Hip replacement surgery is required when there is a major dysfunction of the hip joint. Dysfunction can result from congenital defects, an accident or injury, or from degenerative disease, like osteoarthritis or rheumatoid arthritis. Regardless of the cause, hip replacement surgery requires the removal of all or part of the hip joint, which is then replaced by synthetic components designed to mimic the operations of a natural, healthy hip.
Qualifying for SSD with a Hip Replacement under the Blue Book Listing
If you’ve had hip replacement surgery and are still unable to work as a result of the procedure, you’ll need to file an application for Social Security Disability (SSD) benefits. The Social Security Administration (SSA) uses the following Blue Book listing to evaluate disability claims based on hip replacement and dysfunction:
- Section 1.02 – Major Dysfunction of a Joint
- Section 1.03 – Reconstructive Surgery or Surgical Arthrodesis of a Major Weight-bearing Joint
When determining what medical records and other supporting documentation should be included in your SSD application, you’ll want to review both of these sections of the Blue Book for further information. You’ll also want to work closely with your treating physician to ensure all your medical records are in order and that the physician’s statement you include in your application accurately reflects the limitations imposed on you by your hip replacement surgery.
Most hip replacements are effective in treating the initial joint dysfunction and allow patients to put weight on the joint and move fairly well shortly after surgery. Some patients may lose the ability to walk for several months, but rarely does the condition last 12 months or longer, which is a minimum requirement for qualifying for SSD benefits.
In most cases, it’s only if something has gone wrong with your hip replacement that you’ll qualify for SSD benefits under the listings appearing in section 1.02 and 1.03 of the Blue Book. If this is true for you, it’s still possible for you to qualify for disability benefits, if your hip replacement results in severe limitations that prevent you from working, but you’ll need to qualify for benefits under a “medical vocational allowance” rather than under a listed impairment.
Qualifying for SSD without meeting the Blue Book Criteria
If you don’t meet the listing criteria in the SSA’s Blue Book, your SSD evaluation will also require your medical documentation and other records to indicate you’re limited in performing other daily activities, potentially including:
- bending, stooping, and/or squatting
- lifting and carrying
- sitting in one place for long periods
- standing for any length of time
These details are essential for the SSA to evaluate your residual functional capacity or RFC, which is a rating of your ability to work and perform central job functions even with a physical impairment.
Whether your claim is evaluated under a listed impairment or reviewed for a medical vocational allowance, the SSA will seek to determine if you’re able to walk effectively.
The medical records and other documentation in your SSD application should prove you’re unable to:
- Walk without the use of two canes or crutches, or a walker
- Move at a reasonable pace, particularly over long distances (a city block or more)
- Walk on uneven or rough surfaces
- Climb stairs at all, or at a reasonable pace while using a single handrail as support
It’s crucial that your medical records, statements from your treating physician, and other documentation of your disability show that your condition has not improved since your hip replacement, and that you continue to be severely limited even after participating in appropriate rehabilitation and physical therapy.
Getting Help for Your Hip Replacement SSD Claim
Because most hip replacements are successful and allow patients to function well following surgery, proving a disability claim based on a hip replacement impairment can be challenging. Your doctor(s) will be a key partner in substantiating your disability. You may also want to consider the benefits of seeking assistance from a Social Security advocate or disability attorney when filing your claim in order to ensure your application and substantiating documentation meets the eligibility criteria for SSD benefits.