Movement Limitations And Social Security Disability
By Pitt Dickey

If people were cars, we'd all be recalled because we are so poorly designed.  We wear out over time.  Injuries, illness and the calendar take their toll on the human body.  This column will review how the Social Security Administration (SSA) evaluates disability claims involving bone and muscle impairments. The short version of the test for Social Security Disability Insurance benefits asks if the person seeking disability benefits has  a physical or mental condition that can be expected to last at least one year which prevents him from not only doing the type of work he has done in the past but any other type of work that exists in the national economy. 

The SSA has developed fourteen " Listings"  which cover  common  health problems that can prevent a person from working.  The first Listing is the musculoskeletal system which essentially describes health problems of the bones and muscles. The SSA notes that disorders of musculoskeletal system can occur due to hereditary, congenital, or acquired diseases during a person's life. Impairments of the musculoskeletal system "may result from infectious, inflammatory, or degenerative processes, traumatic or developmental events, or neoplastic, vascular or toxic/metabolic diseases.  In English, this means orthopaedic   problems can result from infections, inflammatory diseases such as rheumatoid arthritis, osteoarthritis, the wearing out of bones through overuse, illnesses such as degenerative disk or joint disease, injuries due to accidents such as car wrecks, falls, parachute accidents,   cancers which affect the bones, lack of blood circulating in the bones, or the body's reaction to toxic exposure.

The key question  for the SSA in evaluating orthopaedic pain is:  What, if any, loss of function results from the impairment?  The SSA requires that the impairment results in a loss of function, and  there is  a clinical diagnosis of the health problem by a licensed physician.  The type of impairment is not as important as the amount of the resulting loss of function.  The SSA defines "loss of function" as "the inability to ambulate effectively on a sustained basis, for any reason including pain associated with the underlying musculoskeletal impairment, or the inability to perform fine and gross movements effectively on a sustained basis."  This inability to function must be reasonably expected to last at least 12 months.    In orthopaedic claims, the SSA evaluates how well a person can walk and how well they can use their hands and arms in determining if the person is eligible for Disability Insurance Benefits. 

The SSA defines the "inability to ambulate effectively" as "an extreme limitation of the ability to walk."  Ineffective ambulation occurs when a person has such severe limitations in the use of his legs that he cannot walk without using two  handheld devices such as crutches or canes which limits the use of both arms.  If the person has had an amputation of one of his arms, then the test is met if he has to use only one crutch or cane in his good arm.
 
To "ambulate effectively" the SSA requires a person to be able to walk at a reasonable pace over a "sufficient distance to carry out the daily activities of living," and to be able to travel without a companion to and from his job or school. The SSA gives examples of  limitations which  constitute ineffective ambulation to include: "the inability to walk without the use of a walker, two crutches or two canes, ...(for)  a distance of a block at a reasonable pace on rough or uneven surfaces, the inability to use standard public transportation, ... the inability to carry out daily activities such as shopping and banking, and the inability to climb a few steps at a reasonable pace with the use of a single handrail."  The SSA  test for walking effectively applies only  to areas outside the person's home. The ability to be able to get around in his own home without crutches or a cane does not mean a person is automatically disqualified for Disability Insurance Benefits. Many people are able to move in their homes by leaning on furniture, walls and relatives for the short distances in their homes that they have to travel.

The "inability to perform fine and gross movements effectively" means an extreme loss of use of both arms or hands. The impairment must "interfere very seriously with the individual's ability to independently initiate, sustain or complete activities." For a person to use their arms and hands  effectively, the person must be able to do such things as "reaching, pushing, pulling, grasping, and fingering" to do daily activities. The SSA gives examples of the inability to perform fine and gross movements such as "inability to prepare a simple meal and feed oneself, inability to take care of personal hygiene, the inability to sort and handles papers or files, and the inability to place files in a file cabinet at or above waist level."

The SSA recognizes that pain can have a major  impact on a person's  loss of  functional abilities in walking or using their hands and arms.  A person seeking disability benefits will have to have medical or lab findings which show a "medically determinable impairment that could reasonably be expected to produce pain or other symptoms."  In effect there must be medical diagnosis of a condition that could cause the pain.  Just the statement by  a person that he is in pain without any medical evidence will not allow the award of disability benefits. The SSA considers  limitations caused by pain such as range of motion of a joints.   The SSA will carefully screen the patient's records for documentation of patient complaints of  "intensity and persistence" of pain in evaluating the disability claim.

A later column will examine how the SSA evaluates specific bone and muscle diseases.

Copyright © Pitt Dickey 2004