If you have suffered a fracture of your femur, tibia, or pelvis and it has resulted in ongoing problems, you may be eligible for Social Security Disability benefits. If you have been in a serious accident, you may have suffered multiple broken bones. While many broken bones heal without problem, you may be one of the less fortunate who has suffered complications that lead to disability.
The Social Security Administration (SSA) administers Social Security Disability Insurance (SSDI), which pays monthly benefits for those who are disabled if enough credits have been earned and enough taxes have been paid in to the SSA. Depending upon the severity of the fracture, complications may occur at different times following the injury.
Immediate complications that may occur at the time of the fracture:
- Injuries to joints, muscles, organs, and major blood vessels
- Hypovolaemic shock, which is a quick loss of body fluid that causes major organs to stop working, if a bone fracture is accompanied by other significant injuries
Early complications may occur within a few days of the fracture:
- Hypovolaemic shock
- Adult respiratory distress
- The compression of blood vessels, nerves, and muscles in a closed area of the body because of swelling
Later complications are those that occur a while after the fracture:
- Improper healing, such as the bone not rejoining or healing in a way that is deformed
- Bone shortening
- Bone dying because of a lack of oxygen
- Bone infection
- Sudeck’s dystrophy, which can cause muscle stiffness, pain, and wasting
- Volkmann’s contracture, which is a permanent contracture of your hand at the wrist making your hand look like a claw and restricting finger use and causing forced movement to be painful
- Myositis ossificans, which is when bone grows in the muscle, causing serious pain
If your fracture has experienced complications, you are going to suffer problems with mobility, pain, and full use of your extremities for a long time after your injury. It could be a situation that actually impacts the rest of your life.
The Costs of Treating the Fracture of Femur, Tibia, or Pelvis
The costs of treating fractures, especially serious ones, can be expensive. There are doctor visits, prescriptions, hospitalizations, and surgery if necessary. The average fracture costs $5,000 to $10,000, but if it requires joint replacement, such as knee replacement or hip replacement, you could pay out as much as $50,000 depending on the complexity of the surgery and the hospital that performs it.
The SSA Evaluation and Medical Qualifications
The SSA uses a medical guide, which is called the Blue Book, to determine whether someone is disabled.
The Blue Book has a specific listing that covers specific bones located in the pelvis, foot, and leg. The listing for Lower Extremity Fracture (Section 1.06) requires a break in your tibia, femur, pelvis, or tarsal bones with:
- Imaging that shows there has been no healing of the bone
- A physical exam in which the doctor could tell by movement or by the feel of the extremity that the bone hasn’t reunited and
- The inability to walk effectively for at least 12 months.
Usually, the SSA requires that your fracture hasn’t healed for at least 6 months and the doctor’s opinion is that it is not likely to heal for at least a year. Your doctor is required to present evidence to effectively back up his opinion.
If you don’t meet the specifics of the listing, you may still have a condition that is considered the equivalent in severity to a listing if your impairments are severe and have at least a 12-month duration. This is called the medical-vocational allowance and is done using a residual functional capacity (RFC).
Getting Disability with a Medical-Vocational Allowance and a RFC
The RFC assesses your mental and physical limitations as stated by your doctor. For example, if a broken femur limits your ability to walk long distances or stand for more than an hour at a time that will have to be indicated. If muscle or nerve damage in the leg because of improperly healed fractures make it impossible to bend, squat, or lift, that should also be included on the form.
Your age, education level, work experience, and transferable skills are also considered. If you take pain medication, which causes drowsiness or nausea that should be mentioned and will be considered during the claim decision. Your mental abilities may also be impacted by your injury because you may be distracted by the ongoing pain and have difficulty concentrating. You may be depressed or suffer anxiety because your injury is failing to heal properly.
Make sure all of your symptoms, your medications and their side effects, and any other physical problems and mental issues are included in your claim, accurately documented, and given consideration along with the serious break that has suffered complications. After the SSA has determined you cannot do your prior work, they will consider your limitations along with your abilities, education, age, and experience to determine if you can perform sedentary, or less demanding work. If they determine you cannot do other work, you may be approved for disability benefits.
Applying Specific Medical Tests to Your Case
Your fractures are documented by x-rays and other images, such as MRIs or CAT scans. These records and physician notes are important assets for providing the evidence and documentation required to be approved for Social Security disability. Provide as much documentation as possible early on in the claim. You can use the Blue Book as a guide for gathering evidence when applying for SSDI.
The claim is a complicated process, and you could be denied for benefits twice. You can file an appeal and provide additional evidence. The last step would be a hearing before an administrative law judge who will rule on your case.
It is not uncommon for the SSA to order a medical evaluation at their expense from the physician they choose. This evaluation is for informational purposes only, so the SSA may use it to confirm the severity of your symptoms and to assist with the decision making process. In some cases, a mental evaluation is ordered to determine if you suffer from stress, anxiety, depression, loss of concentration, or other mental impairments that may impact your ability to work.