Can You Get SSDI for Complex Fractures?
TL;DR: Yes, if your fracture resulted in non-union, malunion, or complications that prevent you from working for at least 12 months. The SSA evaluates complex fractures under Listing 1.17 (fracture of the femur, tibia, pelvis, or one or more of the tarsal bones) or 1.18 (abnormality of a major joint). Single fractures that heal normally usually do not qualify, but fractures requiring multiple surgeries, those with hardware complications, or non-healing fractures often do.
A simple fracture that heals in 6 to 8 weeks will not get you SSDI. But complex fractures are a different situation entirely. When bones shatter into multiple fragments, fail to heal, require plates and screws that cause their own problems, or result in permanent joint damage, the disability can last well beyond 12 months.
The SSA needs to see that your fracture has caused or is expected to cause functional limitations lasting at least 12 consecutive months. The clock starts from the date of the injury, not the date you apply.
What SSA Listings Cover Complex Fractures?
| SSA Listing | Condition | Key Requirements |
|---|---|---|
| 1.17 | Fracture of femur, tibia, pelvis, or tarsal bones | Non-union or malunion with solid fixation and inability to ambulate effectively for 12+ months |
| 1.18 | Abnormality of a major joint | Chronic joint pain with abnormal motion, joint instability, or surgical fusion of a major weight-bearing joint |
| 1.20 | Amputation due to any cause | If fracture complications led to amputation |
Medical Evidence the SSA Needs
Imaging and Surgical Records
- Initial X-rays or CT scans showing the fracture pattern and severity
- Operative reports from all surgical procedures
- Follow-up imaging showing healing progress or lack thereof
- Documentation of hardware placement, removal, or complications
- Records of non-union or malunion diagnosis
Treatment and Recovery Records
- Physical therapy records with objective measurements of progress
- Orthopedic follow-up notes documenting persistent limitations
- Records of infection, hardware failure, or need for revision surgery
- Bone growth stimulator use if applicable
Functional Documentation
- Weight-bearing status and restrictions
- Range of motion measurements of affected joints
- Gait analysis or description of walking limitations
- Whether you need assistive devices (crutches, walker, cane, wheelchair)
RFC for Complex Fracture Cases
| Functional Area | What the SSA Evaluates |
|---|---|
| Ambulation | Can you walk without assistive devices for a reasonable distance |
| Weight bearing | Are there restrictions on standing or bearing weight on the affected limb |
| Lifting/Carrying | How does the fracture affect your ability to carry objects |
| Fine motor skills | If upper extremity fracture, can you grip, grasp, and manipulate objects |
| Workplace mobility | Can you navigate stairs, uneven surfaces, and workplace environments |
Common Denial Reasons
- The SSA expects the fracture to heal. For most fractures, the SSA assumes recovery within 12 months. You need documentation showing why your fracture is different.
- Insufficient evidence of non-union or complications. Follow-up imaging at 6, 9, and 12 months showing persistent fracture lines is critical.
- No functional limitations documented. Even with a visible fracture on X-ray, you need your doctor to document what you physically cannot do.
- Failure to follow treatment recommendations. If your orthopedist recommended physical therapy or a bone stimulator and you did not follow through, the SSA may deny your claim.
Compassionate Allowance
Complex fractures do not qualify for Compassionate Allowance fast-track processing. However, if your fracture resulted from a condition that does qualify (such as certain cancers that weakened the bone), that underlying condition may qualify.
Function Report Tips
- Describe exactly how the fracture affects your mobility: stairs, distances, surfaces you can and cannot navigate
- List all assistive devices and how often you use them
- Explain what household tasks you can no longer perform
- Describe your pain management routine and how it affects your alertness
- Note any complications: swelling, infection, hardware pain, limited range of motion
Getting your documentation right is critical for complex fracture claims. ClaimPath generates SSA-compliant disability documents for a flat $79, which is far less than the 25% of back pay a disability attorney would take from your benefits.
Related Condition Guides
Frequently Asked Questions
Can You Get SSDI for Complex Fractures??
TL;DR: Yes, if your fracture resulted in non-union, malunion, or complications that prevent you from working for at least 12 months. The SSA evaluates complex fractures under Listing 1.17 (fracture of the femur, tibia, pelvis, or one or more of the tarsal bones) or 1.18 (abnormality of a major joint). Single fractures that heal normally usually do not qualify, but fractures requiring multiple surgeries, those with hardware complications, or non-healing fractures often do.
What should I know about compassionate allowance?
Complex fractures do not qualify for Compassionate Allowance fast-track processing. However, if your fracture resulted from a condition that does qualify (such as certain cancers that weakened the bone), that underlying condition may qualify.
What are the best practices for function report tips?
Getting your documentation right is critical for complex fracture claims. ClaimPath generates SSA-compliant disability documents for a flat $79, which is far less than the 25% of back pay a disability attorney would take from your benefits.