Musculoskeletal Disability

Many common disabilities involving the musculoskeletal system result in one or more of the following functional losses that last for at least 12 months:

• Inability to Ambulate Effectively—Simply put, this means an extreme limitation of the ability to walk. Examples of ineffective ambulation are the inability to walk without the use of a walker, two canes or crutches, to use standard public transportation, to carry out routine daily activities, and/or to climb a few steps using a single handrail. The ability to walk independently about one’s home does not, in and of itself, constitute effective ambulation.
• Inability to Perform Fine and Gross Movements Effectively—Defined as the extreme loss of function of both upper extremities, a person is considered disabled under this criterion if he/she is unable to prepare a simple meal and feed oneself, to take care of personal hygiene, to sort and handle papers or files, and/or to place files in a file cabinet at or above waist level.
• Pain or Other Symptoms—For pain to be considered a contributing factor to functional loss, medical or laboratory findings must show the existence of a medically determinable impairment that could reasonably be expected to produce the pain or other symptoms as well as the criteria for functional limitations.

Diagnosis and evaluation of musculoskeletal impairments must include a detailed description of the rheumatologic, orthopedic, neurological, and other findings appropriate to the specific impairment, determined on the basis of objective observation during the examination and not simply a report of the individual’s allegation. Because abnormal physical findings may be intermittent, a record of ongoing management and evaluation must establish their presence over a period of time.

A person who uses an orthotic or prosthetic device should be evaluated with the device in place to determine the individual’s maximum ability to function. When an individual with an impairment uses a hand-held assistive device, such as a cane, crutch or walker, examination should be with and without the use of the assistive device unless contraindicated by the medical judgment of a physician.

An individual who has not received ongoing treatment despite the existence of a severe impairment(s) will be evaluated on the basis of the current objective medical evidence along with the individual’s medical history, symptoms, and medical source opinions.

Treatments for musculoskeletal disorders may have effects, both beneficial and adverse, that vary widely and may be temporary or long-term. As such, the finding regarding the impact of treatment must be based on a sufficient period of treatment to permit proper consideration or judgment about future functioning.

This summary cannot cover every medical condition and/or functional loss. The Social Security Administration offers more detail on its website. (Look under “SSAS Hot Links”, and then under “Listings”.)