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.
Full Answer
When to apply for disability for knee replacement surgery?
When Knee Replacement Surgery is Unsuccessful. Social Security disability and SSI disability benefits are available only to those who are unable to work for at least a year. Most people under 60 or 65 recover from knee replacement surgery sufficiently enough to go back to work within a year.
Do you qualify for Social Security disability benefits with knee pain?
We put a lot of weight on our knees every day, and when a knee disability makes walking or standing painful or impossible, you may qualify for Social Security disability benefits. With the help of a Fort Lauderdale Social Security disability representative, you may file a claim to seek the benefits to which you are entitled.
What is a 100% disability rating for knee replacement surgery?
Total Knee Replacements: If your knee disability becomes so severe that a total knee replacement is required you will automatically receive a temporary 100% rating for one year post surgery. After that one year period, the knee will be rated according to the severity of any remaining problems.
What are the requirements to qualify for a knee replacement?
This listing requires you to have: some type of abnormality in your knee that's seen at a physical exam or on x-rays or MRIs an inability to walk without a walker, crutches, two canes, or a wheelchair.
Is knee replacement surgery considered a disability?
Knees, hips, and ankles, all fall into the category of a major weight-bearing joint. Most joint surgeries do not result in disability. The reason for that is most people recover after surgery in under one year. To receive disability benefits, you must have at least one year of disability to be found disabled.
Can you get disability for a knee injury?
Because most knee injuries are short-lived, very few people with knee pain will win an SSDI award. However, for those people with more long-term knee problems, a disability award is possible.
What qualifies you for a knee replacement?
To qualify for a knee replacement, you need to meet two major requirements. One is that you have a significant amount of cartilage loss. This is usual evaluated by taking X-rays of the knee while you are in a standing position. The loss of cartilage is seen as narrowing of the space between the knee bones.
Are there permanent restrictions after knee replacement?
Employees who have knee replacement surgery are usually on crutches for three to six weeks. Our experience shows that most are considered totally disabled and paid lost wages. Even after resuming most daily activities, it is not uncommon to have permanent work restrictions.
What percentage of disability is knee surgery?
The VA rates knee replacements under 38 C.F.R. § 4.71a Code 5055. The rating criteria ranges from 100 percent to 30 percent disabling. The 30 percent rating is the minimum rating for a knee replacement, meaning if you had a knee replacement and it is service-connected, you will be rated at least at 30 percent.
What percentage of disability is a knee injury?
The most common rating VA assigns for limitation of flexion of the knee is 10 percent, although the highest rating a veteran can receive is 30 percent.
Can a knee replacement be rejected by the body?
Knee implant rejection is extremely rare. People may confuse it with infection, but the two are different complications. Implant rejection, or metal hypersensitivity, happens when metal in the implant triggers a reaction in the patient's body. This can be an allergic reaction or an autoimmune response.
Why you should not get a knee replacement?
Increased Risk of Heart Attack, Stroke, and Bleeding Stomach Ulcers. Knee replacement patients aged 60 and up are 31 times more likely to experience a heart attack in the two weeks following surgery. When you amputate a joint from a patient, there is severe trauma to the blood vessels and bone marrow space.
What limitations do you have after knee replacement surgery?
After recovery, you can engage in various low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations.
What is the most commonly reported problem after knee replacement surgery?
Knee Stiffness One of the most common problems people experience after knee replacement is a stiff knee joint. Often these symptoms can cause difficulty with normal activities including going down stairs, sitting in a chair, or getting out of a car.
What is the newest procedure for knee replacement?
Minimally-invasive quadriceps-sparing total knee replacement is a new surgical technique that allows surgeons to insert the same time-tested reliable knee replacement implants through a shorter incision using surgical approach that avoids trauma to the quadriceps muscle (see figure 1) which is the most important muscle ...
What are the complications of knee replacement surgery?
Complications from total or partial knee replacement surgery can include chronic pain, loss of range of motion, locking/clicking, and stiffness. Most patients with chronic knee problems who go through surgery do benefit from reduced symptoms, but sometimes the improvement is not enough to return to work.
