Disability Benefits for Amputations
A single amputation of a leg below the knee does not guarantee disability benefits. Here's what types of amputations do qualify.
Amputation is the loss of one of the body's extremities: arm, leg, hand, or foot. Leg amputations most often are done surgically, because of complications from diabetes or atheroslcerosis, but traumatic accidents can also cause the loss of a limb. Amputation of a hand or arm is usually the result of an industrial accident. If the amputation renders a person unable to work, the amputee might be eligible for Social Security disability benefits -- under certain circumstances.
The fact that you have had a body extremity amputated does not automatically qualify you for disability benefits. The only exception to this rule is if you have both hands amputated, a leg amputated up through the hip joint (hip disarticulation), or a pelvic amputation (hemipelvectomy). For all other amputations, you need to prove that you are unable to work. The Social Security Administration (SSA) lists the few circumstances where you can automatically qualify for benefits, called the official impairment listing for amputation (listing 1.05), but if you don't meet the official listing, you may still be able to prove that your amputation makes it impossible for you to work.
Official Listing Requirements for Amputation
To meet (qualify for) the Social Security Administration’s (SSA) medical listing for amputations, you must have suffered one of the following:
- Amputation of both hands
- Amputation of one or both lower extremities at or above the ankle with stump complications resulting in inability to use a prosthetic device to walk effectively
- Amputation of one hand and one lower extremity at or above the ankle with the inability to walk effectively, or
- Hemipelvectomy or hip disarticulation.
The SSA defines an inability to walk effectively as needing both hands to use a walker, crutches, or canes to get around, or needing help getting to work or using public transportation. An issue that will arise is whether a prosthetic device (e.g., an artificial leg) can help you ambulate, perform daily living activities, or work. Use of one cane with a prosthetic device would not qualify you as unable to walk effectively as you would only need to use one hand to walk -- unless you had lost the other hand through amputation.
Qualifying for Disability Benefits By Reduced Functional Capacity
Most amputees can’t qualify under the above impairment listing – for instance, a person with a below-the-knee amputation (BK amputation, or BKA) who can use a prosthetic device to walk, or a person who lost an arm below the elbow, would be denied under the official Social Security listing. However, you might be able to qualify for disability benefits if your amputation has reduced your "functional capacity" to such an extent that there is no work you can do, given your age, education, and experience.
The SSA will give you a rating of the type of work it thinks you can do (sedentary work, light work, medium work, or heavy work) based on your amputation and your doctors’ restrictions (such as no crawling, kneeling, or working at unprotected heights). Your rating is called your residual functional capacity (RFC). If the SSA determines there are no jobs you can be expected to do with your RFC, there’s a chance you could qualify for disability benefits under what’s called a medical-vocational allowance.
If you cannot stand or walk for six to eight hours per day, you should receive a sedentary RFC. If your amputation was above the knee and you’re using a prosthetic device to walk but you have difficulty, you should be able to get a sedentary RFC. But if your amputation was below the knee and you are able to use a prosthetic device effectively, you might receive a medium RFC.
The lower the RFC, the fewer jobs you can do. Even so, your chances of getting disability through a medical-vocational allowance are low unless you are over 50. For instance, if you have a sedentary RFC, you might be considered disabled if you are over 50, have a high school education, and have limited skills. But if you are younger than 50 and literate, the SSA will presume that you can learn a new job. Even worse, if the SSA says you can do medium work, you won’t be considered disabled unless you’re older than 55, have less than a 6th grade education, and have limited skills. For more information, see Nolo's article on how Social Security decides disability based on your abilities and limitations.
Medical Evidence Required
The SSA will request your medical records from your treating doctor. Your records should include documentation of your amputation, your ability to use a prosthetic device, and your ability to walk, bend, squat and rise.
Your doctor should also address the likelihood that your functional limitations will improve or whether your condition is likely to stay the same. To get Social Security disability benefits, your disability must have lasted or be expected to last at least twelve months. If your amputation was recent, and the SSA believes you will be able to walk effectively within 12 months, it will deny your benefits.
Applying for Disability Benefits for Amputations
In order to apply for SSI (for low-income people) or SSDI (for workers who have paid taxes over many years) due to disability based on an amputation, you should fill out the SSA’s standard application and sign releases that permit your medical providers to send your medical history and records to the SSA for consideration of your disability claim. After the SSA has examined your application and medical records, an SSA official will make a determination as to your eligibility for benefits.
Presumptive Disability Benefits
When you apply for SSI disability benefits, you might be able to get immediate cash payments if you have one of the following:
- amputation of two limbs, or
- amputation of a leg at the hip.
This is called "presumptive disability" -- the SSA assumes that your condition will qualify for disability benefits, so it starts paying them right away. The SSA will pay benefits until your claim is approved or denied, for a maximum of six months. If your claim is ultimately denied, you don't have to repay the presumptive disability benefits. There are no presumptive disability payments for SSDI applicants.