Avascular necrosis, or bone death (osteonecrosis), happens when an area of the bone does not get enough blood supply. Avascular necrosis causes small breaks throughout the bone structure that can eventually lead to fractures. The hips are a common place for avascular necrosis to occur.
Trauma to a joint or bone in the area, the long-term use of some steroidal medications, excessive consumption of alcohol, and sickle-cell anemia can all cause or contribute to avascular necrosis. This condition is also sometimes called aseptic necrosis or ischemic bone necrosis.
The symptoms of avascular necrosis are pain in the joint, reduced range of motion, and stiffness, and vary in intensity depending on the stage of the disease. Some patients feel no pain from the disease.
Avascular necrosis is treated with medications, physical therapy, and in more serious cases, surgery. Prognosis depends on what joints have been affected and how far the bone death has progressed.
To determine whether you are eligible for disability because of your avascular necrosis, the Social Security Administration (SSA) must examine the documented symptoms of your condition and decide whether they actually prevent you from working.
First, the SSA will determine whether your avascular necrosis is eligible for automatic approval under any of its disability listings. Although avascular necrosis is itself not a listed disability, if you have suffered major damage to your joints as a result of the disease, you may be eligible for automatic approval under the joint listing.
To win automatic approval for joint problems due to your avascular necrosis, you must:
The affected joint must be either a weight-bearing joint that causes you to be unable to walk without a walker, two crutches, or two canes; or an important upper extremity joint (like a shoulder, elbow, wrist, or hand) that stops you from performing delicate movements (like sorting papers or buttoning your clothes) or larger movements (like reaching for something at or above waist-level or lifting something).
You should meet with your doctor to review the criteria of the disability listing on joints so that you can determine if your avascular necrosis satisfies the requirements of this listing.
If you had hip replacement surgery due to bone death in your hips, you may be able to get disability benefits if you are still unable to walk properly after surgery. For more information, see our article on disability benefits after hip replacement surgery.
You can still win your disability claim even if you don’t meet the above listing requirements. A disability examiner who works for Social Security will decide, based on the medical evidence you have provided, whether you can still do your old job. If the examiner believes you can still perform your past work, your claim will be denied; if, on the other hand, the examiner agrees that you can no longer do your old job, the examiner will determine whether there is any other work you could do.
To make this determination, the examiner will review all the medical evidence you have provided in support of your claim and prepare a Residual Functional Capacity assessment (RFC). An RFC details how your avascular necrosis has affected your ability to perform certain job-related functions. For example, if the avascular necrosis has damaged the joints in your dominant hand so that you can no longer write or hold a pen, your RFC would reflect extreme limitations in your ability to perform fine motor skills. Without the use of your dominant hand, it would be difficult for you to perform most secretarial work. It would also be hard for you to perform sorting or assembly jobs that require manual dexterity in both hands.
There may be environmental restrictions reflected in your RFC, as well, which are restrictions about the types of work you can do. For example, if your affected joint is in the knee, foot, or ankle, you would be unable to perform jobs that require balance or climbing. This limitation would prevent you from performing many construction positions.
If you have developed avascular necrosis in your knee or hip, you will be limited as to what jobs you can perform. For example, your RFC may limit your ability to lift and carry objects to those that weigh less than 15 pounds, limiting your work to more sedentary positions, such as an order taker or receptionist.
If you are limited to lifting and carrying objects that weigh less than 10 pounds, you would be unable to perform almost all jobs. Necrosis in your hips and knees may also prevent you from kneeling or stooping. The complete inability to stoop usually results in a disabled finding.
If you have osteonecrosis in both your hips and a bone in your arm, but it has not advanced to the stage where you would meet the requirements of the joint listing (above), you could get disability benefits because you might be limited to sedentary work because of your hip problems, but be unable to do the fine motor skills required in most sedentary jobs.
For more information on how Social Security decides what you can and can't do and how that translates into the decision to grant you disability benefits, see our section on RFCs and when you can't perform most sedentary work.
In addition to the medical requirements, to be approved for disability, you cannot earn more than about $1,200 per month from working, and your disability must prevent you from earning that amount for at least 12 months. There are additional requirements depending on the program you qualify for: SSDI (for people who have a qualifying work history with employers who have paid taxes to the SSA or SSI (for those who meet the SSA’s income and asset tests).