How long can you be out of work after knee replacement?
When you file a disability claim after knee replacement surgery, Social Security will generally assume that the outcome of your surgery will be positive and that you will be out of work for six months at most. As a result, Social Security denies many knee replacement claims since they don't meet the 12-month duration requirement.
How long does it take for a disability to be reviewed?
If you are approved for benefits, you may be labeled "expected to improve," and your case will likely be reviewed within a year or two after your benefits start .
How long does it take to recover from knee replacement surgery?
Recovery time generally varies from a few weeks to a few months.
Can you walk and climb on Social Security?
If you are able to walk and climb and do the things noted above, you are unlikely to meet Social Security's listings for reconstructive surgery or dysfunction of a joint. But that's not the end of the disability determination. Social Security must then look to whether you can go back to your prior job in your present condition.
What is the best way to get a knee replacement?
In order to be considered a good candidate for knee replacement surgery, you first need to receive screenings and treatment from your primary care physician who participates in Medicare and accepts assignment. Your primary doctor may also refer you to an orthopedic specialist.
Is surgery covered by Medicare?
These doctors’ services are covered under Medicare Part B as they are performed on an outpatient basis. If surgery is the medically necessary option, then the surgery itself will be performed at a surgical center and should also be covered under Medicare Part B as an outpatient service.
Does Medicare cover knee replacement?
Medicare Coverage for Knee Replacement Surgery. One of the biggest concerns seniors and Medicare recipients under the age of 65 who qualify due to disabilities face is the costs associated with knee replacement surgery. In the majority of cases, knee replacement surgery and its associated treatments are covered under different parts of Medicare.
ELIGIBILITY FOR SSD & SSI BENEFITS AFTER KNEE REPLACEMENT SURGERY
If you have ever had surgery, you know pain doesn’t disappear after the operation. In fact, even with surgery, you may still have major problems with pain. Problems occur when the pain prevents you from working. It may also prevent normal activities, like standing or sitting. Chronic pain may result in the inability to walk.
RESIDUAL FUNCTIONAL CAPACITY
When your ability to perform activities, such as sitting and standing, is impaired, it is known as impairment in your “ residual functional capacity .” If your residual functional capacity is limited, then the SSA may find you cannot sustain full-time work. If you cannot do your old job, you should apply for disability benefits.
RECONSTRUCTIVE SURGERY OF A WEIGHT-BEARING JOINT
In order to win disability benefits, your impairment must meet or equal a listing. Meeting a listing means having all the criteria on the list. Equalling a listing means having a combination of symptoms that are as severe as those in the listing.
1.17 Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint (see 1.00H ), documented by A, B, and C
A. History of reconstructive surgery or surgical arthrodesis of a major weight-bearing joint.
APPLY FOR SSD BENEFITS AFTER KNEE REPLACEMENT SURGERY
If you have not returned to work after you knee surgery, you may be eligible for disability benefits. In order to prove disability, you should hire a law firm that specializes in disability. Cannon Disability is that firm. We have over 30 years of legal experience representing disabled individuals.
CONTACT CANNON DISABILITY LAW AFTER KNEE REPLACEMENT SURGERY
It is always our goal to win disability benefits for our clients. Your ability to care financially for yourself and your family relies upon the results of your SSD case. Additionally, your ability to receive Medicaid and also Medicare depends upon whether you are successful with your disability claim.
THE TOP SSD ATTORNEYS WANT TO HELP YOU AFTER YOUR KNEE REPLACEMENT SURGERY
We will use our legal skills to help you through the disability process. It is our goal to win your case. But, it also our goal to make it easier for you. We offer a free consultation. And, there is no obligation to become a client if you call. You can simply ask questions. That is what we are here for.
What conditions are considered to be eligible for Medicare?
Even though most people on Social Security Disability Insurance must wait for Medicare coverage to begin, two conditions might ensure immediate eligibility: end-stage renal disease (ESRD) and Lou Gehrig’s disease (ALS).
