The Social Security Administration uses the guidelines laid out in the Blue Book to determine whether or not a claimant qualifies for Social Security disability benefits. The Blue Book divides disabling conditions into fourteen broad categories. Each of these categories breaks down the basic requirements to qualify for disability benefits. The first category deals with disorders of the musculoskeletal system.
What Are Musculoskeletal Disorders?
Musculoskeletal disorders are disorders or injures that affect the tendons, spinal discs, cartilage, nerves, joints, muscles bones etc. They can affect body movement and they can be caused by tedious repetition.
While the Blue Book recognizes several distinct causes of musculoskeletal disorders (including heredity, injury, disease, etc.), the main thing the SSA concerns itself with is not the cause of the disability but the extent to which it affects your ability to perform meaningful work. The guidelines laid out in the Blue Book for deciding disability claims for musculoskeletal disorders relate primarily to how the disability affects your ability to move, perform tasks, and concentrate on a job.
The SSA breaks musculoskeletal disorders into the following categories:
- Amputations. Generally, two limbs need to be amputated to qualify for Social Security disability (though you may qualify with one amputated limb in many cases). In some cases, you will need to show that prosthetic devices could not be used to help you work again.
- Fractures. Fractures can qualify you for disability benefits in some cases, but you must be able to show that the fracture is expected to make it impossible for you to work for a year or more.
- Joints. Disorders involving the knees, hips, ankles, shoulders, elbows, wrists, etc. are judged based on how they affect your ability to walk, push, pull, stand, sit, lift, and perform fine motor skills. The SSA will seek to determine whether you could continue to work with reasonable accommodation.
- Spine. Here again, the SSA is looking to determine whether a spinal disorder affects your ability to move, perform standard work tasks, stand, sit, or concentrate.
For most musculoskeletal conditions, you will need to show that you have been treated by a doctor. Medical imaging (X ray, CAT scan, MRI, etc.) is generally accepted as one form of proof of the disability. Depending on the type of musculoskeletal condition, you may also have to undergo a battery of physical tests.
Many types of musculoskeletal conditions improve with time. In order to qualify for Social Security disability benefits, you will need to demonstrate that your disability has lasted or is expected to last twelve months or more. It’s important that those who are claiming disability benefits due to musculoskeletal conditions to continue seeing their doctors. The SSA will consider whether you have been following prescribed treatments and whether they have had an impact on your condition.
Here is a list of specific conditions that falls within evaluation for the musculoskeletal system:
- Anterior Poliomyelitis
- Apert syndrome
- Avascular Necrosis
- Back Pain
- Bone Spurs
- Carpal Tunnel Syndrome
- Club Foot Deformity
- Cubital Tunnel Syndrome
- Degenerative Disc Disease
- Degenerative Joint Disease
- Fracture of the Femur, Tibia, or Pelvis
- Fracture of an Upper Extremity
- Herniated Disc
- Hip Pain and Related Disorders
- Hip Replacement
- Inflammatory Arthritis
- Joint Pain
- Knee Pain and Related Disorders
- Knee Replacement
- Low Birth Weight
- Lumbar Stenosis
- Lyme Disease
- Major Dysfunction of a Joint
- Nerve Root Compression
- Muscular Dystrophy
- Neck Pain and Neck Problems
- Piriformis Syndrome
- Reflex Sympathetic Disorder
- Rheumatoid Arthritis
- Ruptured Disc
- Shoulder Disability
- Shoulder Pain and Shoulder Problems
- Shoulder Replacement
- Soft Tissue Injury (Burns)
- Spina Bifida
- Spinal Arachnoiditis
- Spinal Cord Injury
- Spinal Fusion
- Spine Disorders
- Torn ACL
- Undifferentiated and Mixed Connective Tissue Disease
For more information about applying with a Musculoskeletal disorder, please visit our page: Tips for Applying for Disability with a Musculoskeletal Disorder
What is a Comprehensive Musculoskeletal Exam for Disability?
You may have a comprehensive musculoskeletal examination completed if you are considering applying for disability benefits from the Social Security Administration (SSA) because of a musculoskeletal disorder. A thorough musculoskeletal exam can help complement other medical evidence you have available that can support an application for disability benefits.
The criteria the SSA uses to determine whether you are eligible for benefits is described in the Blue Book under section 1.00 – Musculoskeletal Disorders. The conditions covered by this category are quite diverse, and include disorders of the skeletal system, including the spine as well as the soft tissues in the muscular system. Disorders of the spinal cord, which is enclosed by the spine, are listed in a different part of the Blue Book.
The SSA assesses all the medical evidence that you supply with your application to determine whether you are eligible. You must be able to show that your symptoms match the Blue Book listing and that they prevent you from working for at least 12 months.
Many applications are initially rejected because of insufficient evidence provided to support the application. A musculoskeletal examination by itself would not be sufficient to establish whether your medical condition is serious enough, but taken in conjunction with other results, such as scans, x-rays, ultrasounds, etc., may help to establish eligibility.
A comprehensive musculoskeletal examination considers and measures such things as:
your ability to walk, run, sit, stand, bend, etc.;
the ability of your joints to move correctly, inspecting the range of motion (rom) of each joint;
degree of joint inflammation;