What this listing covers
A complex or non-healing fracture occurs when a major bone in your lower body, such as the femur, tibia, pelvis, or ankle bones, fails to knit back together properly. These injuries often involve severe trauma that disrupts your bone structure, requiring extensive surgical intervention or multiple procedures to stabilize the area.
These fractures significantly impact your ability to stand, walk, or perform basic work tasks. Even with treatment, your pain and instability can make it impossible to maintain a consistent work schedule, as you may require specialized mobility AIDS or be unable to put weight on the affected limb for an extended time.
How SSA evaluates a claim under this listing
Under Listing 1.22, the SSA evaluates whether your fracture has achieved a solid union. They look for medical evidence confirming that your bone has not healed properly, which is typically documented through imaging like X-rays or CT scans that show a failure to fuse, alongside clinical findings that your bone remains unstable.
Beyond the physical state of your bone, the SSA requires proof that your condition has lasted or is expected to last for at least 12 months. You must also demonstrate a documented medical need for specific assistive devices, such as a walker, bilateral canes, or a wheelchair that requires the use of both hands to operate.
Evidence that strengthens a claim
The most critical evidence includes recent imaging reports that clearly show your fracture has not achieved solid union. You should also provide detailed operative reports from every surgery you have undergone, along with clinical notes from your orthopedic surgeon that document the ongoing instability of your bone.
Functional reports from your doctors are essential to show how your injury limits your daily activities. If you use a walker or wheelchair, your medical records must explicitly state the medical necessity for these devices. Statements from physical therapists regarding your progress or lack thereof can also provide a clear picture of your functional limitations. An attorney can help you organize this evidence to meet SSA standards.
How an attorney helps
A disability attorney helps by ensuring your medical records are organized to align with the specific criteria of Listing 1.22. They can help obtain necessary functional capacity statements from your doctors that clearly explain why you require mobility AIDS to function. By preparing your evidence and guiding you through the application or appeal process, an attorney ensures that the SSA has a complete and accurate picture of your inability to work.
Frequently asked questions
A non-healing tibia fracture may qualify under Listing 1.22 if you can provide medical evidence that your bone has not achieved a solid union and you require a walker, bilateral canes, or a wheelchair for mobility. The condition must be expected to last at least 12 months. An attorney can help you determine if your medical records meet these specific SSA requirements.
The SSA evaluates pelvic fractures by looking for objective evidence that your bone has not healed and that you have a documented medical need for assistive devices to walk or stand. They review imaging and clinical examination reports to confirm the severity and duration of your impairment. An attorney can help you gather the right documentation to support your claim.
You need objective medical evidence, including imaging like X-rays or CT scans, that confirms your fracture has not healed. You also need clinical reports from your surgeon detailing the lack of bone union and records supporting your medical need for mobility AIDS. An attorney can help you ensure all required evidence is submitted to the SSA.
If your claim is denied, you have the right to request a reconsideration and, if necessary, a hearing before an ALJ. You must file your appeal within the specific timeframe provided in your denial notice. An attorney can help you identify missing evidence and strengthen your case for the next stage of the process.
