Complex Bone Fractures and SSDI Eligibility

A complex or non-healing fracture occurs when a major bone in your lower body, such as the femur, tibia, pelvis, or talocrural bones in your ankle, fails to knit back together properly. These injuries often involve severe trauma, multiple bone fragments, or complications that prevent your bone from achieving a solid union despite medical intervention.

These fractures significantly disrupt your ability to stand, walk, or perform basic work tasks. Because these bones are essential for weight-bearing, a failure to heal often results in chronic pain, instability, and an inability to maintain the physical demands of a standard work environment, such as lifting, carrying, or standing for extended periods.

Under Listing 1.22, the SSA looks for evidence that your fracture has not achieved a solid union. This means your imaging must show that the bone has not healed, and clinical examinations must confirm the area remains unstable. SSA requires this evidence to be documented by an acceptable medical source.

To qualify, you must also demonstrate a documented medical need for a walker, bilateral canes, bilateral crutches, or a seated mobility device that requires both hands to operate. This limitation must have lasted, or be expected to last, for a continuous period of at least 12 months, proving that your injury prevents you from performing sustained work-related activities. An attorney can help you gather the necessary documentation to prove your case.

Your claim relies on objective medical evidence, including recent X-rays, CT scans, or MRIs that clearly show the lack of a solid bone union. Operative reports from any surgeries are critical, as they provide details on the complexity of your fracture and any complications that occurred during or after the procedure.

Beyond imaging, your medical records must include detailed physical examination reports that document your muscle strength, range of motion, and the specific medical necessity for your assistive device. Statements from your treating physician regarding your functional limitations and your response to ongoing treatment are also vital to establishing the severity of your condition. An attorney can help you ensure your medical records meet these specific requirements.

Many claims are denied because your medical record fails to link your fracture to a specific, ongoing functional limitation. SSA often rejects applications if your imaging does not clearly show a non-union or if your file lacks a formal, documented medical need for a specific assistive device. If your records do not clearly explain why you cannot stand or walk for a full workday, the agency may conclude that your injury does not meet the required level of severity. An attorney can help you identify and correct these documentation gaps.

A disability attorney helps by ensuring your medical file is complete and directly addresses the criteria in Listing 1.22. They work with your doctors to obtain the necessary functional capacity statements that prove your inability to sustain work. By organizing your evidence and preparing you for the application or appeal process, an attorney helps you present a clear, medically supported case to the SSA.