Getting Disability Benefits After Knee Replacement Surgery

Knee replacement surgery—whether partial or total—involves the substitution of plastic or metal parts to repair damaged tissues and bone in the knee joint. Surgery is often recommended for patients with advanced knee problems such as degenerative joint disease or osteoarthritis.

Orthopedic surgeons perform almost 800,000 knee replacements per year in the U.S., and the vast majority are successful. Many people recover from surgery in a few weeks or months, but complications can extend the recovery window, sometimes significantly. If you're still unable to work full-time one year after your surgery, you may qualify for Social Security disability benefits.

Permanent Restrictions After Knee Replacement

Most people under 55 or 60 recover well enough from knee replacement surgery to go back to work within a year, meaning they won't be eligible for Social Security disability. But sometimes the surgery isn't completely successful in reducing knee pain or restoring range of motion in the joint. While most patients do report some improvement in pain and mobility following surgery, this improvement isn't always enough to allow them to return to work.

Other times, complications result in additional symptoms that can make full-time work a struggle. Difficulties following total or partial knee replacement surgery can include chronic pain, loss of flexibility, swelling, and joint locking or clicking. These problems may be caused by infection, defects in the artificial joint material, or loosening of the bond attaching the implant to the bone.

Due to the structural nature of these complications, they often require patients to undergo a second surgery ("revision") which can add many months to the time off work. Even after revision surgery, some people still report permanent limitations in their ability to walk and stand. When these limitations are significant enough to meet a disability listing or eliminate all jobs, Social Security will award an applicant benefits.

How to Get Social Security Disability for a Knee Replacement

When deciding whether you qualify for benefits for a knee replacement, Social Security determines whether you meet the criteria of a listed impairment (in which case you'll automatically get disability benefits) or whether you have functional limitations that restrict the type of jobs you can do. In either case, you need to be off work for at least 12 months— though this can include the time leading up to the surgery as well as the recovery period.

Qualifying for Knee Replacement Under the Musculoskeletal Listings

Listed impairments are conditions or disorders that Social Security considers especially severe. You can qualify for disability benefits if you have medical evidence that matches the requirements under a specific listing. People who've had knee replacement surgery may meet the criteria for listing 1.17, Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint or listing 1.18, Abnormality of a major joint in any extremity.

You can meet listing 1.17 if you can provide Social Security with evidence of all of the following:

• surgical records showing that you had partial or total knee replacement on one or both knees
• notes from your doctor that you have difficulty moving because of your knee problems, and
• documentation that you can't walk without an assistive device, such as a walker, crutches, two canes, or a wheelchair.

Note that this listing doesn't apply to knee replacements that fail years after surgery. Many knee replacements do loosen or deteriorate over time, sometimes requiring a second surgery, but this often doesn't happen until years after the first surgery. To qualify under listing 1.17, you have to be able to show that your difficulty walking started soon after your knee replacement surgery (following a reasonable period of recovery and rehabilitation).

If you have pain and trouble walking years after surgery, you could qualify for benefits under listing 1.18. This listing requires you to provide evidence of each of the following:

• ongoing knee pain or stiffness
• abnormal range of motion, instability, or immobility of one or both knees
• a physical examination or medical imaging (such as an X-ray or MRI) showing that something is wrong with your knee, and
• an inability to use both hands, either because you need them to operate an assistive device (like a walker or a wheelchair) or because you have another condition that limits your upper extremity functioning.

The criteria listed above must be present at the same time or within a "close proximity of time," typically meaning 4 months (12 months during the "pandemic period" beginning April 2, 2021 and ending on May 11, 2025). So if you had ongoing knee pain in 2020 but didn't have an MRI until 2024, Social Security might not count the MRI—unless, in a doctor's opinion, the MRI findings could be reasonably expected to have been present in 2020.

Qualifying Under the Medical-Vocational Guidelines for Knee Problems

Many people with knee problems, even those with failed knee replacement surgery, won't meet the strict requirements of the listings above. For instance, if you need one cane to walk (but not two), you're unlikely to meet a musculoskeletal listing. But that's not the end of the disability determination process. If you don't meet a listing, Social Security must then decide whether you can go back to your past work in your present condition, and, if not, whether other jobs exist that you can perform.

To determine your current capabilities, Social Security will create a residual functional capacity (RFC) statement for you. Your RFC is a description of what you can and can't do, physically and mentally, despite your limitations. For example, if you had a double total knee replacement, your RFC might say that you can't stand for more than two hours a day, climb a few stairs at a time while using a handrail, and walk on rough or uneven surfaces at a reasonable pace.

Social Security compares the limitations in your RFC to your prior job duties to see if you can still do that work today. If your old job was sedentary (a desk job, for instance), you'll have a tougher time getting benefits, because it's hard to show that knee replacement surgery keeps you from doing a sit-down job. But if your past job required lots of standing or bending, the agency is more likely to agree that you can't do your past work.

