Interpretation of new Social Security musculoskeletal listings

On December 3, 2020, the Social Security Administration (SSA) published new listings for evaluating musculoskeletal disorders.  85 Fed. Reg. 78164.  In general, the new musculoskeletal disorders listings listings remove the “inability to ambulate effectively” criteria, have additional focus on the need for assistive devices, and require more lower-body conditions to be paired with restrictions on use of upper extremities.  The new listings became effective for cases filed after or pending after April 2, 2021.

SSA has issued additional guidance regarding the new musculoskeletal listings. When considering the need for assistive devices under the new listings, SSA is to consider the most restrictive device for which the claimant has a documented medical need.  The phrase documented medical need means evidence from a medical source that supports the medical need for an assistive device for a continuous period of at least 12 months.

The functional criteria in the new listings is met if the medical evidence shows that a claimant uses a wheeled and seated mobility device that involves the use of two hands with a documented needs lasting 12 consecutive months.  If the claimant uses a wheeled and seated mobility device that involves the use of one hand, SSA is to consider whether the claimant has a documented medical need for a two handed assistive device.  This evidence includes inability to bear weight on lower extremities, instability, inability to rise from a seated position without assistance or the use of both arms, significant weakness in the legs, or amputation of the lower extremities at or above the ankle with inability to use a prosthesis.

For certain of the new listings, all required criteria must be present simultaneously, or within a close proximity of time.  In evaluating listings with imaging requirements, SSA determines whether the findings on imaging are reasonably expected to have been present within a close proximity of time of the other required elements.  (EM-21027, April 2, 2021.)

Posted in SSI