Social Security Standards for Musculoskeletal Disability

A high percentage of SSDI and SSI disability claims are due to musculoskeletal disabilities. Back pain, arthritis, as well as leg and arm injuries that impair functional ability are all classified as musculoskeletal disabilities. SSA defines a musculoskeletal disability as a condition that significantly impairs function, or the ability “to ambulate and perform fine and gross movements on a sustained basis.”

Functional impairment will be considered, regardless of the cause(s), and includes pain associated with the underlying musculoskeletal impairment. The condition must have existed for, or be expected to last for at least 12 months. For the purposes of these criteria, inability must be due to physical impairment – if the inability to function is caused by mental impairment, a different set of criteria must be applied.

The SSA will determine if an individual is able to ambulate or perform fine and/or gross movements effectively based on the evidence contained in their case record.

Ineffective Ambulation

The regulations require for any cause, impairment of gross motor movement, (i.e. walking) “an extreme limitation in the ability to walk.” For example, if the arms and hands are limited by the need to use crutches, a walker, or two canes – a person who is only able to ambulate by using both hands to assist would be considered impaired.

“Effective ambulation” is defined as being able to sustain a “reasonable walking pace over sufficient distance to be able to carry out activities of daily living.” Additionally, an individual must be able to travel unassisted (without a companion), to and from their place of employment or school.

In addition to the examples listed above, ineffective ambulation would also include the inability to use standard public transportation or to climb a few steps, being unable to walk a block at a reasonable pace on rough or uneven surfaces, not being able to carry out routine ambulatory tasks like banking and shopping, as well as other possible unspecified situations.

Not being able to move independently about your own home without the use of assistive devices does not constitute effective ambulation in and of itself.

Fine Motor Impairment

Loss of function in both upper extremities indicates fine motor impairment if it “interferes with” being able to “initiate, sustain or complete activities.” Effective use of the upper extremities means that an individual must be capable of reaching, pulling, pushing, grasping, and utilizing their fingers in a sustainable way.

Examples of inability to perform fine and gross movements effectively are, but are not limited to, not being able to prepare a simple meal and feed oneself or to perform basic personal hygiene, and not being able to sort and file papers or place files in a cabinet that sits above waist level.

Arthritis

The SSA regulations utilize the results of various imaging techniques, examine anatomical deformity, limitation of motion, and chronic joint pain. The most recent part of the regulations considers function.

An applicant must show the involvement of “one peripheral weight-bearing joint” (ankle, knee, or hip) that results in an extreme inability to walk, or the involvement of “one peripheral joint in each upper extremity” (wrist-hand, elbow, or shoulder) resulting in the loss of ability to perform gross and fine motor movements effectively.

Pain

Other symptoms, including pain, are often an important contributing factor to functional loss. Medical laboratory findings must prove that a medically determinable impairment(s) exists that could reasonably be expected to produce the debilitating symptoms.

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