of the claimant that they or their representative give

the SSA high-quality ADL information. There are numerous

SSA forms eliciting information about ADL’s and functional

limitations, such as the SSA-3368 Disability Report and the

SSA-3369 Work History Report, in addition to specific ADL

forms the SSA asks to have completed at the very beginning

of the disability determination process. Every effort should be

made to complete these forms with specific examples, rather

than to answer “No” or in a generalization.

Legal text cross-reference: See Social Security Issues

Annotated (Bohr), §204.8, regarding the impact of daily ac-

tivities on credibility.]

a. General. Regardless of the cause(s) of a musculoskeletal impair-

ment, functional loss for purposes of these listings is defined as the

inability to ambulate effectively on a sustained basis for any rea-

son, including pain associated with the underlying musculoskeletal

impairment, or the inability to perform fine and gross movements

effectively on a sustained basis for any reason, including pain associ-

ated with the underlying musculoskeletal impairment. The inability

to ambulate effectively or the inability to perform fine and gross

movements effectively must have lasted, or be expected to last, for at

least 12 months. For the purposes of these criteria, consideration of

the ability to perform these activities must be from a physical stand-

point alone. When there is an inability to perform these activities due

to a mental impairment, the criteria in §12.00ff are to be used. We

will determine whether an individual can ambulate effectively or can

perform fine and gross movements effectively based on the medical

and other evidence in the case record, generally without develop-

ing additional evidence about the individual’s ability to perform the

specific activities listed as examples in §1.00B2b(2) and §1.00B2c.

b. What We Mean by Inability to Ambulate Effectively

(1) Definition. Inability to ambulate effectively means an ex-

treme limitation of the ability to walk; i.e., an impairment(s) that

interferes very seriously with the individual’s ability to independent-

ly initiate, sustain, or complete activities. Ineffective ambulation is

defined generally as having insufficient lower extremity functioning

(see §1.00J) to permit independent ambulation without the use of

a hand-held assistive device(s) that limits the functioning of both

upper extremities. (Listing 1.05C is an exception to this general defi-

nition because the individual has the use of only one upper extremity

due to amputation of a hand.)

(2) To ambulate effectively, individuals must be capable of sus-

taining a reasonable walking pace over a sufficient distance to be able

to carry out activities of daily living. They must have the ability to

travel without companion assistance to and from a place of employ-

ment or school. Therefore, examples of ineffective ambulation include,

but are not limited to, the inability to walk without the use of a walker,

two crutches or two canes, the inability to walk a block at a reasonable

pace on rough or uneven surfaces, the inability to use standard public

transportation, the inability to carry out routine ambulatory activities,

such as shopping and banking, and the inability to climb a few steps at

a reasonable pace with the use of a single hand rail. The ability to walk

independently about one’s home without the use of assistive devices

does not, in and of itself, constitute effective ambulation.

c. What we mean by inability to perform fine and gross move-

ments effectively. Inability to perform fine and gross movements

effectively means an extreme loss of function of both upper extrem-

ities; i.e., an impairment(s) that interferes very seriously with the

individual’s ability to independently initiate, sustain, or complete

activities. To use their upper extremities effectively, individuals must

be capable of sustaining such functions as reaching, pushing, pull-

ing, grasping, and fingering to be able to carry out activities of daily

living. Therefore, examples of inability to perform fine and gross

movements effectively include, but are not limited to, the inability

to prepare a simple meal and feed oneself, the inability to take care

of personal hygiene, the inability to sort and handle papers or files,

and the inability to place files in a file cabinet at or above waist level.

d. Pain or other symptoms. Pain or other symptoms may be an im-

portant factor contributing to functional loss. In order for pain or other

symptoms to be found to affect an individual’s ability to perform ba-

sic work activities, medical signs or laboratory findings must show

the existence of a medically determinable impairment(s) that could

reasonably be expected to produce the pain or other symptoms. The

musculoskeletal listings that include pain or other symptoms among

their criteria also include criteria for limitations in functioning as a

result of the listed impairment, including limitations caused by pain.

It is, therefore, important to evaluate the intensity and persistence of

such pain or other symptoms carefully in order to determine their

impact on the individual’s functioning under these listings. See also

Secs. 404.1525(f) and 404.1529 of this part, and Secs. 416.925(f) and

416.929 of part 416 of this chapter [III of federal regulations].