Pathologic Fractures and SSDI Eligibility

A pathologic fracture occurs when your bone breaks due to an underlying medical condition rather than a high-impact injury. These fractures often result from diseases that weaken bone density, such as osteoporosis, bone tumors, or metabolic bone disorders. Because your bone is structurally compromised, even minor movements or daily activities can cause a break.

Living with this condition often means constant pain and the need for frequent medical intervention. A single fracture can take months to heal, and the risk of recurring breaks makes it difficult to maintain a consistent work schedule. You may find that the physical limitations caused by these fractures, such as the inability to lift, stand, or walk for long periods, prevent you from performing basic job duties.

Under Listing 1.19, the SSA evaluates the frequency and severity of your bone breaks. To meet this listing, you must document at least three separate pathologic fractures within a consecutive 12-month period. The SSA requires objective medical evidence, such as imaging reports and surgical notes, to confirm that these fractures were caused by an underlying medical condition.

Beyond the frequency of fractures, you must demonstrate a significant, long-term functional limitation. This means your condition must prevent you from performing work-related activities, such as using your hands for fine movements or walking effectively, for at least 12 months. You must provide medical documentation showing a clear need for assistive devices like a walker, crutches, or a wheelchair. An attorney can help you organize your medical evidence to meet these strict requirements.

Strong claims rely on a complete medical record that links your bone fragility to your functional limitations. You need consistent imaging, such as X-rays or MRI scans, that document each fracture and the underlying cause. Operative reports from any surgical procedures are essential, as they provide detailed findings about the state of your bones and the complications you have faced.

Non-medical evidence is equally vital to show how your condition impacts your daily life. A detailed statement from your treating physician regarding your physical restrictions and the medical necessity of any assistive devices helps the SSA understand your limitations. Additionally, function reports from family members can provide context on your daily struggle to perform basic tasks like lifting or standing. An attorney can help you organize your medical evidence to meet these strict requirements.

Many claims are denied because your medical record fails to show that the fractures occurred within the required 12-month window. Others are rejected because the evidence does not clearly link your bone condition to a specific, long-term functional limitation that prevents work. The SSA often denies cases where the documentation of the need for an assistive device is missing or does not specify that the need is expected to last for at least one year. An attorney can help you organize your medical evidence to meet these strict requirements.

A disability attorney helps by ensuring your medical records are organized to meet the specific requirements of Listing 1.19. They work with your doctors to obtain clear statements regarding your functional limitations and the medical necessity of your assistive devices. By identifying gaps in your evidence early, an attorney helps you build a more persuasive case, which is critical if your initial application is denied and you need to pursue an appeal.