Pathologic fractures due to any cause SSDI Claims in Washington

Medical criteria

SSA Blue Book listing

1.19 Pathologic fractures due to any cause

Listing criteria (20 CFR Appendix 1, Part A)

(see 1.00J), documented by A and B: A. Pathologic fractures occurring on three separate occasions within a 12-month period. AND B. Impairment-related physical limitation of musculoskeletal functioning that has lasted, or is expected to last, for a continuous period of at least 12 months, and medical documentation of at least one of the following: 1. A documented medical need (see 1.00C6a) for a walker, bilateral canes, or bilateral crutches (see 1.00C6d) or a wheeled and seated mobility device involving the use of both hands (see 1.00C6e(i)); or 2. An inability to use one upper extremity to independently initiate, sustain, and complete work-related activities involving fine and gross movements (see 1.00E4), and a documented medical need (see 1.00C6a) for a one-handed, hand-held assistive device (see 1.00C6d) that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand (see 1.00C6e(ii)); or 3. An inability to use both upper extremities to the extent that neither can be used to independently initiate, sustain, and complete work-related activities involving fine and gross movements (see 1.00E4).

Body system category

1.00 Musculoskeletal Disorders

Common denial reason

Pathologic fracture claims are frequently denied when fractures are treated as acute events without evidence of ongoing inability to perform work-related activities for the required duration.