Getting Social Security Disability for Bone Fractures

People who've been in car, motorcycle, or other accidents often have multiple broken bones, but most are denied benefits because the breaks are expected to heal fully within a year.

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Broken bones (known as fractures) can occur in any bone in the body. The place of the broken bone in the body and the severity of the break affect how you may be impaired by the broken bone. While most fractures heal without permanent injury, there are several complications that can occur with broken bones. These complications can lead to disability. Below is an outline of possible complications and the timeline in which they normally occur.

Potentially Disabling Complications From Bone Fractures

Immediate complications (complications that occur at the time of the fracture)

  • Injury to muscles, joints, major blood vessels, and organs
  • Hypovolaemic shock (quick loss of body fluid that causes major organ to stop working) if significant other injuries accompany the bone fracture

Early complications (complications that occur within a few days after the fracture)

  • Infection
  • Compartment syndrome (the compression of nerves, blood vessels, and muscles in a closed area of the body due to swelling)
  • Hypovolaemic shock (quick loss of body fluid that causes major organ to stop working) if other significant injuries accompany the bone fracture
  • Embolism (blood clot)
  • Adult respiratory distress syndrome

Late complications (complications that occur a while after the fracture)

  • Improper healing, including the bone not rejoining, or healing in a deformed way
  • Bone death due to lack of oxygen
  • Shortening of the bone
  • Sudeck's dystrophy, which can cause muscle wasting and stiffness and pain
  • Bone infection
  • Volkmann’s Contracture, which is permanent contracture of the hand at the wrist (making your hand look like a claw). Use of your fingers is severely restricted and forced movement of your fingers is very painful.
  • Myositis ossificans, which is when the bone grows within the muscle, causing pain.

Qualifying for Social Security Disability Benefits

There are two ways in which you can qualify for Social Security Disability benefits. First, you can prove that you meet or equal the requirements of a disability listing from the Social Security “Blue Book,” which contains a list of impairments that are predetermined to be disabling based on their severity. Secondly (if you do not meet or equal a listing), you can show that you are unable to work.

Meeting a Listing

There are two listings in the Blue Book that cover broken bones. Specifically, there is a listing that covers certain bones in the pelvis, leg, and foot, and another listing that covers broken bones in your arms.

Lower extremity fracture. This listing requires a break in your femur, tibia, pelvis, or one or more tarsal bone with:

  • An X-ray or other imaging showing there is no union of the bone (no healing)
  • A physical exam in which the doctor could feel or tell by movement that the bones had not reunited, and
  • The inability to walk effectively that has lasted, or is expected to last, for at least 12 months.

Social Security generally requires that your fracture hasn't unhealed for least six months and a doctor's opinion that it is unlikely to heal for a total of at least 12 months. The doctor must have evidence to back up this opinion. See our article on getting disability for hip replacement for a discussion of what Social Security considers to be an inability to walk effectively.

Upper extremity fracture. This listing requires a break in the humerus, radius, or ulna with:

  • An X-ray or other imaging showing there is no union of the bone (no healing)
  • Being under treatment of a surgeon directed toward restoring use of the arm, and
  • Function not having returned and not being expected to return within 12 months.
The requirements of the listing for a broken arm or forearm bone can only be satisfied while you're under the care of a surgeon. If you haven't had any improvement for six months after a surgical procedure, Social Security usually assumes that you won't get any better with more treatment and will no longer consider you to be under active surgical management.

For both of these listings, your lack of functional abilities should be shown through treating doctor’s notes of limitations, supported by medical evidence as to the reason for the limitation. Physical therapy reports, if available, would be helpful to show real functional limitations.

Equaling a Listing

If you do not meet one of the above listings, your condition may "equal" (be considered equivalent in severity to) a listing if your impairments are similar to but not exactly the same as in a listing. To equal a listing, your impairment must be equal to that listing in severity and duration.

Those with broken bones may equal a listing if they broke a bone that causes the same functional limitations as the listing but isn't a bone that is listed in the listing. Alternately, an applicant may have a broken bone that is listed, and the bone healed fully, yet there are still functional limitations due to other problems, such as nerve or muscle damage caused by the break. If you have one of the other complications listed above after your bones have healed, the resulting impairments may be able to meet a listing. (See our section on medical conditions for all of the listings.)

A Decrease in Your Ability to Work

If your bone fractures do not meet a listing, you could still be eligible for disability benefits if you are unable to do any job. In assessing whether there is any work you can do, Social Security uses a Residual Functional Capacity (RFC) form, which assesses your physical and mental limitations.

For example, if your broken arm bones have affected your ability to lift, push, pull, or reach overhead, this should appear in your RFC. If you have leg bone fractures that make it hard for you to stand, sit, or walk for certain periods of time, this should be in your RFC. Those with improperly healed breaks may have limitations in use of the injured limb due to nerve or muscle damage. Or if there is bone death or contracture of the muscles due to the break, an individual may have no use of that limb. In addition, sometimes a fracture into a joint space will cause arthritis that makes it difficult to use the joint.

While most applicants filing for disability because of fractures apply on account of physical difficulties, their mental abilities may be affected as well. Individuals who experience significant ongoing pain may be distracted by the pain and have difficulty maintaining attention to tasks. If the pain interrupts sleep, concentration may be further limited due to fatigue. Additionally, constant pain may decrease one’s ability to deal with stressful situations or conflicts with co-workers.

If you claim in your application that pain or fatigue affects your ability to work, or this is mentioned in your medical records, Social Security will assess your ability to complete work tasks, to handle work stress, and to interact properly with coworkers and supervisors in a mental RFC. With regards to reports of pain, Social Security requires medical documentation that proves the possible sources of the pain in order to properly weigh the effects of the pain on your overall impairments. (For more information, read our article on how Social Security evaluates chronic pain.)

After Social Security assesses all the above limitations, the agency will consider whether they keep you from doing your prior work. If so, the agency will then consider your limitations along with your age, education, and work experience to decide whether there is other, less demanding work that you can adjust to. For more information on this analysis, see our series of articles on how Social Security decides whether you can work.

by: , Contributing Author

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