Do Broken Bones Qualify for Social Security Disability?

Broken bones (“fractures”) are some of the most common injuries seen at hospitals or doctors’ offices. While most fractures heal within a few months and don’t cause any permanent limitations, complications can sometimes occur that may potentially be seen as disabling, depending on how significantly the fracture impairs your ability to function (and for how long).

The Social Security Administration (SSA) only awards benefits to people who have a medical impairment that keeps them out of work for at least 12 months, so if your broken bone is as good as new after several months, you won’t qualify for disability. But complex fractures or surgical complications can extend your recovery period well beyond the one year mark. Before you apply for disability benefits, it’s a good idea to learn some of the legal and medical basics so that you can make your claim as strong as possible.

Are Broken Bones a Disability?

Not often, but they can be. Social Security will consider you disabled if you have a medically determinable impairment that keeps you from earning at or above the level of substantial gainful activity for a year or longer. Because most broken bones heal within a few months, they usually don’t qualify for disability benefits (SSDI or SSI).

Bones that don’t heal properly or require extensive surgical intervention are more likely to meet the agency’s definition of disability. That means you’ll need to show either that your fracture meets a Blue Book listing or that it causes functional limitations that keep you from working regularly at any job. Usually, this will depend on how severe the fracture is and which bone is broken. A broken ankle that doesn’t heal well can affect your ability to walk and stand on the job, for example.

Qualifying for Disability by Meeting a Listing for Bone Fractures

“Listings” are medical conditions that the SSA considers especially severe. The agency can award you disability benefits if you have documentation that exactly matches, or is equivalent to, the requirements of a listed impairment. This is known as “meeting (or equaling) a listing.”

There are two listings in the Blue Book—the agency’s medical impairment manual—that address broken bones. Listing 1.22 covers certain bones in the pelvis, leg, and foot, and listing 1.23 covers broken bones in your arms. (The SSA assesses back injuries and head injuries—including impairments caused by spine or skull fractures—under the listings for neurological disorders.)

Listing 1.22 for a Non-Healing or Complex Fracture of the Leg, Ankle, or Foot

You may be eligible for disability benefits under listing 1.22 if you have a broken femur (thigh bone), femur (thigh bone), tibia (the large shin bone) pelvis, or one or more talocrural (ankle) or tarsal (foot) bones, including the calcaneus bone in the heel. In order to meet the requirements listing 1.22, you'll need to have the following evidence in your medical records:

• an X-ray, CT scan, or MRI showing there isn't a solid union of the bone (that is, the bone in question is broken)
• a physical exam in which the doctor can feel or tell by movement that the bones haven't reunited, and
• a documented need for a walker, two canes, two crutches, or a seated mobility device requiring the use of both hands to operate.

You’ll also need to show functional limitations that have lasted, or are expected to last, at least 12 months. So if you had to use a walker for three months only, you won’t meet or equal the listing.

Listing for a Non-Healing or Complex Fracture of a Broken Arm

Bone fractures in your upper extremities (arms) are covered in listing 1.23. To get disability under this listing, you’ll need to show the following:

• you're still under a surgeon's care for a break in your upper arm bone (humerus) or a bone in your forearm (radius or ulna), and
• you're unable to begin, sustain, and complete work-related activities that require "fine or gross" movements of your arms or hands.

Again, you’ll need to show that these functional limitations have lasted or are expected to last for 12 months in order to meet the listing, and you’ll need to have medical imaging (X-ray, CT scan, or MRI) showing that the bone hasn’t healed properly or is a complex fracture.

Note that you can only meet the requirements of the listing for a non-healing broken arm bone if you're awaiting additional surgery or medical treatment that's expected to improve function in your arms. If your doctors are done treating your fractures and you still have problems using your arms and hands, you won't meet the listing, but you can try to prove you can no longer work any job.

Qualifying for Disability by Proving You Can No Longer Work After a Bone Fracture

Most people aren’t able to meet or equal the strict requirements of a Blue Book listing. But you can still qualify for disability if you can show that limitations in your residual functional capacity (RFC) rule out all full-time work. (Getting benefits this way is also known as a “medical-vocational allowance.”)

Your RFC is an assessment of the most you’re capable of performing, physically and mentally, in a work environment. For example, if you have a complex or non-healing bone fracture, you might have reduced ability to use the injured limb due to nerve damage. A broken bone can also cause contracture of the surrounding muscles that can make it hard to move, or joint space fractures ("articular or periarticular fracture") that can cause difficulty using the joint.

Social Security reviews your medical records and your activities of daily living to determine what limitations should be included in your RFC. If you have an upper extremity fracture, your RFC will contain restrictions on how much weight you can lift and carry, how long you can push and pull, and whether you’re able to reach overhead and to your sides. An RFC for somebody with fractured lower extremity bones will include restrictions on how long you can stand and walk, as well as whether you need to elevate your legs to reduce pain.

Once the agency has arrived at your RFC, it will compare the limitations in your RFC with the demands of your past work. If you can’t do your past work with your current RFC, Social Security will then look to see if any other jobs exist that you can do given your limitations. For most people under the age of 50, this usually means needing to show that you can’t do even the simplest sedentary work. People 50 years old and older may have an easier time qualifying for benefits thanks to a special set of rules called the medical-vocational grid.

