Knee Pain and Social Security Disability: What You Need to Know

Welcome to Season 2, Episode 26 of Winning Isn't Easy: Social Security ®. In this episode, we'll dive into Knee Pain and Social Security Disability: What You Need to Know.

Chronic knee pain can affect far more than mobility - it can make even routine daily activities difficult and, in some cases, prevent a person from maintaining full-time employment. For individuals pursuing Social Security Disability (SSD) benefits, proving the severity of a knee condition requires more than documenting a diagnosis or prior surgery. In this episode of Winning Isn't Easy, attorney Nancy Cavey explains how chronic knee conditions, including persistent pain following knee replacement surgery, may qualify for SSD benefits. She discusses the medical evidence Social Security looks for, the importance of documenting functional limitations, common reasons knee-related disability claims are denied, and the steps claimants can take to build a stronger case for benefits.

In this episode, we'll cover the following topics:

One - Can Chronic Knee Pain Qualify for Social Security Disability?

Two - What Social Security Looks for in Your Medical Records

Three - Common Reasons SSD Claims for Knee Pain Are Denied

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ®. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:15 - 00:01:10]

Are your knees constantly giving you trouble, even after surgery? Let's talk about how chronic knee pain can qualify you for your Social Security disability benefits and what steps you need to take to strengthen your Social Security Disability claim. Welcome back to Winning Isn't Easy, the podcast where we break down everything you need to know about navigating the Social Security claims process. I'm your host, Nancy Cavey, and before we get started, I've got to give you a legal disclaimer. This podcast isn't legal advice. The Florida Bar Association says I have to tell you that, but nothing will ever prevent me from giving you an easy-to-understand overview of the Social Security disability claims process, the games that are played during this process, and what you need to know to get the disability benefits you deserve. So off we go. Now, chronic knee problems are not just painful. They can make everyday tasks like standing, sitting, or even cooking feel impossible.

Nancy Cavey [00:01:10 - 00:02:04]

I know because I've had multiple knee surgeries. Now, for millions of people, these struggles go beyond discomfort and can potentially qualify them for Social Security disability benefits. If you've had knee surgery, including a total knee replacement, and still experience pain, swelling, or instability, this episode is for you. We'll explain the different types of knee conditions that can support a Social Security disability claim, what Social Security Administration is looking for in your medical records, and how to document your functional limitations effectively. I'm also going to discuss the common reasons why a claim is denied because of knee problems and and how legal experts can help you navigate the Social Security disability claims process. My goal is for you to understand how to organize your evidence, document your limitations, and give yourself the best chance of approval. So let's get started. I'm going to talk about 3 things today.

Nancy Cavey [00:02:05 - 00:02:31]

Number 1, can chronic knee pain qualify you for your Social Security disability benefits? Number 2, what is Social Security looking for in your medical records? And 3, What are the common reasons that Social Security Disability claims for knee pain are denied? But before we get started, let's take a quick break and make sure that you're coming back with a piece of paper and a pencil to take notes because we've got a lot of great information that will help you get the Social Security Disability benefits you deserve.

Narrator of Disability Insurance Advertisements [00:02:32 - 00:02:53]

Are you considering filing for Social Security Disability or has your claim been denied already? Either way, you require a copy of Your Rights to Social Security Disability Benefits, which will cover everything you need to Know About the Social Security Disability Claims Process. Request your free copy of the book at kvlaw.com today.

Nancy Cavey [00:03:07 - 00:04:32]

Welcome back to Winning Isn't Easy. Can chronic knee pain qualify me for my Social Security disability benefits? Do your knees pop, lock, crack, swell, or give way? Sounds like my knees. Do you have difficulty standing, sitting, walking, climbing stairs? If you've had a knee surgery, including total knee replacement, and are struggling with pain and mobility, any of these conditions might be able to qualify you for your Social Security disability benefits. Now, to win, you have to prove that they prevent you from performing substantial gainful activity. In other words, Either you meet a Listing at step 3 or you can't go back to your past work or other work in the mythical, hypothetical, not real-world national economy. I'm often asked, okay, well, that sounds good, but tell me what common knee conditions will support a claim. It can include ankylosis, arthritis, bone spurs, bursitis, chondromalacia, dislocation of the knee, swelling, hyperextension, instability, Osgood-Schlatter's disease, Osteoarthritis, osteomyelitis, rheumatoid arthritis, patellofemoral pain syndrome, known as runner's knee, shin splints, tendinitis, tuberculosis of the knee. Now, if you have one or more of these conditions, Social Security benefits might be available for you if you're unable to do your past work or other work.

