The Basics of SSDI Eligibility

To qualify for SSDI, you must meet two basic criteria:

• Work History: You need to have worked a certain number of years and paid into Social Security through payroll taxes. The number of work credits required varies depending on your age at the time of your disability.
• Disability Definition: The Social Security Administration (SSA) defines disability as an inability to work for 12 months or longer due to a medical condition or a condition that is expected to result in death.

Your knee injury must meet the SSA’s definition of disability, which means it must be severe enough to prevent you from performing any significant work activity.

When a Knee Injury May Qualify for SSDI

Not all knee injuries automatically qualify for SSDI. For a knee injury to meet the SSA’s criteria, your condition must prevent you from working. Some examples of knee injuries that may qualify for SSDI include:

• Severe Osteoarthritis: If you have severe osteoarthritis in your knee that causes chronic pain and limits your ability to walk, stand, or sit for extended periods, this could qualify as a disabling condition.
• Knee Replacement Surgery: After knee replacement surgery, you may experience limitations in mobility, which can interfere with your ability to work. If the recovery and rehabilitation process makes it impossible for you to work for at least 12 months, you may qualify for SSDI.
• Ligament Injuries (ACL or MCL): Severe injuries to the anterior cruciate ligament (ACL) or medial collateral ligament (MCL) may cause instability, pain, and difficulty moving, which could meet the SSA’s disability requirements.
• Fractures and Chronic Pain: If you’ve sustained a severe fracture or chronic knee pain from an injury that results in long-term disability, it may be considered disabling if the pain limits your daily activities and work ability.

How the SSA Evaluates Knee Injuries for SSDI

When determining whether you qualify for SSDI due to a knee injury, the SSA uses a process known as the Listing of Impairments, a set of guidelines that describe medical conditions that automatically qualify for disability benefits. The SSA doesn’t have a specific listing for knee injuries, but your condition may qualify under the broader categories of musculoskeletal impairments.

Here’s how the SSA evaluates knee injuries:

• Step 1: Severe Impairment
  Your knee injury must be severe enough to prevent you from working. The SSA will evaluate how the injury affects your ability to perform basic work-related tasks like standing, walking, and sitting. If your knee injury prevents you from performing these tasks for 12 months or longer, it could meet the severity requirement.
• Step 2: Meeting or Equaling a Listing
  There isn’t a specific listing for knee injuries, but they may qualify under musculoskeletal impairments or joint dysfunction. To meet the SSA’s requirements, your knee condition must be so severe that it significantly limits your ability to walk, stand, or lift. If your knee injury leads to functional limitations like the inability to walk long distances or stand for extended periods, it may equal a listing in the SSA’s criteria.
• Step 3: Residual Functional Capacity (RFC)
  If your knee injury doesn’t meet or equal a listing, the SSA will assess your Residual Functional Capacity (RFC). This evaluation measures how your injury limits your ability to perform work tasks. The SSA will consider whether you can do your previous work or any other type of work, taking into account your knee injury’s impact on your physical abilities.

What Evidence You Need to Support Your SSDI Claim for a Knee Injury

To increase your chances of being approved for SSDI due to a knee injury, it’s important to provide thorough and detailed evidence. The SSA will want to see medical documentation that shows the severity of your injury and its impact on your ability to work. Here’s what you should include:

• Medical Records: Provide complete records from your doctor, orthopedic specialist, or physical therapist that show your knee injury’s diagnosis, treatment, and prognosis. This includes X-rays, MRI results, or surgical records if you’ve had any procedures done.
• Doctor’s Statements: Ask your doctor to provide a statement explaining how your knee injury limits your ability to work. A detailed explanation of how your condition affects your daily activities and job performance can strengthen your case.
• Physical Therapy and Rehabilitation Records: If you’ve gone through physical therapy or rehabilitation, bring records from these sessions to demonstrate the ongoing challenges you face due to the injury.
• Pain Management Records: If you’re undergoing pain management treatment, such as injections or medication, include records of your treatment plan and the level of pain you are experiencing.

Common Reasons SSDI Claims for Knee Injuries Are Denied

Many SSDI claims for knee injuries are initially denied because applicants don’t provide enough medical evidence or fail to demonstrate how their injury impacts their ability to work. Some common reasons for denial include:

• Insufficient Medical Evidence: If you don’t have enough documentation from doctors or specialists showing the severity of your injury and its impact on your work, your claim may be denied.
• Failure to Meet SSA’s Definition of Disability: If your knee injury doesn’t prevent you from performing basic work tasks or doesn’t meet the SSA’s severity requirements, you may be denied.
• Lack of Duration: To qualify for SSDI, your knee injury must last at least 12 months or be expected to result in death. If the SSA determines that your injury won’t last long enough to meet this requirement, your claim may be denied.