New Musculoskeletal Listing

May 25, 2021 in

If you are struggling to work due to a severe medical condition, you may consider applying for social security disability benefits through the federal government. Social security disability benefits are funded through the federally administered social security administration. To be eligible for the disability insurance program, you must pay taxes to social security through your working wages or income. The taxes you pay to social security are there in the event you suffer from a disability, require federal health insurance called Medicare, or later in life when you reach retirement age. The disability program does not have an age requirement, simply a showing that you are disabled under social security’s definition of disability.

When you apply for social security disability benefits, the social security administration will review your claim to see if you are disabled. During the review, social security will evaluate your alleged medical conditions and by determining if they automatically qualify you for disability benefits. When developing the disability program, social security created a list of medical conditions which are thought to be so severe as to automatically qualify you for benefits. For the majority of claims, the social security administration will use a five-step process to determine disability. However, a small number of claims qualify for disability stopping at the third step of the process. If your case is approved based upon a listed medical condition, social security will still need to review the claim using the first to steps of the process but they will stop at the third step if approved based on a listing.

Social security will periodically review and update their listed conditions. A medical listing for post-traumatic stress disorder was added a few years ago to the mental health listings. Most recently, social security revamped their entire musculoskeletal listings. This listing, found under 1.00, generally evaluates claims involving the bones in your body. There are nine total categories under listing 1.00 for the musculoskeletal system.

The first listing is 1.15, which evaluates disorder of the spine with nerve root compromise. This Listing is quite difficult to meet as it requires you to have A, B, C and D criteria. The A criteria requires proof of pain, paresthesia or muscle fatigue. The B criteria requires a physical examination documenting muscle weakness, nerve compression, or sensory changes. The C criteria requires imaging documenting the nerve root compression and the D criteria requires the physical limitation to have lasted or be expected to last for a continuous period of at least 12 months.

Listing 1.16 is similar to 1.15 that in that both involve the spine. However, listing 1.16 specifically reviews the lumbar spine for spinal stenosis. Similar to 1.15 there are four criteria which must be met. The A criteria requires symptoms of neurological compromise. The B criteria requires proof of the neurological compromise through a physical examination. The C criteria requires imaging or an operative report of the nerve root compromise with lumbar spinal stenosis. And the D criteria requires the impairment to have lasted for 12 months or expected to last for 12 months.

The next listing, 1.18, involves major joints in any extremity of your body. To qualify for this listing, you need evidence showing you suffer from chronic joint pain or stiffness with abnormal motions. This must be documented through physical examinations or imaging. And similar to the other listings, the condition has a twelve-month durational requirement with the need for an assistive device or inability to use both upper extremities.

Listing 1.19 evaluates claims involving bone fractures. This is proven from fractures occurring on three separate occasions in a twelve-month time frame with physical limitations expected to last for twelve months with the requirement of an assistive device or the inability to use both upper extremities.

Listing 1.20 involves an amputation to any limb no matter the cause. If the amputation involves one of your extremities you will also need to document the need for an assistive device or if involving an upper extremity, a documented inability to independently complete work-related activities involving fine and gross movements. If the amputation involves one or both lower extremities you must show the inability to use a prosthesis and a medical need for an assistive device.

Listing 1.21 evaluates soft tissue injuries requiring surgical management. The surgical management must be directed toward saving, reconstructing, or replacing the affected part of the body, expected to be ongoing for a period of twelve months, and maximum benefit from therapy has not yet been achieved.

The last two listings, 1.22 and 1.23 involve non-healing fractures. Both require proof of a non-union under imaging, with physical limitations expected to last a minimum of twelve months and the documented need for an assistive device involving the use of both hands.

The new Listings involving the musculoskeletal system are more restrictive and difficult to prove. In general, meeting or equaling a listing is difficult. With these new listings, social security is certainly making a statement that if you are found to meet one of these listings then there is absolutely no question as to your physical ability. You are most certainly disabled if you have the medical evidence to support a disability under the new musculoskeletal listings. One important takeaway from the new listings is that your medical provider must properly document all of your limitations in the physical examination section of their treatment notes. It is not helpful for your medical provider to simply copy and paste notes from the prior visit. Your doctor must do an actual examination every time and note those limitations in the physical examination. It is also important if your doctor recommends the use of an assistive device for the doctor to not only include that recommendation in the treatment plan but also explain the reason for the need of the assistive device. This places a much greater focus on the doctor actually notating your treatment notes. It also places a greater need for imaging to document your medical conditions. If you are not found disabled under the new musculoskeletal listings, you may still qualify for disability benefits. However, the evaluation of your claim will simply require the full five-step process for analysis.

To have the best chance of being approved under this new listing, contact us at the LaBovick Law Group for a free evaluation. We are warriors for justice and will fight aggressively to obtain you the benefits you deserve. Call us today at (561) 625-8400.

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