This post discusses Social Security Disability Benefits for Bone Fractures. If you or someone you care for has sustained a bone fracture and are unable to work, read on for how SSA will evaluate your claim for disability benefits.
Types of Bone Fractures
Bone fractures are common in childhood and are usually not complicated for children. But as we age, bones become brittle and recovering from a fracture becomes more difficult. Fractures in adults can occur from a serious accident or even coughing in those with weakened bones.
There are different types of fractures but displaced, non-displaced, open, and closed are the main ones. In displaced fractures, the bone has snapped in two and the parts do not line up straight. An open fracture occurs when the bone breaks through the skin. This skin penetration comes with a risk of deep bone infection (Via WebMD).
Certain bone fractures come with higher risks to one's health. A break in the femur bone can be life-threatening due to severe bleeding and complications.
The spine holds the spinal cord which is a major part of the central nervous system. Any bone fractures that occur in the spine can cause nerve damage and instability in the body.
The skull protects the brain and any fracture to the skull can result in brain injury.
Our hands, including our wrists, make our lives possible. A wrist fracture can be difficult to recover from due to our inability to stop using it.
Hip fractures can spell disaster for older adults. The surgery needed to correct the hip fracture and the time needed to heal can both be devastating (via Movement Orthopedics).
In addition to the above, there is also the risk of non-union after fracture. Non-union occurs when the fractured bone fails to heal. The FDA defines nonunion as a fracture that persists for a minimum of 9 months without signs of healing for three months (via NIH).
Even with proper surgery and physical therapy, bone fractures can result in disability, especially if the individual is older, has suffered multiple broken bones or improper healing is involved.
Types of Social Security Disability Benefits
The first step to attaining disability benefits is to apply. You can apply online or at your local SSA District office. When you apply, SSA will make an initial determination about what type of benefit(s) you are eligible for.
Also watch: Who can apply for Social Security Disability?
SSA (generally) offers two types of benefits: Social Security Disability Insurance Benefits and Supplemental Security Income.
Social Security Disability Insurance (SSDI)
SSDI is based on the credits from the work you have done in your life. You must be found disabled before your date last insured (DLI) to be found eligible for SSDI. Your DLI is calculated by counting your “quarters of coverage” from your earnings record. You must have 20 “quarters of coverage” of the last 40 quarters. Simply put, you must have worked 5 years of the last ten years (in general). In addition, Adult Disabled Children can be eligible for benefits off their parent’s account.
Supplemental Security Income (SSI)
SSI (Supplemental Security Income) is a need-based program and you must meet income/asset standards in addition to being found disabled under the five steps above. In 2023, SSI is $914.00 per month for an individual and $1,371 for an eligible couple. SSI will be reduced by 1/3 if you are receiving financial help from others. In NC, SSI recipients are also entitled to Medicaid.
Five Step Sequential Evaluation Process
Before you are entitled to either benefit, the Social Security Administration must find your disabled under the Five Step Sequential Evaluation Process.
At every step of the below Disability Process, SSA uses the Five Step Sequential Evaluation to determine if you are disabled.
- Step 1 – Are You Working? The Social Security Administration defines work as “Substantial Gainful Activity” (SGA). SGA is roughly defined as work from earnings that average more than $1,470 (2023) a month. If you are making that amount you generally will not qualify for disability.
- Step 2 – Is Your Condition “Severe”? Severity is key when it comes to what qualifies as a disability. Severe is defined by the Social Security Administration as: your condition must interfere with basic work-related activities for your claim to be considered.
- Step 3 – Is Your Condition on the List of Disabling Conditions? The Listings are very hard to meet in most cases and not always interpreted as a common reading would suggest. If you meet a listing you are gravely ill. The listings are found here.
- Step 4 – Can You Do the Work You Did Previously? The Social Security Administration will look at your past work and determine if it was sedentary, light, medium, or heavy. They also will evaluate the skill level: unskilled, semi-skilled and skilled. For instance, an attorney would be sedentary skilled work. The Dictionary of Occupational Titles is found here.
- Step 5 – Can You Do Any Other Type of Work? If the Social Security Administration finds that you cannot do what you used to do, they then look to see if you can do anything else. This is where the “grids” come into play. The grids are the Medical-Vocational Guidelines. The grids are only for exertional impairments. Non-exertional impairments are not considered by the grids. If you are found to be capable of any other work, you will be found not disabled. Read The Grids and Your Social Security Disability Case.
Read more at NC Social Security Disability Lawyer
Social Security Disability for Bone Fractures
An important fact to remember when considering whether you may be able to obtain Social Security Disability Benefits for your bone fracture is SSA's duration requirement. To be found disabled, your disability must have lasted or is expected to last for at least one year (or to result in death). In simple terms, if your fracture heals and you are able to return to work in less than a year, you are not eligible to receive Social Security Disability benefits.
The Social Security Administration can evaluate bone fractures under 1.00 Musculoskeletal System, specifically at 1.19, 1.22 and 1.23.
1.19 - Pathologic fractures due to any cause
Pathological fractures are caused by diseases or treatments that weaken bone, making them vulnerable to breaks. Osteoporosis and chemotherapy are both examples.
Listing 1.19 requires fractures on three separate occasions within a 12-month period AND
A need for an assistive device involving the use of both hands OR the inability to use one hand with the necessity for a one handed assistive device OR the inability to use both upper extremities.
This listing essentially requires that a person cannot use their hands.
1.22 - Non-healing or complex fracture of the femur, tibia, pelvis, or one or more of the talocrural bones
Listing 1.22 requires imaging (X-ray, MRI, CT) that demonstrates that the union is not healing or complex in the lower extremities and the need for an assistive device that uses both hands. This listing essentially also requires that a person cannot use their hands.
1.23 - Non-healing or complex fracture of an upper extremity
Listing 1.23 requires imaging (X-ray, MRI, CT) that demonstrates that the union is not healing or complex in the upper extremities and the inability to perform fine or gross movements.
The above listings, as with most listings are difficult to meet. As far as 1.19, bones that are brittle enough to break spontaneously (without serious injury) will cause pain and weakness that preclude work at the first break (not three as required by the listing). Non-unions are painful and repeat surgeries may be needed. This alone could eliminate a person's ability to work.
In addition to the listings mentioned above, SSA can use the Medical Vocational Guidelines (Grid Rules) to find someone disabled from their bone fracture. The Grids help those that are 50 years of age and older and have a residual functional capacity for sedentary work (generally).
NC Social Security Disability Lawyer
If you have sustained a bone fracture and have been out of work for a year or your doctor informs you that you will be out of work for a year or more due to your fracture, file a claim for Social Security Disability benefits as soon as possible and call The Bishop Law Firm.
We represent Social Security Disability clients in Raleigh, Durham, Fayetteville, Cary, Rocky Mount, Wilson, Smithfield, Louisburg, Chapel Hill, Roanoke Rapids , Winston Salem, Garner, Greensboro, Greenville and surrounding areas in North Carolina. Call us today for a free case review, (919) 615-3095 or start online now.
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