Joint abnormalities are often the basis for receiving Social Security disability benefits. Some Social Security listings require “gross deformity” to meet the listing. If you have difficulty with a major joint such as hips, knees, ankles, shoulders, elbows, wrists or hands, contact one of our Boise Social Security Attorneys for a free evaluation of your condition. You can ask question of an actual attorney rather than a paralegal or secretary.
Gross anatomical deformity of a joint means that the joint disfigurement, enlargement, instability, slippage, etc. can be observed on physical examination. Here are some of the terms that are used to describe joint deformity: ankylosis (bony fixation), subluxation (slippage out of alignment), instability (inability to maintain alignment), and contracture (soft tissue fixation). The deformity may be visually observable or detected by touch or by secondary effects such as the loss of range of motion. Range of motion (ROM) should be determined passively, i.e., with the doctor moving the limb as active range of motion, i.e., the patient moving the limb is less reliable because it is hard to tell if the patient is giving best efforts. Except in extreme cases, shoulder and hip deformity must be seen through imaging such as x-ray.
There are several conditions that can cause joint deformity. Arthritis, for example, can be sufficiently severe that bone growth on both sides of a joint fuses the joint together (bony ankylosis). Other conditions may result in fibrous ankylosis, where the joint is fixed because of hardening of tissues (ligaments, tendons, skin) around the joint, as a result of traumatic damage, disease process, or disuse. With fibrous ankylosis, tissue looses its elasticity and the joint can no longer move.
The inability to manipulate hands is particularly disabling. Several conditions can result in the inability to finger or hand objects. For example, Volkmannís ischemic contracture is where the hand becomes fixed in a bent position on the wrist, and the hand become claw-like. This may be the result of a crushing injury around the elbow that interrupts blood supply to the forearm muscles. Another condition is the Dupuytrenís contracture where the fingers become fixed because the ligaments and tendons on the bottom of the hand become hardened and the hand will not open.
It is extremely important to understand that a full range of normal motion does not mean a claimant does not meet a listing because abnormal motion can greatly impair function even if the normally expected range of motion is present. In fact, ligament laxity is a condition where there is too much motion and it can be quite disabling because of abnormal forward (anterior), backward (posterior), or sideways (lateral) motion. It is important that doctors do not simply note “full ROM”. They also need to report the presence or absence of abnormal range of motion.
X-ray, CT and MRI can be helpful, but the right imaging must be used. For example, a plain X-ray might be sufficient to rule out a bony arthritic process, but would not show soft tissue damage (e.g., fibrous ankylosis) that would be visible on a MRI. To meet a listing there must be evidence of joint involvement (joint space narrowing, bony destruction, or ankylosis), whether or not there is soft tissue damage resulting in instability.
Joint deformity of itself is not enough to meet the listing. If the deformity is in the hip, knee, or ankle joint, the claimant must not be able to effectively ambulate. The nature of ineffective ambulation is discussed by the SSA in Listing 1.00B2b. If the joint deformity is in shoulder, elbow, or hand-wrist joint in each upper extremity, the nature of ineffective function is defined by the SSA in Listing 1.00B2c.
For more information on how a joint deformity may qualify you for Social Security Disability benefits, contact one of our Social Security Disability Attorneys in Boise Idaho.
Originally posted 2014-01-27 14:04:17.