What this listing covers
A pathologic fracture occurs when your bone breaks due to an underlying medical condition rather than a significant injury or trauma. These fractures often result from diseases that weaken your bone structure, such as severe osteoporosis, bone tumors, or metabolic bone disorders.
These fractures can significantly impact your daily life by causing chronic pain, instability, and a loss of mobility. When your bones break repeatedly, it becomes difficult to perform basic tasks like walking, lifting objects, or maintaining personal hygiene, often making it impossible to sustain consistent work activity.
How SSA evaluates a claim under this listing
Under Listing 1.19, the SSA evaluates the frequency and severity of your bone breaks. To meet this listing, you must provide medical evidence of pathologic fractures occurring on three separate occasions within a 12-month period.
Beyond the frequency of the fractures, the SSA requires documentation of a severe functional limitation that has lasted or is expected to last for at least 12 months. You must show a documented medical need for assistive devices like a walker or crutches, or an inability to use your hands and arms to perform work-related movements. An attorney can help you gather the necessary evidence to meet these requirements.
Evidence that strengthens a claim
Strong claims rely on clear medical documentation of each fracture event. This includes X-rays, CT scans, or MRI reports that confirm the breaks and identify the underlying condition causing your bone fragility.
You also need detailed reports from your treating physician that describe your physical limitations. Evidence showing your need for mobility AIDS, such as a wheelchair or bilateral canes, and records of your ongoing treatment plan are essential to demonstrate the duration and severity of your impairment. An attorney can help you organize this evidence to support your claim.
How an attorney helps
A disability attorney helps you bridge the gap between your medical records and the specific requirements of Listing 1.19. They ensure your physician’s reports clearly document the frequency of your fractures and the resulting functional limitations. By organizing your evidence and preparing your case, an attorney helps you present a complete picture of your disability to the SSA, which is vital for navigating the application or appeal process.
Frequently asked questions
No, a single fracture typically does not qualify. SSA Listing 1.19 specifically requires evidence of pathologic fractures occurring on three separate occasions within a 12-month period, combined with significant, long-term functional limitations. An attorney can help you review your medical history to see if your situation aligns with these criteria.
The SSA defines a pathologic fracture as a break caused by an underlying medical condition that weakens the bone, rather than an external injury. This is distinct from a traumatic break caused by a fall or accident. You must provide medical evidence of the underlying disease and the resulting bone fragility.
A denial is not the end of your claim. You have the right to request a reconsideration, and if that is denied, you can request a hearing before an administrative law judge. An attorney can help you identify missing evidence or clarify your functional limitations to strengthen your appeal.
The most critical evidence includes medical records documenting the date and nature of each of the three fractures within the 12-month window. Additionally, you need objective clinical findings that prove your inability to walk or use your hands for work-related tasks. An attorney can help you ensure these documents meet SSA standards.