Nancy Cavey [00:04:32 - 00:05:22]

So let's talk about what is Social Security disability benefits. I need to set the stage here for you. SSDI provides benefits to individuals who are unable to work due to a medical condition expected to last at least 12 months or result in death. Now SSDI is different from health insurance. It replaces income lost due to your disability. Now ultimately, if you get Social Security Disability benefits, you may be eligible for Medicare, but you have to have— Social Security. Satisfy the 5-month elimination period and then be on Social Security benefits for 24 months. So 29 months of ineligibility for Medicare is obviously something that's important, but I want you to understand that if your Social Security benefits are awarded, there's only a 5-month waiting period where you won't get benefits for the first 5 months.

Nancy Cavey [00:05:22 - 00:06:20]

Hopefully you'll get some retroactive benefits, but thereafter your money benefits will pick up and continue. Now that I set kind of the stage, Social Security disability benefits are primarily based on 2 factors. One, medical evidence, which documents the fact that you have what's called a medically determinable impairment, that you may or may not meet a Listing at Step 3, but you have significant physical restrictions and limitations that prevent you from doing your past work or other work in the national economy. And of course, one of the big things is work history. You need to have earned enough credits through previous employment to be insured. Otherwise, you might be eligible for SSI too if you meet the asset test. So let's assume you've got enough quarters of coverage, you have a medically determinable impairment, one of those medical conditions that I listed. Now the big issue is how your knee pain impacts your functional ability.

Nancy Cavey [00:06:21 - 00:07:26]

Social Security is going to look at how your knee pain impacts your ability to perform basic work functions like standing or walking for extended periods of time, which I think means more than 30 minutes, sitting or getting up from a chair without assistance, lifting or carrying or handling objects. So hopefully lifting no more than 10 pounds Occasionally. And climbing stairs or ladders. Now documentation of how your knee pain limits your activities is really crucial to the success of winning at step 4, your past relevant work. You have to prove that you can't do your work. So let's assume that your job, for example, is a real estate agent or a salesperson or somebody at Home Depot where you're on your feet all day or you're climbing up ladders or scaffolding. Obviously, if you have knee problems, you will be hard-pressed to do the actual duties of your past work. But please understand, that is not where your case is going to be decided.

Nancy Cavey [00:07:26 - 00:08:25]

It is going to be decided at step 5, which is a crazy cockamamie test of, is there other work in the mythical hypothetical, not real-world national economy you would not want to do, does not pay a living wage, if you have your age, your education, Your skills and your restrictions and limitations. That's where documenting the restrictions and limitations are important because Social Security will say at step 5 that you could be a surveillance system monitor or you could sort nuts and bolts or even address envelopes. Those are sedentary jobs which require you to sit down all day. So you have to prove that you can't do that sedentary job because of your knee issues. It might be, for example, that because of pain, you're up and down every 30 minutes, and you're taking breaks that are greater than the number of breaks that one has to take. That would put you off pace. Let's say that you have swelling and you have to elevate your legs 3 times a day for 30 minutes at a pop using ice. That's a problem.

Nancy Cavey [00:08:25 - 00:09:29]

That would prevent you from doing sitting. Let's also say that you use canes, crutches, or other assistive devices prescribed by your doctor. That would potentially be considered an accommodation, And one which would interfere with your ability to work. So it's a combination of factors here, the nature of your symptoms, locking, popping, swelling, how often it occurs, how it impacts your ability to sit, whether you've got to alternate sitting and standing, how that impacts your ability to maintain pace and production, and of course, ultimately absenteeism. It's the documentation of all these things that will really be crucial at step 5. Now, by the way, if you're over 50, you might also be eligible for the Grids. But the question there really becomes, because of your restrictions and limitations, are the skills that you've learned eroded, destroyed? Are they just gone because of the nature of your restrictions and limitations? Got it? I hope you found this segment very insightful because we're just setting the stage to what Social Security is going to look for in your medical records. Let's take a break.

Nancy Cavey [00:09:56 - 00:11:09]

Welcome back to Winning Isn't Easy. What does Social Security look for in your medical records? Now, when reviewing a Social Security claim, the Social Security claims examiner is going to review your medical records, and there are a number of things that they're going to be looking for. If they don't find them, it can be a big problem in the success of your claim. So number one, what is the diagnosis? What are the imaging studies and test results That corroborate the actual diagnosis. What's the treatment history? Have you had surgeries? What was the success of that surgery? Were you compliant with physical therapy? What medications are you taking? Any side effects of medications? Now, what's also ultimately important is— are the nature of your symptoms and how those symptoms impact functional limitations. So they would be looking for things like popping, locking, give way, stiffness, swelling, limited range of motion, difficulty walking, standing, or climbing, the need to change positions, and the need for assistive devices like canes, walkers, or braces. Now remember, that's just not it. That's not all you need.

