Disability Benefits for Avascular Necrosis

How SSA Evaluates Avascular Necrosis Under Listing 1.18

Avascular necrosis, also called osteonecrosis, occurs when the blood supply to a bone is interrupted and the bone tissue begins to die. It most often affects the hip, but can also involve the knee, shoulder, or other joints, leading to pain, collapse of the joint surface, and arthritis. SSA evaluates the resulting joint damage under Blue Book listing 1.18, which covers abnormalities of a major joint in any extremity.

What the Listing Requires

To meet listing 1.18, your records generally must show all of the following:

• A documented joint abnormality with the bone death and joint damage caused by avascular necrosis.
• Pain, stiffness, or loss of motion in the affected joint.
• Imaging findings — X-ray, MRI, or CT confirming the osteonecrosis and joint damage.
• A serious functional limitation — a documented need for a walker, two canes, or two crutches when a weight-bearing joint like the hip or knee is involved, or an inability to use both arms effectively when a shoulder is involved.

Because the functional requirement is strict, a single affected joint may not meet the listing unless it seriously limits walking or the use of both arms. Avascular necrosis often involves more than one joint, especially when it is caused by steroids, heavy alcohol use, or conditions like sickle cell disease, and SSA considers the combined effect of all affected joints. It also reviews whether joint replacement restored function or left lasting limits.

Medical Evidence for an Avascular Necrosis Claim

These claims rest on imaging plus a record of how the damaged joints limit you. SSA will look for:

• Imaging — MRI (which detects early disease), X-rays, or CT showing bone death, joint collapse, or arthritis.
• Exam findings — reduced range of motion, pain with weight-bearing or movement, and gait problems.
• Treatment records — medications, core decompression, or joint replacement surgery, and your response.
• Functional notes — how far you can walk, how long you can stand, and whether you use an assistive device.

Ask your orthopedic doctor to describe how the affected joints limit walking, standing, and, for the shoulder, reaching and lifting. List every joint involved, since avascular necrosis is often multifocal. A record that ties your imaging to specific, lasting limits gives your claim the strongest footing.

Qualifying Through an RFC Assessment

When avascular necrosis does not meet listing 1.18, SSA assesses residual functional capacity (RFC). Hip or knee involvement limits standing, walking, climbing, and squatting, and may require a cane or walker, while shoulder involvement limits reaching and lifting. As the joint surface collapses and arthritis develops, pain often worsens with activity and reduces how long you can stay on your feet.

Pain and the medications used to treat it can also affect sleep, concentration, and stamina. SSA builds these limits into an RFC — frequently sedentary work with limited standing and walking, or restricted overhead use of the arm — and compares it to your past jobs. If you cannot return to that work, the medical-vocational grid rules may direct a finding of disabled, particularly for claimants age 50 and older, and involvement of several joints at once can rule out a wider range of work.

Tips for a Stronger Avascular Necrosis Claim

• Get an MRI. It detects avascular necrosis earlier than X-rays and documents the extent of bone death.
• List every affected joint. The disease often strikes more than one joint, and the combined limits strengthen your claim.
• Explain your walking limits. Tell your doctor how far you can walk and whether you need a cane or walker.
• Document post-surgery limits. If joint replacement did not fully restore function, make sure the remaining limitations are recorded.
• Note the cause. Steroid use, sickle cell disease, or heavy alcohol use can explain multiple joints and related conditions SSA should consider.