If you recently received a hip replacement, you are far from alone. Those who have recently had a hip replacement may qualify for Social Security disability benefits. To qualify for disability benefits after a hip replacement, you must meet the SSA's Blue Book listing outlining the specific medical qualifications.
As stated, if you have received a hip replacement, you are not alone. According to data from the HealthDay Reporter, hip replacements are more common now than they’ve ever been.
In fact, in people aged 45 to 54, hip replacements have increased by 205% over the past few years. Part of the reason for this increase is ever-improving technology, making hip replacements faster and less painful than before.
Unfortunately, even modern medicine cannot make hip replacements painless. While many recipients see recovery within 4-6 months, others can still face complications from their surgery for up to a year after, or even longer.
If you are struggling to live your daily life due to continued pain and complications after your hip replacement, then you may qualify for financial assistance through the Social Security disability benefits program.
Is A Hip Replacement A Permanent Disability?
So, is a hip replacement a permanent disability? While the Social Security Administration (SSA) recognizes hip replacements as an impairment that is disabling under Section 1.03 of the Blue Book, there is no mention that a hip replacement is a permanent disability. Nonetheless, you might still be able to receive hip replacement disability benefits—regardless of whether or not it is considered a permanent disability—if you meet certain requirements. One of the most important requirements to meet in order to have the best chance of qualifying for hip replacement disability benefits through the SSA is your hip’s condition interfering with and prohibiting your ability to perform the essential functions of your job as well as other tasks of your daily life.
Hip Replacement Disability Benefits
A hip replacement is a surgical procedure in which an artificial joint is put into a person’s hip as a substitution for the damaged portion(s) of the hip that were removed. Arthritis is one of, if not, the primary causes responsible for hip replacements.
Typically, hip replacement surgery is performed on patients who have severe, chronic pain in and reduced mobility of their hip. This surgery is usually the last resort, following these patients’ exhaustion of every other treatment option available to them to help improve their hip pain (e.g., medications, physical therapy (PT), and steroids).
If you have undergone this surgical procedure, and are thereby unable to continue working for at least the 12 months that follow your surgery, there may be financial assistance available to you via hip replacement disability benefits.
Compared to other surgical operations, the hip replacement procedure is seen as one of the most successful ones. This is because, in the majority of hip replacement cases, the procedure results in a reduction in hip pain as well as an improvement(s) in hip mobility. Generally speaking, people who undergo hip replacement surgery report improvements in their daily activities and their quality of life, increased mobility, and reduced pain. And, upwards of 90 percent of patients who undergo hip arthroplasty and adhere to their postoperative rehabilitation plans report experiencing improvements in their health.
Nonetheless, the hip replacement procedure still comes with its risks and, unfortunately, not all recipients of this surgery have the experience or reap the benefits of a full hip replacement recovery. So, if you have had a hip replacement, you find yourself in the position of not getting to experience the benefits of a full recovery, and most importantly you are unable to work because of your hip replacement, you may be able to get hip replacement disability benefits through the Social Security Administration (SSA).
Hip replacement disability benefits are usually awarded to people who endure long-term difficulties with their hip replacement. When the SSA evaluates hip replacement disability applications, they utilize their manual called the “Blue Book” to determine eligibility for these benefits.
There are two Blue Book listings that may help you qualify for hip replacement disability benefits. These two listings fall under Section 1.00–Musculoskeletal Disorders. Some signs that you might qualify for hip replacement disability are explained below.
Using the Social Security's “Blue Book”
Social Security disability benefits are for those whose conditions leave them unable to work or care for themselves independently for 12 months or longer. This is how the Social Security Administration (SSA) defines “total and permanent disability.” You can review how the SSA evaluates each condition in their compiled guidelines, known as the Blue Book.
Of course, depending on your condition, there are different requirements to determine whether or not your symptoms can help you qualify. These requirements are organized and listed in the Social Security Administration’s Blue Book.
Hip replacements are listed in the Blue Book under Section 1.03: “Reconstructive Surgery or Surgical Arthrodesis of a Major Weight-Bearing Joint.” Here, it states that hip replacements can help you qualify for disability benefits if you are unable to ambulate effectively (and are not expected to do so) within 12 months of your surgery.
