The Social Security Administration establishes impairment listings to determine whether or not the medical evidence, on its face, establishes a disability, and qualifies a person for disability benefits.
The “Muscoskeletal” impairments address joint and muscle disorders. This article focuses on Listing 1.02, entitled “Major dysfunction of a joint (due to any cause).”
The listing requires evidence of a “gross anatomical deformity.” This could be a “subluxation,” “contracture,” or “fibrous anklyosis, instability.” Along with any of these findings, there must be chronic joint pain and stiffness with signs of limitation of range of motion, or some other abnormal motion of the affected joint. In addition to all this, your records must show on an x-ray are MRI, some kind of finding, including joint space narrowing, bony destruction, or ankylosis of the affected joint.
That is not all. You also have to establish that these problems are occurring in a weight-bearing joint, and that you are not able to “ambulate effectively.” For shoulder and arm, wrist or hand conditions, you must also show that your condition significantly limits "fine and gross movements.”
Let’s start out with “gross anatomical deformity.” The term “subluxation” means that the joints are not aligned properly. The knee joint may have damage that causes it to align improperly, causing significant problems.
A “contracture” refers to a permanent shortening of a muscle, tendon, or ligament. This is a condition common in cerebral palsy, and can also result from a traumatic brain injury, or some other neurological issue.
An “ankylosing” joint is a joint that is permanently stiffened. This could be due to chronic inflammation of the joint structures, or a buildup of bony arthritis that permanently limits the ability to move the joint.
The listing then addresses objective signs of limited range of motion. Often times, when a patient sees an orthopedist or a physical rehabilitation doctor, the physician will perform range of motion testing. Although there is some voluntary aspect to this testing, it is generally considered an objective finding. This means that the doctor can observe the limitation without asking for patient feedback.
Even if there is an objective sign of limited range of motion, Social Security also wants some imaging study to confirm the abnormality in the joint. This is an even more objective finding, because it is a picture of the problem. The listing refers to “joint space narrowing.” Joint space narrowing can occur in the spine where the intravertebral disc is dehydrated, and results in a narrowing of the space between the neck or back bones. “Bony destruction” refers to a wearing down of the actual bone, which could be due to arthritis, or the after effect of an injury.
The last part of the listing addresses “ineffective ambulation.” This requirement applies to problems in the hip, knees, or other "weight bearing joints." This phrase simply means that you are not able to get around very well. Social Security defines this as an “extreme limitation of the ability to walk.” The level of limitation may require some sort of assistive device that requires both hands, like a walker, or crutches. However, there are examples in the listing of limitations in getting about, even without the use of a walker or crutches.
For shoulder, arms and hand conditions, the listing refers to an inability to perform “fine and gross movements.” This means that the claimant is unable to effectively reach, push, pull, grasp or finger in order to carry out everyday activities. Examples include preparing meals, eating, taking care of personal hygiene, or sorting through papers or files.
As with most of these impairment listings, there is a heavy emphasis on clinical findings and objectively verifiable test results. Although many people will be found disabled even if they do not meet a listing, reviewing the listing provides a useful framework for gathering the information you need to prove disability.
If you have questions about what medical evidence you must gather in order to prove disability under Social Security, call us at 503-325-8600. We have extensive experience reviewing medical records, and working with physicians to document disability.
