Disability Benefits After Undergoing Knee Replacement Surgery

February 9, 2022
Dayes Law Firm

Knee replacement surgery is a major, but common surgical procedure to help relieve pain and restore function to a knee joint that has been severely damaged, often due to arthritis. While most people make a full recovery after surgery, some people experience complications, such as knee replacement failure.

An unsuccessful surgery can leave a person with chronic knee pain, loss of range of motion, swelling, stiffness and reduced mobility. A second “revision” surgery may even be required. Complications from knee replacements can also prevent a person from returning to his or her previous job or working at all.

If knee replacement surgery has affected your life, disability benefits may be an option. However, not everyone who applies for Social Security Disability for a knee replacement is awarded benefits. Sufficient medical evidence is required in order to have a chance at getting a disability claim approved.

Dayes Law Firm is here to help. The initial consultation is free and confidential.

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Meeting Criteria Under Blue Book Listing

The Social Security Administration (SSA) evaluates disability claims for knee replacements by looking at whether or not you meet the criteria (i.e. clinical and lab tests) for one of its Blue Book listings.

It is important to work with your treating doctor to make sure that you have completed all of the specific medical criteria required by the SSA. This is because knee replacements are generally considered a successful surgery. Most people are able to recover within a year. The medical evidence submitted must show that your impairment is severe enough to be granted disability benefits.

Knee replacements are listed in Section 1.17 of Musculoskeletal Disorders (reconstructive surgery or surgical arthrodesis of a major weight-bearing joint). To meet or equal this listing, your knee issues must cause significant physical limitations, such as an inability to walk, bend down or climb stairs.

The SSA will require the following documentation:

  • Record of knee replacement surgery on one or both knees
  • Notes from your doctor about your difficulty to move due to your knee issues
  • Evidence that you cannot walk without an assistive device (i.e. wheelchair and crutches)

It is important to note that this listing only applies if it has been at least a year since your knee replacement surgery. This includes following a reasonable period of recovery and rehabilitation.

However, a knee replacement can wear out or become loose over time. If you have had chronic knee pain and reduced mobility years after surgery, you may be eligible for disability benefits under listing 1.18 (abnormality of a major joint(s) in any extremity). This listing requires the following:

  • A history of chronic pain or stiffness
  • Abnormal motion, instability or immobility in the joint
  • Record of this abnormality on a physical exam or imaging test
  • An inability to walk without a walker, crutches, two canes or a wheelchair

Medical-Vocational Allowance for Knee Issues

If your knee issue does not meet a Blue Book listing but is still severe enough to keep you from working, you may qualify for a medical-vocational allowance.

The SSA will conduct a thorough review of your medical records to determine how your knee issues post-surgery impair your ability to perform day-to-day activities and function on the job. If the review concludes that you cannot maintain gainful employment, your disability claim may be approved.

The SSA will also establish a residual functional capacity or RFC rating for you. This will inform them of the type of work (i.e. sedentary, light or medium work) you are able to perform given your limitations.

Evidence of Your Knee Replacement Surgery

You and your treating doctor will need to submit medical evidence of your knee replacement surgery. This includes your knee diagnoses, any X-rays or MRIs, as well as pre-and post-surgical notes. An experienced lawyer at our firm can help you gather all of this information from your treating doctor.

The surgical notes should include:

  • How long you are able to walk
  • If you must use an assistive device
  • How long you are able to stand
  • If you can kneel, bend, or crouch
  • If you can lift or carry heavy items
  • If you can climb stairs without help

The SSA will also want to know the treatments you have undergone post-surgery. In addition to physical therapy or rehabilitation, perhaps you are on certain pain medication or taking therapeutic injections.

Keep a journal of how your chronic knee pain impacts your daily activities, such as driving, cleaning, or grocery shopping. Consistent and accurate documentation of your limitations may also strengthen your disability claim.

Get Help Obtaining Disability After Knee Surgery

If you need help with the claims process or appealing a denial notice, Our Phoenix-based Social Security Disability lawyers are here to offer qualified legal counsel.

The initial consultation is free of charge so there is no risk to you. We charge nothing up front for our services and only get paid if we help you get benefits.

Call (866) 320-4770 to talk to a lawyer.