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 |
SSA evaluates disability claims using the Blue Book, which lists qualifying conditions and the specific criteria each must meet. If your condition matches a Blue Book listing, approval is more straightforward. Even if your condition does not match a Blue Book listing exactly, you can still qualify through a medical-vocational allowance. This considers your age, education, work experience, and functional limitations together. Consistent treatment records are critical. SSA looks for ongoing documentation showing your condition limits your ability to work, not just a single diagnosis.
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)
Request your medical records directly from each provider rather than relying on SSA to gather them. SSA requests can take months, and records sometimes get lost in the process. Include records from every provider you have seen for your disabling conditions, even if a visit seemed minor. Gaps in treatment history are one of the most common reasons for denial. Medical records from the past 12 months carry the most weight, but older records help establish the onset date. A treatment history spanning several years shows the condition is persistent, not temporary.
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 |
The RFC form is often the single most important document in your case. It translates your diagnosis into specific physical or mental limitations that SSA uses to determine whether you can work. Ask your treating physician to complete the RFC form, not a doctor you have seen only once. SSA gives more weight to opinions from providers with a long treatment relationship. Be specific on the RFC. 'Patient cannot lift over 10 pounds' is far more useful than 'Patient has lifting restrictions.' Exact numbers for sitting, standing, walking, and lifting limits help the judge make a clear decision.
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.
A denial does not mean your case is over. About 2 out of 3 initial SSDI applications are denied, and many of those denials are overturned on appeal. Read your denial letter carefully. It tells you exactly why SSA denied your claim. The most common reasons are insufficient medical evidence and SSA determining you can still perform some type of work.
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.
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Frequently Asked Questions
Can You Get SSDI for Complex Fractures??
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 or resulting in permanent impairment may be eligible for SSDI benefits.
How does compassionate allowance work for complex fractures?
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 should I include in the function report for a complex fracture claim?
Getting your documentation right is critical for complex fracture claims. 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.