An “inability to ambulate” is defined by the SSA as an extreme limitation of a person’s ability to walk, use their legs, or get around without the use of both arms.
If it has been longer than a year since your surgery and you are still unable to walk reliably without assistance, then you may be able to qualify for benefits.
Potentially Qualifying Before Surgery
The SSA Evaluation and Medical Qualifications
One thing that some applicants are unaware of is that they may qualify for benefits prior to the surgery. By providing evidence of your medical condition before the surgery, you may qualify for retroactive disability benefits to also cover a period before your hip replacement.
Under Section 1.02 of the Blue Book, “Major Dysfunction of a Joint Due to Any Cause,” it states that an applicant with hip problems can qualify for benefits if they have:
- a gross anatomical deformity (subluxation, contracture, bony or fibrous anklyosis, etc.) and chronic joint pain and stiffness,
- signs of limitation of motion or other abnormal motion of the affected joint(s),
- medical imaging to demonstrate the narrowed joint space, bony destruction, or anklyosis of the hip, and
- an inability to ambulate effectively (as explained previously)
This listing is far more complex than Section 1.03, so it is understandable to be unsure of your qualifications here. The best way to know if your hip condition has qualified since before the surgery is to speak with your physician and receive/redo tests to further understand your diagnosis.
Preparing for the Application
The majority of work required on the disability application comes in the preparation beforehand. Once you have the required paperwork ready, all that’s left is to get started on the SSA’s website. Below are the most important pieces of medical information you should prepare before starting your application:
- MRI/CT scans: Imaging is arguably the most important test you can provide to demonstrate the severity of your hip issue, before and after surgery. Include all imaging scans taken since the beginning of your hip problems.
- Residual Functional Capacity test: This test measures your current ability to do many of the physical functions necessary for daily life, such as walking, sitting, standing still, or standing up from sitting, pushing, lifting, or bending.
- Current and past treatment attempts: The SSA will want to know everything you tried before and after surgery to fix your hip complications. Those with a treatment-resistant condition are more likely to qualify for benefits before surgery.
- Physical therapy logs: This will also help the SSA to see how, despite treatment attempts, you have been unable to see positive results.
- General medical history: This includes even regular physician check-up notes that go back as far as you can get them. The better the SSA understands your medical history, the more likely you are to receive benefits
Using Your Disability for a Hip Replacement
If you are a veteran, you might have received a disability rating for a hip replacement. Although the Social Security Administration (SSA) does not refer to a disability rating to determine your eligibility for Social Security Disability (SSD), the rating can help you gain approval for financial assistance.
The Veterans Administration (VA) initially sets the disability rating for a hip replacement at 100 percent. This allows a veteran struggling with a hip in poor condition to receive some form of financial assistance to address the potentially disabling medical condition.
Receiving a 100 percent initial disability rating for a hip replacement is one of the few circumstances where a veteran receives financial assistance for a medical condition the veteran recovers from fully.
A 100 percent initial disability rating for a hip replacement expires after one year, After the expiration date for the 100 percent disability rating, a veteran can ask for a disability rating that combines a hip replacement with another medical condition such as a damaged knee to restore the 100 percent disability rating.
The VA does not require you to have hip replacement surgery performed at a VA sanction hospital for you to become eligible for disability benefits.
If you decide to undergo surgery hip replacement surgery outside the VA healthcare system, you must file a disability claim before the end of 12 months to receive the initial 100 percent disability rating for hip replacement.
Under any scenario that a veteran receives an initial 100 percent disability rating, the veteran receives a new rating after the expiration of 12 months.
You can refer to your initial 100 percent disability rating to expedite your claim, as well as use your disability rating to demonstrate eligibility for SSD benefits.
Working With a Disability Attorney
Even if you feel certain you’ll receive benefits, you never know what will happen until you see results. Regardless of your situation, it may be wise to play it safe and consider consulting with an attorney before you apply.
Not only do most offer free consultations, but the majority are legally required to not take payment unless they help you win your case. For help with filing paperwork, updating the SSA, and potentially building your case in court, there is no better resource than a disability attorney.