Medical Evidence You’ll Need to Show to Get Disability for a Bone Fracture

Your medical records are the foundation of your disability claim. Without medical evidence, the SSA can’t award you benefits, whether by meeting a listing or through a medical-vocational allowance. Because broken bones often heal within a few months, it’s especially important that you have medical documentation of all of the steps you’ve taken to treat the fracture and why it hasn’t been fixed properly within a year.

Documenting the Fracture Itself

The SSA will be looking for evidence that you have a broken bone in the first place. Your medical records should include medical imaging showing that the fracture hasn't healed properly (meaning there isn't a solid union of the bone) or that the fracture is complex. Complex fractures usually have one or more of the following features show up on X-ray, MRI, or CT scan:

• bone fragments
• more than one break in a single bone
• bone loss due to severe trauma
• damage to the surrounding soft tissue, or
• severe cartilage damage to or dislocation of the associated joint.

If you were hospitalized as a result of your broken bone, your records should contain the hospital admission and discharge documents. Surgical procedures should also be included, as well as any medications and ambulatory devices you were prescribed.

Documenting Complications from Bone Fractures

Bone fractures can cause other complications that can lead to long-term impairments. Some of these complications occur at the time of injury, while others show up days or even months later. Possible immediate complications of bone fracture include injuries to soft tissue (like muscles, joints, tendons, ligaments, and major blood vessels) and damage to internal organs (such as your heart, kidneys, liver, or brain).

Some complications won't surface until a few days or weeks after you break a bone. Some of these complications can be dangerous and even life-threatening, such as:

• infection (most common in open fractures and those requiring surgery to repair)
• compartment syndrome (internal swelling that causes compression of nerves, blood vessels, and muscles)
• embolism (blood clot), including a pulmonary embolism which can result from leg, hip, and pelvic fractures, and
• adult respiratory distress syndrome (which causes fluid to build up in the lungs).

If you suffer broken bones in a serious accident and lose a lot of blood, you could develop hypovolaemic shock (also called hemorrhagic shock), which can cause major organs to stop working. That can sometimes lead to long-term impairments. Other complications that may not develop until weeks or months after the fracture may include:

• improper healing (the bone not rejoining or healing in a deformed way)
• shortening of the bone
• bone death due to lack of oxygen
• myositis ossificans (bone growth within the muscle, causing pain)
• Volkmann's contracture (permanent tightening of the hand at the wrist making your hand look like a claw and severely restricting the use of your fingers), and
• complex regional pain syndrome (CRPS) which can cause muscle wasting (atrophy), stiffness, and chronic pain.

Your doctor's treatment notes should include a medical source statement explaining your limitations and how the objective medical evidence supports your doctor’s findings. Physical therapy reports demonstrating a reduced range of motion in the affected limb can also bolster your claim.

Social Security Considers Any Mental Impairments

If you're filing an SSDI or SSI claim for bone fractures, you'll likely apply based on your physical difficulties. But your mental abilities might be affected as well, especially if you're experiencing significant, ongoing pain. Chronic pain can affect your ability to work. It can be distracting, making it difficult to stay focused on tasks, and if the pain interrupts your sleep, your stamina might be further limited due to fatigue. Pain can also make it hard for you to deal with stressful situations or conflicts with co-workers.

If you claim that pain or fatigue affects your ability to work, or this is mentioned in your medical records, Social Security will use a mental RFC form to assess your ability to complete work tasks, handle work stress, and interact with coworkers and supervisors. Make sure to let your doctors or therapists know about how any pain you’re experiencing is affecting your cognition so that your symptoms can be recorded in your medical notes.

Do I Get SSDI or SSI Benefits for Broken Bones?

Before Social Security can determine whether you’re medically disabled, you’ll first need to meet the non-medical eligibility requirements for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). SSDI pays more per month than SSI, but eligibility for SSDI is determined by your work history, so you might not qualify if you haven’t worked in a long time. SSI is available regardless of your work history, but you’ll need to show that you have income and assets below certain levels.

If you’re awarded benefits, the exact monthly amount you’ll receive will depend on whether you qualify for SSDI or SSI. For more information, check out our articles on how much you’ll get from SSDI and how much you’ll get from SSI.

How to Apply for Disability Benefits

Filing for SSDI or SSI is a fairly straightforward process. You can choose from one of the methods below to begin your application.

• One easy way is to file your claim online. You don’t have to complete the application in one sitting, and you’ll get a tracking number so you can check the status of your claim.
• You can also apply over the phone by calling Social Security at 800-772-1213 (TTY 800-325-0778) 8 a.m. and 7 p.m., Monday through Friday.
• If you prefer to file in person, you can schedule an appointment with a representative at your local Social Security field office.

For more information, see our article about applying for Social Security disability benefits.

What If Social Security Denied My Claim?

Getting SSDI or SSI for broken bones can be a challenge. Social Security will probably be skeptical that such a common injury is serious enough to keep you out of the workforce entirely, at least at first. Because it takes several months for the agency to process your initial application, your bone may not have healed yet, but it could be too soon to tell whether you’ll be back in shape before 12 months have passed.

If the SSA denied your claim because the agency thinks you’re likely to recover within a year, you can appeal the denial. An appeal gives you the chance to gather more evidence, and the passage of time will provide more clarity on whether your bone will heal well enough (and soon enough) for you to return to work. By the time you’ve requested a hearing with an administrative law judge, it’s likely that one year will have passed. If your scheduled hearing date arrives and you’re armed with enough evidence showing that your fracture still isn’t restored to the point where you can work, you’ll have much better odds of getting a favorable decision, especially if you’ve enlisted the help of an experienced disability attorney to develop your claim.