By Robert J. Osborne, Esq.
To meet the listing for a major dysfunction of a joint, a person must have a gross anatomical deformity, such as subluxation, contracture, bony or fibrous ankylosis, or instability. Additionally, a person must have chronic joint pain and stiffness with signs of limitation of motion or other abnormal motion of the affected joint(s). Further, the person must present findings on appropriate medically acceptable imaging of joint space narrowing, bony destruction, or ankylosis of the affected joint(s).
The dysfunction of the joint must involve either a major peripheral weight‑bearing joint, such as the hip, knee, or ankle, or one major peripheral joint in each upper extremity, such as the shoulder, elbow, or wrist‑hand. If the dysfunction involves a major peripheral weight-bearing joint, it must result in an inability to ambulate effectively. If the dysfunction involves a major peripheral joint in each upper extremity, it must result in an inability to perform fine and gross movements effectively.
Inability To Ambulate Effectively
An inability to ambulate effectively means an extreme limitation of the ability to walk. Generally, a person must have such poor lower extremity functioning that the individual cannot walk independently without the use of a hand‑held assistive device(s) that limits the functioning of both arms.
The Social Security Regulations state, “To ambulate effectively, individuals must be capable of sustaining a reasonable walking pace over a sufficient distance to be able to carry out activities of daily living. They must have the ability to travel without companion assistance to and from a place of employment or school.”
The Social Security Regulations include examples of ineffective ambulation, such as:
- The inability to walk without the use of a walker, two crutches or two canes;
- The inability to walk a block at a reasonable pace on rough or uneven surfaces;
- The inability to use standard public transportation;
- The inability to carry out routine ambulatory activities, such as shopping and banking; and
- The inability to climb a few steps at a reasonable pace with the use of a single hand rail.
The ability to walk independently about one’s home without the use of assistive devices does not, in and of itself, constitute effective ambulation.
Inability to Perform Fine and Gross Movements Effectively
The Social Security Regulations define the inability to perform fine and gross movements effectively as “an extreme loss of function of both upper extremities,” such as an impairment that interferes very seriously with one’s ability to start, continue or complete activities on his or her own.
Effective use of a person’s upper extremities requires that the person have the ability to reach, push, pull, grasp, and finger on a sustained basis that would allow the person to carry out activities of daily living. The Social Security Regulations include the following examples of the inability to perform fine and gross movements effectively:
- The inability to prepare a simple meal and feed oneself;
- The inability to take care of personal hygiene;
- The inability to sort and handle papers or files; and
- The inability to place files in a file cabinet at or above waist level.
Evaluation of Pain or Other Symptoms
Pain or other symptoms may significantly contribute to an individual’s loss of function of a joint. The Social Security Regulations state, “In order for pain or other symptoms to be found to affect an individual’s ability to perform basic work activities, medical signs or laboratory findings must show the existence of a medically determinable impairment(s) that could reasonably be expected to produce the pain or other symptoms.”
The Social Security Administration must evaluate the intensity and persistence of pain or other symptoms carefully in order to determine their impact on a person’s loss of function of a joint.
Documentation
Since some impairments improve with time or respond to treatment, the Social Security Administration usually needs to see a person’s clinical record over time to assess the severity and expected duration of an impairment.
Some people will not have received ongoing treatment or will not have an ongoing relationship with a doctor. In those cases, the Social Security Administration will evaluate an impairment on the basis of the current objective medical evidence and other available evidence. The Social Security Administration will consider an individual’s medical history, symptoms, and medical source opinions.
If an individual who does not receive treatment cannot show an impairment that meets the criteria of the listing for major dysfunction of a joint, the individual may have an impairment that equals the listing, or may prove disability based on consideration of his or her residual functional capacity and age, education and work experience.