If you're unable to do your past job, Social Security then decides whether other, less demanding jobs exist that you can perform. Sedentary work can still require up to two hours a day of walking or standing, so if you can't be on your feet for that long—or you need to elevate your legs to relieve knee pain—the agency should find that you can't do sit-down jobs and award you disability. Applicants 50 years of age and older may be able to get benefits even if they can perform sedentary work using a special set of rules known as the medical-vocational grid.

Evidence You Need to Qualify for Disability After a Knee Replacement

You or your doctor will need to submit medical records showing a diagnosis of your knee problems, medical imaging such as X-rays, MRIs, or CT scans, and hospital admission and discharge notes for the dates of each surgery. It also helps to have your doctor fill out a medical source statement or an RFC form stating which movements you have difficulty with. Your RFC form should cover the following:

• how long you can walk for before you need to stop
• whether you need to use an assistive device such as a cane or walker
• whether you can walk on uneven surfaces
• how long you can stand for before you need to sit or lie down
• whether you need to elevate your legs while sitting
• whether you can crouch, stoop, kneel, or bend
• how much weight you can lift or carry, and
• whether you can climb stairs alone or with the use of a railing.

You can click on the thumbnail below to view a sample completed RFC form for a disability applicant with a total knee replacement. The sample form is meant to give you an idea of the kinds of medical opinions that Social Security finds persuasive. Try to get your doctor to be as comprehensive when filling out the RFC form. Don't worry if your form doesn't match the example form exactly—it should be tailored specifically to your medical history and limitations.

Social Security will also want to see what treatments you have tried post-surgery, such as pain medication, physical therapy, vocational rehabilitation, and therapeutic injections. It's important to let the agency know whether there are any medications you can't take because the side effects affect your ability to function well.

Make sure that you also provide a report or diary about how your chronic pain impacts your activities of daily living—such as driving, housekeeping, grocery shopping, or socializing—as well as activities that require concentration, so that Social Security can consider these limitations when assessing your RFC. And if you have anxiety or depression due to chronic pain, the agency should consider these conditions in combination with your knee impairment.

Can You Get Short-Term Disability for Knee Replacement?

Social Security doesn't provide short-term disability benefits for people who are out of work for less than one year. (This is called the 12-month durational requirement.) However, you may qualify for private short-term disability benefits if offered by your employer, or temporary disability insurance if you live in one of the five states (California, Hawaii, New York, New Jersey, and Rhode Island) that provide public short-term disability benefits.

If you file a disability claim right after knee replacement surgery, Social Security will assume that the outcome of your surgery will be positive and that you'll be out of work for six months at most. As a result, Social Security denies many knee replacement claims for not meeting the 12-month duration requirement. But if you couldn't work for months leading up to the surgery due to knee problems or you have extensive postoperative treatment that keeps you out of work, the total time you're unable to work can easily add up to a year.

If you do recover from knee surgery enough to work while you're still waiting for a disability hearing, but after being off work for 12 months, you could get benefits for a "closed period"—a period with a fixed end. In any case, Social Security will wait to make a disability decision until you have had ample time to recover from the surgery and attempt to rehabilitate your knee. If you are approved for benefits, your case may be labeled "expected to improve." This means your case will likely be reviewed within a year or two after your benefits start.

Can I Get a VA Disability Rating for a Total Knee Replacement?

Veterans who have a service-connected knee replacement can get disability compensation from the VA. Unlike Social Security, the VA will assign a disability rating to your medical conditions according to how severely they limit your functioning. The VA then uses that rating in part to determine the amount of disability payments you'll receive.

The VA uses the Schedule of Rating Disabilities (38 CFR 4.71) to assign disability percentages to each condition. Veterans with a total knee replacement can receive a 100% disability rating for four months following the surgery, with a minimum 30% rating after four months up to a 60% rating if the veteran is experiencing chronic painful motion or weakness in the affected limb.

How to Apply for Disability Benefits

Filing for Social Security disability benefits is a fairly straightforward process. You have several options to choose from:

• Apply online using Social Security's web portal. Currently, SSDI applications can be completed entirely online, but SSI applications must be finished over the phone or in person.
• Call the national Social Security hotline at 800-772-1213 (TTY 800-325-0778) from 8 a.m. to 7 p.m., Monday through Friday, to speak with a representative.
• Visit your local Social Security field office. Some offices ask you to make an appointment ahead of time, so it's best to call ahead and check.

Veterans seeking disability compensation from the VA will need to complete Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. You can fill this form out online, or you can download it and mail it to the following address:

Department of Veterans Affairs
Claims Intake Center
PO Box 4444
Janesville, WI 53547-4444

You can also fax the completed Form 21-526EZ to 844-531-7818 (248-524-4260 if you're outside the U.S.), or bring it to your local VA office.

Getting Legal Help With Your Disability Claim

While you don't need to get an attorney to file for Social Security or VA disability benefits, it's generally a smart idea. According to a survey of our readers, having an experienced disability lawyer by their side dramatically increased their chances of winning benefits. Your attorney can help you gather the necessary medical evidence to support your claim and craft a winning argument for an administrative law judge. Most disability lawyers offer free consultations, so it doesn't hurt to ask around and find one who's a good fit for you.