The short answer to this question is a yes, knee replacement qualifies for disability.
Knee replacement surgeries have been listed under conditions qualifying for Social Security Disability Benefits as per the Social Security Administration. You may avail of these benefits if you have undergone a knee replacement surgery that has left you unable to do any work for at least a year.
Most patients experience a considerable improvement in the condition of the knee after a knee replacement surgery. However, sometimes a patient may not recover well enough to get back to work. The Social Security Disability Insurance (SSDI) may offer support to all the people who are in recovery and cannot earn their livelihood due to some medical complications.
How Do You Qualify for Social Security Disability Insurance After Knee Replacement?
Social Security Administration (SSA) is responsible for giving disability benefits to suitable patients. The list of impairments with qualifying criteria and symptoms is mentioned in their book called the Blue Book (link ahead). The category ‘Knee replacements’ is placed under Section 1.0 Musculoskeletal System of this medication guide.
SSA states that you can avail of disability benefits if you cannot “ambulate effectively” and shall not recover within a year. It is applicable for knee replacement surgeries as well the diseases and injuries that affect the knees.
Your applications will be scanned by the SSA for medical proof. You will be considered for disability benefit basis the following criteria:
- If you have dysfunction of the knee joint. It could include anything that affects your ability to walk, things like a change in shape, stiffness, severe pain, or any condition that affects your ability to walk.
- If for a year (or longer), you are unable to commute to work after knee replacement surgery.
- Any other condition that makes you unable to work after surgery, such as a failed surgery, excessive pain, or other medical complications.
But it is not easy to qualify for this social security benefit since most of the time the required paperwork is either missing or inadequate. So you must take the help of your health care provider to get the necessary medical documents ready.
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How Will You Prove Disability After Knee Replacement Surgery?
To prove disability, here is a reference list from the Blue Book. It covers all the documentary evidence required for your application and to qualify for disability benefits.
- You will need records of your knee condition or your surgery from your orthopedic surgeon.
- Statement from your doctor about your condition after a physical examination mentioning particularly,
- Inability to move a sufficient distance at a particular pace.
- Any assistive devices used by you such as crutches, canes, wheelchairs, walkers, etc.
- Any pain experienced while moving and its severity.
- Inability to travel unaccompanied or whether support or companion is needed to travel back and forth from work.
- Unable to carry out everyday chores such as showering, cooking, doing market errands, etc.
- All supporting tests, X-rays, or any other imaging, showing the complications in healing after your knee surgery.
- All other supporting reports of any secondary conditions which happened after the surgery, such as infections, blood clots, etc.
- Evidence supporting the fact that you have not or may not be able to return to your comfortable walking state within a year.
- Records of all pain-relieving medications, steroids, or any other drugs administered for managing your persistent pain.
- Any physical therapy or rehabilitation techniques suggested to you.
- Any major lifestyle changes due to the knee condition.
- Information on whether you will be able to get back to your previous work or not.
- If not, will you be able to do any other work?
All in all, you have to prove to the SSA that your knee disability is so severe that you can’t get back to work for at least a year.
If you fail to qualify for the criteria mentioned by the SSA, there is another option for you. You might be eligible for some benefits under the Medical-Vocational Allowance.
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Medical-Vocational Allowance (MVA)
If you do not qualify for criteria from the Blue Book but still have such a severe condition that you are unable to work, Medical-Vocational Allowance may help you.
How to be eligible?
If you are an adult who cannot work after knee replacement and are only trained for or done a single job in your life, have limited education or financial means, you may qualify for MVA.
How to apply?
You will have to apply with all your past and present medical and surgical records, tests, and a residual functional capacity test (test to evaluate daily functions such as walking, running, standing, pushing, pulling, etc.)
You can apply for these benefits on your own, or you can hire a disability attorney. They can help you with the initial application, or if your application is not accepted and you need to reapply.
In case your application is rejected again, you could reach out to an administrative judge. He will go through your appeal and give a suitable verdict.
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Veteran Affairs (VA) Disability for knee replacement
Veterans Disability is a support system for those American veterans who had knee conditions or had to undergo knee replacement surgery due to events during their military service.
How to be eligible
For eligibility, it will have to be approved medically that the disability (or at least 50% of it) was due to some injury, illness, or event that happened during your military service and is not a recent one. It would be under consideration even if the event may not have caused it but would have aggravated your previously present knee condition.
For this, you will have to establish a direct link between your military service and your disability. This link can be in the form of any diagnosis or surgical records, statements from the orthopedic surgeon, or test records of that time. In addition, you will have to associate all this with the military event as well.
SSA often judges the range of disability by a Disability Benefits Questionnaire (DBQ) that has to be filled by your doctor as evidence for the claim.
A Compensation and Pension Exam (C&P) may be done in cases where you may be unable to give satisfactory proof of your condition. The VA may support or refuse your claim based on this.
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There are different VA disability ratings from 30 to 100 percent for knee pain and its other associated conditions.
- 30 percent means that if you had a knee replacement due to any service-related event, you will have a minimum rating of 30 percent.
- 100 percent is the maximum that can be given till one year after the surgery, after which you will be re-evaluated for pain and knee movement range.
- For idea, the compensations for these ratings till 31st December 2020 were as follows,
- For 30 percent – USD 441.35 per month
- For 100 percent – USD 3146.42 per month
In the end, even though knee replacement surgeries are common, it is extremely difficult to receive disability benefits for them since they are expensive.
It is suggested you check the Blue Book thoroughly beforehand for all clauses and criteria. Prepare your medical documentation properly with all necessary reports.
And finally, it is a good idea to take the help of a disability attorney who has expertise in this field and will help you pass your claims and receive your disability benefits.
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