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Qualifying for SSDI for Knee Replacement

Qualifying for SSDI for Knee Replacement

In the United States, around 700,000 knee replacements are performed each year, by Orthopedic surgeons, with the vast majority of them being successful. During partial or total knee replacement surgery, plastic and metal parts replace damaged tissues and bone in the knee joint. Depending on the severity of the injury, recovery time might range from a few weeks to a few months. You may be qualified for Social Security disability payments if you underwent knee replacement surgery on a knee with degenerative joint disease or after a serious knee accident and it failed.

How are Knee Replacements a Disability?

Knee replacements use metal and plastic pieces to replace a damaged knee that is in agonizing pain due to arthritis or an accident. There are three types of surgery: partial (removing only a section of one knee), total (replacing the entire knee), and bilateral (replacing both knees) (replacing both knees at the same time).

Qualifying for SSDI for Knee Replacement

A knee replacement is reviewed under the section 1.03 of the Blue Book, which deals with reconstructive surgery or surgical arthrodesis of a major weight-bearing joint. The SSA considers a knee replacement to be a successful procedure in general since most patients recover within a year.

However, there are some circumstances in which benefits may be granted. To assist you in gathering information, here is a list of the most important medical evidence that you will need to provide in order to be approved for SSDI.

When deciding on your claim, Social Security will consider whether you meet the criteria for one of its "medical listings [1.03] or other qualifiable 'symptoms' that prove your knee replacement is 'severe enough' to prevent you from working under substantial gainful activity (SGA)," in which case you will receive disability payments automatically, or if it must consider vocational variables, such as the type of work you can do. In any case, you must be off work for at least 12 months, which can include both the time leading up to the surgery and the time recovering from it.

Qualifying for Surgery of a Major Joint

The question is whether the SSA considers osteoarthritis of the knee a disability? Yes, it is considered as a disability provided you meet any of the following conditions.

Social Security examines knee surgery problems by looking at the following medical "listings" from its impairment listings:

  • - Reconstructive surgery on a large weight-bearing joint or
  • - A substantial joint deformity in any extremity.

To qualify for any of these lists, your knee difficulties must make walking or climbing stairs extremely difficult.

To be deemed incapacitated under the reconstructive surgery listing, listing 1.17, you must provide Social Security with the following evidence:

  • - Documents indicating that you underwent knee surgery on one or both knees (partial or total)
  • - Your doctor's certification that you have trouble moving due to knee difficulties, as well as,
  • - Documentation indicating you can't walk without the aid of a walker, crutches, two canes, or a wheelchair.

This list does not include knee replacements that fail years after surgery. Many knee replacements loosen or degenerate over time, necessitating a second operation, but this seldom occurs until years after the original surgery. To be eligible for this classification, you must be able to:

  • - Demonstrate that your difficulties walking began immediately after your knee replacement surgery (following a reasonable period of recovery and rehabilitation).

If you are still in pain and having difficulty walking years after surgery, you may be eligible for compensation under the second listing, listing 1.18, for abnormalities of a major joint. This listing necessitates the following:

  • - A history of joint discomfort or stiffness instability or
  • - A lack of normal mobility in the joint, and
  • - An inability to walk without the use of a walker, crutches, two canes, or a wheelchair.

In addition to meeting the Blue Book symptoms for Impairments, you would also need to qualify for Non-medical requirements for SSDI in order to win disability benefits for knee replacement.

If you meet the above medical and non-medical conditions, you may be assured that you will qualify for SSDI with knee replacement. If you have already applied and awaiting a decision, you could also check for signs whether you have won your disability claim here. 

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Wednesday, 07 December 2022