Can you get Social Security disability for Musculoskeletal Disorders?

Musculoskeletal conditions are among the most common reasons people apply for Social Security disability, and they are also among the hardest claims to win at the listing stage since the rules changed.

If you have a back, neck, or joint condition that keeps you from working, the two things worth understanding are what the listings now require, and why most of these claims are decided somewhere else entirely.

The rules changed in 2021

Social Security rewrote the musculoskeletal listings effective April 2, 2021. This was not a renumbering exercise. The way these claims are assessed changed fundamentally, and a great deal of published guidance, including on law firm websites, still describes the old system.

Under the old rules, a claimant had to show an inability to ambulate effectively if the condition affected walking, or an inability to perform fine and gross movements effectively if it affected the hands. Those standards no longer exist.

The new listings are built around documented medical need for assistive devices, and they are considerably more demanding.

What the functional criteria now require

Most of the musculoskeletal listings include a functional requirement, and it is satisfied by at least one of the following:

• A documented medical need for a walker, bilateral canes, or bilateral crutches, or a wheeled and seated mobility device involving the use of both hands
• An inability to use one upper extremity to independently initiate, sustain, and complete work-related activities involving fine and gross movements, together with a documented medical need for a one-handed assistive device that requires the use of the other upper extremity, or a wheeled mobility device involving one hand
• An inability to use both upper extremities to the extent that neither can independently initiate, sustain, and complete work-related activities involving fine and gross movements

Read those carefully, because the practical consequence is significant. Every route requires both of your upper extremities to be occupied or unusable.

A single cane will not satisfy this. Neither will difficulty walking on its own. A person who cannot walk more than fifty feet but has full use of their hands generally will not meet a musculoskeletal listing now, however genuine their limitation. In effect, a lower body condition has to be paired with an upper body limitation.

What “documented medical need” means

This phrase does a great deal of work. Social Security defines it as evidence from a medical source supporting your need for the device for a continuous period of at least twelve months, describing any limitation in your upper or lower extremity functioning, and describing the circumstances in which you need to use it.

That level of detail rarely appears in an ordinary appointment note. If you use an assistive device, it is worth asking your doctor specifically to record why you need it, what it does for you, and in what circumstances, rather than assuming a mention of the device is enough.

Worth knowing the other way round as well: Social Security does not require a prescription for the device. What it needs is the documented medical need, so a walker you have relied on for a year without ever being formally prescribed one can still count, provided your doctor puts the need in writing.

One further requirement: for most of these listings, all of the required criteria must be present at the same time, or within a close period of one another. Social Security currently reads that as a twelve-month window, though that is a temporary widening of a four-month rule. Findings scattered across several years may not satisfy a listing even if each one appears somewhere in the file.

The current musculoskeletal listings

Section 1.00 now contains the following:

• 1.15 Disorders of the skeletal spine resulting in compromise of a nerve root, which covers most back and neck conditions including herniated discs, degenerative disc disease, and nerve root compression
• 1.16 Lumbar spinal stenosis resulting in compromise of the cauda equina
• 1.17 Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint
• 1.18 Abnormality of a major joint in any extremity, which covers conditions such as osteoarthritis, joint instability, subluxation, contracture, and ankylosis
• 1.19 Pathologic fractures due to any cause
• 1.20 Amputation due to any cause
• 1.21 Soft tissue injury or abnormality under continuing surgical management, which includes burns
• 1.22 Non-healing or complex fracture of the femur, tibia, pelvis, or one or more of the talocrural bones
• 1.23 Non-healing or complex fracture of an upper extremity

Listing 1.15, the spine listing, requires four things together: pain, paresthesia, or muscle fatigue in a neuro-anatomic distribution; examination or test findings showing muscle weakness and signs of nerve root irritation, tension, or compression, plus either sensory changes or decreased deep tendon reflexes; imaging consistent with the compromise; and the functional criteria described above.

A note about opioids

This is worth knowing, because it worries people. Social Security states expressly that a musculoskeletal disorder may meet or medically equal these listings regardless of whether you were prescribed opioid medication, and regardless of whether you were prescribed it and did not take it.

Declining opioid pain management, or being unable to obtain it, does not count against you under these listings.

Why most of these claims are won elsewhere

Because the listings are now so demanding, the great majority of musculoskeletal claims are decided at the next stage, on residual functional capacity. That is where the real argument usually happens, and it is worth understanding how it works.

I can’t stand for very long. Can I get disability?

I talk to many people who experience pain when performing jobs that require standing, whether for short or long periods. The reasons vary, but the common theme is that the pain becomes unbearable enough that the person has to sit or lie down.

Social Security may decide that your inability to stand leaves you capable of what it calls sedentary work. In other words, a sit-down job.

Many people who find themselves reduced to sedentary work have never done a desk job in their lives. A construction worker with a severe impairment that prevents standing is usually shocked to learn Social Security believes he can perform work he has never done. Vocational experts at hearings may testify that sedentary jobs include packers, assemblers, surveillance system monitors, and various other occupations.

Does that mean you lose?

Not always. Several other factors come into play.

Pain that continues when you sit. If the pain you experience while standing does not stop when you sit down, that undermines the whole sedentary premise. Continuous severe pain in both positions may be enough to win the claim on its own.

Your age, education, and past work. These matter enormously and Social Security applies specific rules to them. An older individual with limited education and no transferable job skills may receive benefits considerably more readily than a younger, more educated claimant with the same physical limitations. The thresholds that matter most are 50, where a claimant limited to sedentary work with no transferable skills is in a considerably stronger position, and 55, where the test drops to light work rather than sedentary. This is not unfairness; it reflects a realistic assessment of who can retrain into unfamiliar work.

Your other conditions. Social Security must consider all of your impairments combined. Suppose you have a back condition that prevents standing, and the pain is manageable when seated, so you are reduced to sedentary work. If you also have major depression that prevents you from concentrating or attending reliably, the combination may support a finding of disability where neither condition would alone.

That combination point is worth taking seriously. Chronic pain and depression frequently travel together, and a claim argued on the back alone may miss the stronger argument.

Other limitations worth documenting

• The need to alternate positions or to lie down during the day, which few jobs accommodate
• Limits on lifting and carrying, which define which exertional category applies to you
• Postural limitations such as bending, stooping, crouching, kneeling, and climbing
• Reaching and handling, particularly overhead reach, which rules out a good deal of sedentary work
• Time off task and absences, since vocational experts routinely testify that employers tolerate neither beyond narrow limits
• Medication side effects, including drowsiness and difficulty concentrating

The evidence your claim needs

Your condition must have lasted, or be expected to last, at least twelve months. Social Security generally needs a longitudinal record, because musculoskeletal symptoms often improve over time or respond to treatment, and evidence over an extended period shows whether your functioning is improving, worsening, or unchanging.

Useful evidence includes:

• Imaging, including MRI, CT, and X-rays, with the reports rather than only the conclusions
• Examination findings recording strength, reflexes, sensation, and range of motion
• Documentation of any assistive device, with the detail described above
• Records of treatments attempted, including physical therapy, injections, and surgery, and what each achieved
• Surgical and operative reports
• A medical source statement addressing how long you can sit, stand, and walk, how much you can lift, and how often you would be absent

Your provider needs to document limitations in the physical examination section of their notes rather than simply recording your reported pain. That distinction is often what separates a strong file from a weak one.

Talk with an Indiana disability attorney

If a musculoskeletal condition is preventing you from working, contact my office at (866) 950-5116 or complete the free consultation form and I will be in touch.