Social Security Disability (SSDI & SSI) for Avascular Necrosis

Avascular necrosis, or osteonecrosis ("bone death"), can happen when the blood flow to bone tissue is cut off. Avascular necrosis causes small breaks throughout the bone structure that can eventually lead to fractures. The most common place for avascular necrosis to occur is the hips.

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. Doctors sometimes refer to the condition as aseptic necrosis or ischemic bone necrosis.

Symptoms and Treatment of Avascular Necrosis

The symptoms of avascular necrosis include joint pain, reduced range of motion, and stiffness. Symptoms vary in intensity depending on the stage of the disease. Some patients feel no pain from the disease, while others may experience pain that significantly restricts their daily activities.

Treatment for avascular necrosis includes medications, physical therapy, and (in more serious cases) surgery. A patient's individual prognosis—doctors' predictions about how well somebody will recover—depends on what joints have been affected and how far the bone death has progressed.

Can I Get Disability for Avascular Necrosis?

If your documented symptoms of avascular necrosis keep you from working full-time for at least one year, you might be eligible for disability benefits from the Social Security Administration (SSA).

You can qualify for disability benefits in one of two ways:

• you meet or "equal" the requirements of a listed impairment, or
• you're unable to work at any job because of your severe impairment.

Before the SSA can determine whether you're disabled, however, the agency needs to see that you meet the financial eligibility requirements for at least one of the disability programs administered by Social Security.

• Social Security Disability Insurance (SSDI) is an entitlement program where eligibility is determined based on your work history.
• Supplemental Security Income (SSI) is a needs-based program available to everybody with less than a certain amount of income and assets.

For more information, see our article on the differences between SSDI and SSI.

Getting Disability for Avascular Necrosis by Meeting a Musculoskeletal Listing

The SSA maintains a category of medical conditions that the agency considers especially severe. Applicants for disability benefits who have certain specific evidence in their medical records can get benefits automatically without needing to prove that they can't do any job. Qualifying for disability this way is known as meeting (or "equaling") a listed impairment.

Avascular necrosis isn't a listed impairment, but if you've suffered major damage to your joints as a result of the disease, you might be eligible for automatic approval under one of the musculoskeletal system listings. For example, because avascular necrosis is commonly found in the hip, any complications you have in the hip may be evaluated under listing 1.18, Abnormality of a major joint.

In order to meet the requirements of listing 1.18, you'll need to have all of the following in your medical record:

• evidence of joint pain and stiffness
• abnormal motion, instability, or immobility of the affected joint, and
• physical examination or imaging of a joint abnormality that shows the damaged bone.

You'll also need to show that the joint is a weight-bearing joint that results in either:

• an inability to walk without a walker, two crutches, or two canes, or
• if an important upper extremity joint (like a shoulder, elbow, wrist, or hand) is affected, you can't perform delicate movements (like sorting papers or buttoning your clothes) or larger movements (like reaching for something at or above waist-level or lifting something).

Other, related listings that you may qualify for include listing 1.19 for pathologic fractures and listing 1.20 for amputations. You should meet with your doctor to review the criteria of the musculoskeletal disability listings so that you can determine if your avascular necrosis satisfies the requirements of one (or more) listed impairments.

Getting Disability for Avascular Necrosis by Being Unable to Work

Few disability applicants have the specific medical evidence required to meet or equal a listed impairment. But you can still win your disability claim even if you don't meet the listing criteria as long as you can show that symptoms from avascular necrosis result in a residual functional capacity (RFC) that rules out all jobs.

How Social Security Determines Your Residual Functional Capacity

Once you file your application for disability benefits, a claims examiner will review all the medical evidence you have provided and prepare an assessment of your RFC. Your RFC details how your avascular necrosis has affected your ability to perform certain job-related functions.

If you've developed avascular necrosis in your knee or hip, you'll likely be limited as to how long you can sit, stand, or walk for—what the SSA calls "exertional limitations." Your RFC will list these. You might also have additional restrictions in your RFC that aren't strength-related ("non-exertional limitations"). For example, if avascular necrosis has damaged the joints in your dominant hand to the extent that you can no longer write or hold a pen, your RFC would limit your ability to perform fine motor skills. Or if your affected joint is the knee, foot, or ankle, your RFC would restrict you from jobs that require balance or climbing.

How Social Security Uses Your Residual Functional Capacity

The SSA doesn't expect you to do a job that's beyond your capabilities. So the claims examiner will compare the restrictions in your RFC with the duties required of your past jobs, to see if you could return to that type of work. If you can't, the examiner will then need to determine if any other jobs are available that you can do with your current RFC.

For example, your RFC may restrict the time you spend on your feet to a maximum of 2 hours per 8-hour work day, limiting your work to more sedentary positions, such as an order taker or receptionist. But if you can't perform fine motor skills, it would be difficult for you to perform most secretarial work, or any sorting or assembly jobs that require manual dexterity in both hands.

Or, if you're unable to perform jobs that require balance, or climbing, you'd be excluded from performing many construction positions. Likewise, necrosis in your hips can prevent you from any stooping or kneeling—limitations that can rule out all jobs.

Most people under the age of 50 need to show that they can't do even the easiest sit-down jobs before Social Security can award them benefits. But applicants 50 years of age and older may qualify for benefits just by being able to show that they can't perform their past work (and can't learn a new one) under a special set of rules called the medical-vocational grid.

Appealing a Disability Denial for Avascular Necrosis

If a claims examiner reviewed your application and thought that you were able to return to your past work or that other jobs exist that you could do, you'll receive a denial letter. (You'll also receive a denial letter if you didn't meet the financial eligibility requirements for SSDI or SSI.)

Don't get too discouraged if your initial application for disability benefits was denied. You always have the option to appeal the denial, and can eventually request a hearing in front of an administrative law judge. Our survey results show that most disability applicants who are ultimately granted benefits don't get approved until after they've been in front of a judge. You may also want to consider contacting a disability attorney to help increase your chances of a successful appeal.