Nancy Cavey [00:11:10 - 00:12:06]

Functional impairments matter. A diagnosis alone is not going to be Enough. In fact, I will tell you, many times when people have total knee replacements, Social Security takes the position that you're not going to be disabled for at least a year, and they'll deny the claim just based on the fact that most people recover from a total knee replacement. What's important, of course, is that, and unfortunately, you have complications or issues that would limit your ability to perform work-related activities. Now, What I talk about with my clients is to say, look, I want you to produce some evidence for us in the form of a really good interval history of your symptoms. What are your symptoms? Locking, popping, all the things I just— laundry list I just went through. And then I say, look, draw a line past each one of these. So if you've got popping or you've got locking, draw a line.

Narrator of Disability Insurance Advertisements [00:12:06 - 00:12:06]

Mm-hmm.

Nancy Cavey [00:12:06 - 00:12:56]

And then I want you to describe where the popping and locking is. I know that sounds crazy, but Social Security doesn't always understand that. So where is it? We want to understand how often it occurs. Is it every time you stand up? Is it every time you try to walk more than an aisle in the grocery store? So the duration also is important. It might be that you wake up in the morning with your knees swollen. And you've got to ice them in the course of the day, or you have to use a brace. So we're talking about symptoms, location, duration, frequency, and then of course a practical example of what problems you have. And sometimes even a day-in-the-life video of difficulty walking, climbing stairs, or performing household tasks can be persuasive.

Nancy Cavey [00:12:56 - 00:13:56]

Now it's got to be a really, really good video. Because I don't want the Social Security Administration to think, ah, well, you think it's difficult, you think it's hard, but it doesn't look that hard to us, based on what they see you doing in the, in the video. So documentation regarding your symptoms, I think, is really important. But that leads me to the role of your doctor in your claim. I think your doctor is crucial to winning your claim because their records have to document The objective findings that you are complaining of, the range of motion, loss of range of motion, the swelling, the popping, the instability. They also want to record and know your severity of your symptoms and frequency. But just as important, you need to be educating your doctor about how your condition would limit work-related functions. Like if you worked at Home Depot and had to do stocking, you'd be, you know, on the forklift, you might be Actually on the floor lifting things and emptying boxes, that sort of stuff.

Nancy Cavey [00:13:57 - 00:15:24]

You want to tell the doctor what those job duties are, but then the problems that you have. Now, of course, if you're no longer able to do that job, we've got to remember that the rest of this test is at step 5. You can't do other work in the mythical hypothetical, not real-world national economy. So think about those stupid sedentary jobs I've mentioned before. Surveillance system monitor, looking at addressing envelopes, or looking at sorting nuts and bolts. What is it about your knees that make it difficult, if not impossible, for you to sit there and do the job? The swelling, the locking, the popping, having to elevate, having to use a walker or other assistive devices. So you've gotta give this information to your physician so that your physician can help ultimately not only document your medical records, but hopefully fill out a form that we Social Security lawyers have created called Residual Functional Capacity forms. An RFC form will document things like how long you can sit, how far you can walk, do you have to alternate sitting and standing, do you have to elevate, do you have issues with having to ice your legs or use knee braces or assistive devices? Would you be off task at least 20% Would you have to take naps in the course of the day? And would you miss time from work? This documentation is really crucial.

Nancy Cavey [00:15:24 - 00:15:46]

And if you have a doctor who won't cooperate with you, it might be time to find another doctor or even potentially see a pain management doctor. They're more inclined to fill out residual functional capacity forms than the orthopedic surgeon who thinks just because they perform surgery on you, You're cured. Got it? It takes a lot of teamwork here to get your benefits. Let's take a break.

Narrator of Disability Insurance Advertisements [00:15:48 - 00:16:15]

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Nancy Cavey [00:16:29 - 00:17:43]

Welcome back to Winning Isn't Easy. What are the common reasons that Social Security disability claims for knee pain are denied? Now, I will tell you, in my experience, often chronic knee pain claims are denied at first. And one of the reasons that they deny these claims first off is that they take the position that you're going to recover within a year, particularly if you've had a total knee replacement. And so they're going to say you don't even meet the longevity requirements at steps 1 or steps 2 in terms of having a medically determinable impairment. Now the other issue, of course, is when they are looking at the medical records, as I've explained, the diagnosis alone is not going to get you your Social Security disability benefits. What we need is an explanation of the objective basis of that diagnosis, X-ray findings, MRI findings, operative reports. But then we need to move on and talk about what— whether or not your medical condition with your knee meets or equals a Listing. Now at step 3, the Social Security Administration uses a book called the Listing of Impairments.

Nancy Cavey [00:17:43 - 00:17:51]

That Listing actually has orthopedic Listings for knee problems. So you can go and look at this Listing and you can see—

Narrator of Disability Insurance Advertisements [00:17:51 - 00:17:51]

Right.