How long does it take to get Medicare if you appeal a decision?
The result: your wait for Medicare will be shorter than two years.
What is ESRD in Medicare?
ESRD, also known as permanent kidney failure, is a disease in which the kidneys no longer work. Typically, people with ESRD need regular dialysis or a kidney transplant (or both) to survive. Because of this immediate need, Medicare waives the waiting period. 2
What to do if your income is too high for medicaid?
If your income is too high to qualify for Medicaid, try a Medicare Savings Program (MSP), which generally has higher limits for income. As a bonus, if you qualify for an MSP, you automatically qualify for Extra Help, which subsidizes your Part D costs. Contact your state’s Medicaid office for more information.
How long does a disability last?
The government has a strict definition of disability. For instance, the disability must be expected to last at least one year. Your work history will also be considered—usually, you must have worked for about 10 years but possibly less depending on your age.
When will Medicare be available for seniors?
July 16, 2020. Medicare is the government health insurance program for older adults. However, Medicare isn’t limited to only those 65 and up—Americans of any age are eligible for Medicare if they have a qualifying disability. Most people are automatically enrolled in Medicare Part A and Part B once they’ve been collecting Social Security Disability ...
Does Medicare cover ALS?
Medicare doesn’t require a waiting period for people diagnosed with ALS, but they need to qualify based on their own or their spouse’s work record. 3
What is a knee disability?
A Knee Disability Must Impair Your Ability to Walk. The Social Security Administration (SSA) defines a disabling knee condition as one that causes a functional loss resulting in the inability to ambulate effectively.
What are the three types of knee disability?
Three of the common types of knee disability are major dysfunction of a knee joint, reconstructive surgery or replacement of the knee joint, and amputation at the knee. Evidence to support these conditions may be physical, such as proof of an assistive device like a prosthetic leg, walker, or cane.
Can you walk without a knee assistive device?
Some examples of ineffective ambulation that may qualify as a knee disability include the inability to: walk without an assistive device (cane, crutches, etc); sustain a reasonable walking pace ...
How long does a veteran have to be on disability for knee replacement?
After total knee replacement surgery, there is an automatic 100% disability rating for one year. After that year has lapsed, veterans will require additional tests for knee flexion, extension, and instability.
What happens if you are denied a claim for knee pain?
Documentation of injuries, surgeries, or other conditions with knee pain as a secondary symptom. If your claim is initially denied for any reason, hope is not lost. The Appeals Modernization Act (AMA) System gives you three options to have your claim reviewed if you disagree with the decision.
What is TDIU disability?
TDIU stands for Total Disability Rating based on Individual Unemployability. On its own, knee pain will not qualify you for TDIU. As mentioned above, the only time knee pain qualifies for a 100% disability rating is following total knee replacement surgery. However, if you already have at least one service-connected disability rated at 60% or more, or two or more disabilities for a combined total rating of 70% or more, and you can’t hold down a job due to knee pain, you may qualify for TDIU.
What is a diagnosis for knee pain?
1. A current diagnosis that includes the disability that is being claimed. In this case, you will need a diagnosis that accounts for the knee pain you are experiencing. If your diagnosis loosely explains your knee pain, it is unlikely that it will apply to your disability claim.
What is a C&P exam for knee pain?
When you don’t have sufficient medical evidence to support your veterans disability claim , the VA may require a Compensation & Pension (C&P) exam for your knee pain. This exam generally happens at a VA hospital or clinic and is conducted by VA medical staff. The purpose of the C&P exam is to support or refute your claim. You will need to submit all medical records to the VA prior to the exam, as your provider will not be able to review any new information once you are there.
Why is pain considered a disability?
However, it is often difficult to prove that pain is the cause of a person’s service-connected disability. This is because pain is not in itself a diagnosis.
What is a medical nexus?
A medical nexus that connects the current, diagnosed disability to the in-service occurrence, incident, or exposure. The medical nexus can make or break a disability claim. A medical nexus letter from a medical provider can establish strong ties between the condition and military service.