If you have had to undergo an amputation and you are unable to work as a result, you may be eligible for Social Security disability benefits. The Social Security Administration (SSA) pays benefits to the individual who has undergone an amputation, as well as certain dependents like a spouse or minor child, if you worked enough throughout your life before your amputation.
Every disability applicant is compared to the SSA's medical guide known as the Blue Book. The Blue Book listing provided by the SSA makes it clear that it applies to amputations for any reason, such as a medical problem, injury or any other kind of trauma. Of course, the impact of the amputation on the individual pertains to which limb was amputated. While amputations of the foot or leg will impact ambulation such as walking, bending or climbing stairs, amputations of the hand or arm will impact fine motor functions and the ability to pull or push.
If you suffer from additional medical conditions along with the amputation, those have to be considered as well. Sometimes multiple medical problems can be the equivalent or surpass the medical requirements set forth for disability in the SSA Blue Book. Even if your case does not meet the guidelines outlined by the SSA's handbook, you may still qualify for Social Security disability benefits.
Financial Expenses Involved with Amputations
Amputations are very costly and often result in significant financial burdens. While amputations may be the result of an accident or trauma, they can also be caused by chronic medical conditions such as type 2 diabetes, heart disease, cancer and hypertension. Those chronic medical conditions are listed among the most expensive health issues in the country, so when an amputation is added on top of that, the costs can skyrocket beyond belief.
During 2002, a study conducted by the Johns Hopkins Center for Injury Research and Policy estimated that the lifetime costs for traumatic amputation was $509,275, which included the initial hospitalization and follow-up stays, inpatient rehabilitation, doctor visits, occupational and physical therapy and the purchase and maintenance of prostheses. Medical costs are the leading cause of bankruptcy in the United States and amputation is among one of those reasons.
The SSA Evaluation and Medical Qualifications
If you are missing an extremity or limb, filing for disability benefits because of an amputation is not necessarily simple. Just because you have an amputation does not mean you are automatically disabled.
You must show that your condition impacts your ability to do your workplace functions, such as walking, grasping, pushing, pulling, bending and lifting. Of course the limb or limbs amputated impact those abilities and the kind of work you have previously done or could be expected to do now based on your experience, age and education level come into play.
The SSA’s Blue Book Section 1.05 lists the specifications for qualifying for disability benefits because of an amputation. The listing specifies that it covers amputations that are the result of any cause. If you meet the listing, you should automatically qualify for disability benefits.
Here are reasons for medical approval because of an amputation:
- The loss of both hands, OR
- You have lost either of your lower limbs right above the ankle and have complications preventing the use of a prosthetic device to aid in ambulation, OR
- You have lost one hand and one lower limb above the ankle and are unable to use a prosthetic device, OR
- You have lost an entire leg either at the pelvic region or hip.
If your amputation limits you to a wheelchair, keeps you from walking a block on an uneven surface, walking without the use of a walker or two crutches, or going up a couple of stairs without handrails, you will almost certainly meet the SSA's medical criteria.
But what if you don't meet the SSA's medical criteria? Just because you don’t meet these qualifications does not mean that you will not qualify for Social Security disability benefits.
Being Approved for SSDI with the Help of a RFC
If you don’t meet the guidelines for automatic approval of disability benefits, your amputation could still warrant approval. A residual functioning capacity assessment, known as an RFC, can make a significant difference in the outcome of your case.
Your physician should complete this form in detail. It says how long you can sit, stand or lie without having to reposition as well as how much you can lift, how frequently you can bend and any other way that your movements or functioning is impacted by your amputation and any other medical conditions that you may suffer.
Disability Determination Services will then have to consider how your amputation affects your ability to perform your routine tasks. It is important that your physicians make detailed notes in your medical records including information about how your prosthetic device cannot be used effectively or how even with the device your functioning is impaired.
Your physician should clearly indicate any and all restrictions you have on daily activities because of the amputation and/or any other confirmed medical problems that you may be suffering. The documentation should state the duration of the condition, your prognosis and any medications that you must take to treat your problems, such as opioids for pain and antibiotics for repetitive infections.
Applying Specific Medical Tests to your Condition
Despite having your medical records and extensive documentation, it is not uncommon for the SSA to order additional medical evaluations at their expense. They can schedule an appointment with a physician to verify your limited functioning and inability to perform your usual duties.
Sometimes a mental evaluation may be required to determine if your amputation has added stress or depression into the mix. Mental illnesses can also play a major role in your inability to work. The examinations preformed by the SSA are designed to see how your performance compares to someone without the impairment. They also check to see if you could do a different kind of work than you had previously done.
These examinations may also include simple laboratory work, such as blood tests and x-rays. Expensive tests are not included in these medical evaluations. Usually with your medical records, documentation and the medical evaluations, Disability Determination Services can make an informed decision.
While some claims are resolved more quickly than others, some claims are denied may require appeals and even an appearance before an administrative law judge for a final decision. With the right information and documentation, you can successfully win your disability case. From the moment of the amputation, the importance is to make sure everything is documented thoroughly. With medical evidence on your site, you can hopefully be approved quickly and focus on what's important: recovery.