Nancy Cavey [00:17:51 - 00:19:01]

all of the elements that the Social Security Administration wants to see. Now, if they don't see those elements in your medical records, you won't meet a Listing, which means that your benefits won't automatically be paid. But then we go on to steps 4 and 5 of the 5-step sequential evaluation. So at step 4, the issue is, can you do your past work based on your restrictions and limitations? And at step 5, is there other work you can do in the mythical, hypothetical, not real-world national economy you wouldn't want to do. It doesn't pay a living wage. So what happens, what you'll see often, is at step 4, generally, you know, particularly if you've got a physical type job, Social Security will say you can't do your past work, but you can do other work, and particularly work that requires you to sit down all day. But remember, your medical records have to tell the story of how long you can stand or walk at a time. How often you need rest breaks, whether you have to elevate your legs, whether you have to ice your legs, whether you're using braces, whether you're using any assistive devices, whether your pain or instability limits repetitive motion.

Nancy Cavey [00:19:01 - 00:20:00]

So some of these sedentary jobs do require you to move side to side, up and down, you know, to get nuts and bolts. So all of that is really relevant to whether you can do a sedentary job. You have to understand that Social Security is not going to fill in the blanks for you. If your medical records aren't documenting the diagnosis, the objective basis of the diagnosis, and your restrictions and limitations, then you've got a problem. Hopefully your doctor will be willing to fill out a form called a residual functional capacity form that we Social Security lawyers have created. But if not, there are times when the Social Security Administration will send you out for what's called a consultative exam. And as stupid as this may sound, I've seen consultative exams for knees conducted by OB-GYNs. Okay, that doesn't make any sense, but they're sending you out for a CE to try to determine your functional limitations.

Nancy Cavey [00:20:00 - 00:21:23]

Now, most of the time, these Social Security doctors will say that you can do light or some form of sedentary work. But you can do the full range of sedentary work, which means that you could sit on your butt 6 out of 8 hours and not have any particular problem and be able to do ultimately those silly jobs of addressing envelopes or sorting nuts and bolts. So you really want your doctor to address your functional restrictions and limitations than having to hope that you'll get a right CE or one that will give you significant restrictions and limitations. What are the steps to strengthen your claim? Well, obviously, you can hear me pounding on this. Gather comprehensive medical evidence, including information about all the diagnostic studies you've had, all your surgeries, the physical therapy visits you've had, any specialty visits you've had, fitting for braces or the use of canes, crutches, or other assistive devices, and documentation regarding your medication and any side effects. Remember, the more objective, the better. 2, document your daily limitations. Now, I've told— talked before about my formula for documenting symptoms, the location of the symptoms, the duration of the symptoms, the frequency of the symptoms, with an example of what difficulty you have.

Nancy Cavey [00:21:24 - 00:22:34]

Yeah, you might have difficulty walking an aisle in Publix, but remember, all of those jobs that I told you that Social Security says people can do are sedentary in nature. So we want to really understand your difficulty standing, walking with the use of assistive devices, particularly in the work setting, the need to alternate sitting and standing. And then of course, number 3, if you can get your doctors to fill out those residual functional capacity forms, they're fantastic. Now Social Security isn't going to tell you about these, and most doctors don't really know about them. So when I represent somebody, I'm sending them a residual functional capacity form for knee problems, and of course any other medical problems they have, and asking them to ask their doctor to help them by completing the residual functional capacity forms. And obviously, if your claim has been denied at the initial stage or the recon stage, you need to understand you'll only have 60 days in which to file an appeal. And if you blow that deadline, you've got to start all over again. So seeking representation by an experienced Social Security disability attorney is really crucial.

Nancy Cavey [00:22:35 - 00:23:57]

We can guide you through the appeals process. We can review your medical records, understand why your claim was denied, and help address the common denial reasons and present your case effectively in a way that Social Security understands. I know that navigating the claims process can be overwhelming and having somebody who understands what it is you're going through and who can help you explain that in a way that the Social Security Administration or even a judge understands is really crucial. We specialize in helping patients and clients with chronic knee pain and we focus on gathering the information that I've talked about. Hopefully you are represented by an experienced Social Security disability attorney who who can provide you with the right guidance and can help improve your chances of approval or winning on appeal while you focus on managing your medical condition. That's— our job is to represent you vigorously, and your job is to be compliant with your doctor's recommendations and do the best job you can healing the— and being able to function in some form around your household. Got it? That's it for this episode of Winning Isn't Easy. If you found this episode helpful, please like a moment— take a moment rather to like it, leave a review, share it with your family, and subscribe to our podcast.

Nancy Cavey [00:23:57 - 00:24:04]

Join us next week for another insightful episode of Winning Isn't Easy Social Security Disability. Thanks.