Avascular Necrosis and Filing for Disability
Avascular necrosis is a severe medical condition that should certainly be listed on an application for SSD or SSI disability benefits. This condition would be evaluated as a musculoskeletal impairment under the SSA Blue Book impairment listing 1.00 Musculoskeletal System - Adult.
Musculoskeletal system impairments are defined as any disorder of the musculoskeletal system that result from a hereditary, congenital, or an acquired pathologic process. Musculoskeletal impairments may also be the result of infectious, inflammatory, or degenerative processes, traumatic or developmental events, toxic/metabolic diseases, or neoplastic diseases (cancers).
Avascular necrosis is localized death of a bone as a result of local injury, drug side effects, or disease. Ultimately this disease will cause destruction of the joint adjacent to the involved bone. The hip is the most common joint affected by avacular necrosis, although it can involve the knee, shoulder, ankle, elbow, or wrist as well.
How Avascular Necrosis is evaluated for disability
Because avascular necrosis does not have its own listing in the SSA Blue Book impairment listings, a person filing for disability for avacular necrosis is often evaluated using the criteria of listing 1.02, Major Dysfunction of a Joint, or 1.06, Fracture of the femur, tibia, pelvis, or one or more tarsal bones. This is the listing used to evaluate osteoarthritis and is discussed at this page: Requirements for filing for disability with arthritis.
If a person is able to meet or equal an impairment listing they will automatically be medically qualified for disability. However, if a person's avacular necrosis does not meet or medically equal a listing, they may or may not have the residual functional capacity to engage in substantial gainful activity. They must prove that they are not longer able to perform SGA level work activity to qualify for disability.
This is accomplished by the information contained in their medical records and their vocational work history; more specifically, what types of work they have done, the functional requirements of each of their jobs, and their job skills. Social Security's disability guidelines require an evaluation of a person's ability to perform any of their past jobs, or other kinds of work their skills might transfer to prior making a disability determination.
If the disability specialist finds that the individual is unable to do past work or other work considering their limitations, age, education, and skill transferability, they may be approved for disability through a medical vocational allowance.
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Qualifying for disability benefits with Avascular Necrosis
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys for disability claims request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
Facts about Avascular Necrosis
1. Avascular necrosis is a progressive, degenerative disorder that kills bone tissue. Loss of blood supply causes the tissue death, which causes tiny breaks and weakening in the bone, eventually causing the bone to collapse.
2. Avascular necrosis is also called osteonecrosis, aseptic necrosis and ischemic bone necrosis.
3. Excessive use of alcohol and steroids, injuries and trauma, and conditions such as sickle cell anemia, arthritis and lupus all contribute to blood loss from bone but it is unknown exactly what causes the condition. Sometimes it occurs without any condition or risk factors present.
4. Any bone in the body can be affected by avascular necrosis, and usually causes pain and deterioration in joints. The femur bone in the thigh is most commonly affected, causing pain in the hip and knee. Shoulder and jaw joints are also commonly affected.
5. Avascular necrosis can occur in more than one bone in the body during the lifelong course of the condition, either at the same or different times.
6. Persistent joint pain is an indicator to see a doctor. Diagnosis of avascular necrosis comes after x-rays and MRI scans of the area of the body where pain is present.
7. If avascular necrosis goes untreated, the condition can progress to severe pain and irreversible disability in the course of just a few years.
8. Treatment of avascular necrosis aims to stop the progression of bone tissue loss. If caught early, avascular necrosis can be treated through pain medications, rest and targeted exercise. Later stages can require surgery such as depression at the core of the bone, reshaping the bone, a bone transplant or even total joint replacement.
9. Most well known patients of avascular necrosis are athletes, including Bo Jackson, Brett Favre, and Ben Dvorak.
10. Well known musicians have also suffered from the condition, including Eddie Van Halen and Micky Dolenz.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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