There are several reasons knee replacement surgery may be necessary, including congenital defects that worsen over time, degenerative diseases that lead to deterioration of the joint, and accidents or injuries that result in permanent joint dysfunction or degradation. No matter the reason knee replacement is required, the surgery actually involves the removal and replacement of all or part of the knee joint with synthetic components designed to restore joint function and normal operations.
Applying for SSD with a Knee Replacement
If you’ve had a knee replacement and are unable to work during your recovering or because of complications from surgery, you’ll need to apply for Social Security Disability (SSD) benefits. Potentially disabling conditions are listed in the Social Security Administration’s (SSA’s) Blue Book, which is the manual used by Disability Determination Services (DDS) staff to evaluate eligibility for disability benefits.
Disability applications filed based on a knee replacement are evaluated by the DDS under the following listings:
- Section 1.02 – Major Dysfunction of a Joint
- Section 1.03 – Reconstructive Surgery or Surgical Arthrodesis of a Major Weight-bearing Joint
While knee replacement surgery is intended to restore joint function, it is not always successful in allowing patients to return to their life and their former employment without additional limitations. Dependent upon the type of work you’ve traditionally done, knee replacement surgery recovery may prevent you from working. Likewise, there can be complications with knee replacement, resulting in lasting impairment.
Your SSD application must contain extensive medical records and other documentation proving your claim for disability benefits. That documentation must either meet the requirements of the aforementioned Blue Book listings, or must qualify you for disability based on a “medical vocational allowance”, which is essentially a favorable SSD eligibility determination made when an impairment is severe enough to prevent gainful employment even though it does not meet the criteria of a specific SSA listing.
To be found eligible for SSD benefits, your condition must have either lasted, or be expected to last, at least twelve months. It must also not only prevent you from working in your previous job or similar positions, but also be sufficiently limiting to prevent you from finding and maintaining gainful employment in a less physically taxing position as well.
With a knee replacement, the DDS will specifically look for your physical limitations including whether your condition prevents you from:
- Bending, squatting or stooping
- Lifting and carrying objects
- Sitting or standing for any length for any length
- Walking with or without the use of canes, crutches, a walker, or braces
- Climbing stairs with the use of a handrail for support
- Walking on rough or uneven surfaces
- Walking at a “reasonable” pace
- Walking particular distances, like a city block or further, at a “reasonable” speed
Necessary Medical Documentation for Knee Replacement
You will additionally want to ensure that the medical records in your SSD application are thorough and contain not only the results of physical examinations by your physician, but also imaging test results and other diagnostic data that shows your range of motion remains limited and that your knee replacement surgery has not resulted in restoration of movement without limitations. Detailed statements from your treating physician can help you tremendously in your disability application by explaining your limitations and the expected prognosis of your condition.
The DDS will also want to see, in your medical records and the other documentation in your application, that despite following prescribed rehabilitation, physical therapy and other treatment regimens, your condition has not – and/or is not expected to – improve.
Getting Help with Your Knee Replacement SSD Application
As the majority of knee replacements are successful in restoring most joint function for patients, being approved for disability benefits after a knee replacement can be tricky. You’ll need to work in coordination with your doctor to ensure your medical records are thorough and accurately reflect the limitations your condition imposes on you.
You may additionally want to consider seeking help with completing your SSD application from either a Social Security advocate or disability attorney. An attorney or advocate can improve your chances of being found eligible for benefits and ensure your application and documentation meet the SSA’s disability criteria.