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Medical Criteria Needed to Qualify with an Amputation

Experiencing a health crisis that requires the removal of a part of your body is a devastating, life-altering moment. Whether it was caused by an accident, infection, or as a result of another illness, an amputation requires many accommodations to your life.

While some people may go on to leading a relatively healthy life, others will be unable to work or function as they did in the past. Thankfully, the Social Security Disability Program (SSDI) was designed to assist individuals, such as yourself, who have become disabled due to the need for an amputation.

Not all individuals who apply for SSDI for an amputation will be awarded financial assistance for their disability. In fact, the majority of amputation patients will not qualify for SSDI merely due to their loss of limb.

Each person who applies for financial support from the Social Security Administration (SSA), is responsible for providing the evidence regarding their condition and its severity.

Your ability to provide thorough, accurate, and timely medical evidence to the Social Security Administration (SSA) will significantly impact your chances of receiving a disability benefits reward.

The Importance of the “Blue Book”

The SSA uses a medical guide, known as the Blue Book, to determine whether or not a condition such as an amputation is severe enough to warrant disability payments. The criteria with which you need to have in order to be approved for an amputation is listed in section 1.05 of the Blue Book.

However, many people who require amputations have additional comorbidities, such as vascular disease. You may also be evaluated using the criteria for the disease which caused the need for an amputation.

To help you with the information gathering process, below is the most relevant medical evidence that you will need to provide to give you the best chance of being approved for SSDI.

It is of vital importance to work with your health care providers to ensure that you have completed all of the medical tests required by the SSA and that all of your medical evidence is in order.

Evidence Needed Related to Your Amputation

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your amputation. You should be able to provide the following evidence:

  • Which limbs have required amputation
  • Any inability to ambulate effectively, such as to walk sufficient distances at a reasonable pace
  • Your ability to ambulate up and down stairs, including whether or not you need to use a handrail
  • Any required use of assistive devices such as two canes, two crutches, or a walker or wheelchair
  • Any pain that you experience related to movement
  • Your ability, or lack thereof, to travel without a companion to and from work or school
  • Any difficulties you have grocery shopping, banking, using public transportation, preparing a meal, feeding yourself, showering, etc.

All of your surgical records from your orthopedic surgeon should be included, including a full operative report.

  • X-rays, CT scans, MRIs, radio-nuclear bone scans, or other imaging results that may help to confirm any difficulty that you have had healing from your surgery.
  • Any secondary infections or complications that may have occurred as a result of your surgery, including skin infections, wound infections, and blood clots.
  • The SSA considers financial assistance for an amputation if the individual has not returned, or is not expecting to return, to adequate ambulation within a year. Therefore, longitudinal records are critical to your application.

While any doctor can provide this information, the SSA gives more weight to the opinion of medical specialists. Therefore, if you are currently working with additional health care providers beyond your primary care physician, be sure to obtain their assistance in gathering this necessary medical information.

Evidence Needed Related to Your Amputation Medications and Treatments

Many patients who require an amputation take medications, which may include analgesics and NSAIDs. In rare cases, some people may still require steroid injections or pain blocks. Other treatments for amputations include physical therapy, occupational therapy, and lifestyle modifications.

It is critical that your physician documents the following:

  • Medications you receive, including the doses
  • How often you require medication
  • Any side-effects that you have experienced related to your medications
  • Any physical or occupational therapy that you receive and how often it is required
  • Any changes to your life as a result of your amputation.

Information on your reactions and side effects to your treatments are essential to provide to the SSA because not every person who requires an amputation will meet a Blue Book listing.

So long as you can prove that you’re still too ill to work due to complications that will persist for at least one year, you might still qualify if you pursue the claim further.

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

If you have experienced complications from your amputation, it is vital that your physician document your quality of life and ability to care for yourself. Your physician should provide notes documenting his or her opinion regarding your limitations and inability to function without unscheduled breaks or days off.

The more specific that your doctor is about your limitations, the better your chances are of being approved for disability benefits. If you are unable to work due to limitations from your disease, you may still qualify for disability through a residual functioning capacity assessment.

Steps You Can Take to Win Your Disability Claim

Applying for Social Security disability benefits can be a time consuming and confusing process. Your ability to gather your medical evidence will be the single most crucial factor in your Social Security disability claim for your amputation.

While you don’t need to provide medical documentation to the SSA yourself, it is helpful to be as organized as possible. When you visit your doctor, it is a good idea to present a written list of symptoms and side-effects that you are experiencing.

There are several ways that your physician can help including:

  • Ensuring that your full medical history is up to date, including how well you are healing from your surgery
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects
  • Carefully documenting your physical exam, including all limitations

While some individuals feel comfortable applying for SSDI benefits alone, a Social Security disability attorney or advocate can offer invaluable assistance. In addition to making sure that your application is thorough, they can answer questions, act as your advocate, and expedite the process.

Remember, your lawyer will not get paid unless you win your amputation claim.

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