Knee Replacement Surgery and Social Security Benefits

If you cannot work due to chronic knee problems, you should consider applying for Social Security Disability benefits. This article explains how Social Security evaluates claims for people with chronic knee problems before and after knee replacement surgery. Knee replacement surgery, however, is not required for approval for benefits.

When knee problems impact your ability to walk effectively, Social Security applies 1.02A of the musculoskeletal listings (or definitions) of disability. Listing 1.02A is below:

1.02 Major Dysfunction of a joint(s) (due to any cause): Characterized by gross anatomical deformity (e.g., subluxation, contracture, bony or fibrous ankylosis, instability) and chronic joint pain and stiffness with signs of limitation of motion or other abnormal motion of the affected joint(s), and findings on appropriate medically acceptable imaging of joint space narrowing, bony destruction, or ankylosis of the affected joint(s). With:

A. Involvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle), resulting in inability to ambulate effectively, as defined in 1.00B2b...

The phrase "major weight-bearing joint" in this listing basically means a joint you need for standing and walking. Knees, along with hips and ankles, fall into this category.

Disability Benefits Before Knee Replacement Surgery

For my clients who need - but have not had - knee replacement surgery, the usual situation is that they have degenerative joint disease or internal joint derangement and the more conservative treatments, including arthroscopy, pool therapy, and/or therapeutic injections, have been unsuccessful. Of this group, some await knee replacement surgery because their orthopedic surgeons were concerned about their younger age. These clients seem to be under 50. The rationale for waiting (when possible) is that artificial knee joints have a life span, and the procedure (apparently) cannot be repeated indefinitely. If you face this situation, certainly discuss these issues thoroughly with your surgeon.

My clients awaiting knee replacement surgery are usually approved for benefits at Social Security benefits hearings under Listing 1.02A when they have:
(1) the appropriate imaging studies with "marked" findings,
(2) examination and ongoing treatment by an orthopedic specialist, and
(3) comments about knee replacement in the treatment records.

A practice note for attorneys and non-attorney representatives: I ask my clients with ongoing knee problems about hip and low back issues. I also ask if the healthier knee is getting worse because of favoring it. My clients commonly develop these problems because of their difficulties walking (their "gait"). These collective mobility issues are taken into account at a hearing. Medical-vocational guidelines apply for those near 50.

Disability Benefits After Knee Replacement Surgery

For my clients who have had knee replacement surgery, the general questions shift to two areas: (1) duration (when will full recovery occur) and (2) the ongoing mechanical integrity of the artificial joint. As for duration issues, I hope my clients benefit from knee replacement surgery so they can get on with their lives. Still, at least a year of disability leading into and after the replacement surgery is necessary for approval for benefits. Technically, if post-surgical recovery happens before a Social Security benefits hearing, a "closed period" of benefits may apply. This means that only backpay, and not ongoing monthly benefits, are payable. This makes sense if your new knee joint gets you back on your feet again.

As for mechanical integrity of the artificial knee joint, I have had some clients who, despite knee replacement and the proper follow-up treatment, still have issues with the joint. They may have problems with locking or clicking. Again, discuss these situations with a qualified professional. In the context of Social Security benefits, you may get ongoing benefits if the knee replacement is less than fully functional. The question becomes a matter of degree.

A practice note for attorneys and non-attorney representatives: If your client needs a cane when standing, you can argue at a hearing that he or she is effectively "one-handed" when standing at potential jobs, even under a "sit-stand option". Important, too, is whether or not your client holds the cane with his or her dominant hand.

A final thought. Social Security benefits are also available for those who may not need knee replacement surgery in the foreseeable future. The ultimate question is how your collective medical issues (physical and emotional) impact your ability to work full-time. There are many problems people can have with joints, such as gout and rheumatoid arthritis. Hand impairments, as well, can be devastating. Pain and immobility from these conditions and others can, depending on the severity, allow you to receive Social Security benefits.

Andrew W. Kinney, Esq.