Musculoskeletal disorders (MSDs) affect the body’s structural framework, including the joints, bones, muscles, tendons, and ligaments. These conditions often result from congenital factors, injury, or degenerative processes, leading to chronic pain and significant limitations in physical movement. When physical impairments prevent sustained work activity, the condition may qualify for formal disability recognition. Qualification is determined not by the diagnosis alone, but by the objective loss of function the disorder imposes on a person’s ability to perform routine activities.
Categorizing Musculoskeletal Impairments
A wide range of MSDs are evaluated for disability, focusing on conditions that cause severe and lasting functional loss. Disorders of the spine are commonly reviewed, especially those involving nerve root compromise, such as a severely herniated nucleus pulposus or advanced degenerative disc disease. These conditions often result in radicular symptoms, including significant motor loss, muscle weakness, and sensory deficits in the extremities.
Major joint disorders also form a significant category, focusing on anatomical deformity and chronic pain in the extremities. This includes severe osteoarthritis resulting in joint space narrowing, bony destruction, or joint instability in weight-bearing joints like the hip or knee. For a joint to be considered a potential qualifier, the abnormality must be readily observable and documented by a medical professional.
Inflammatory arthritis, such as Rheumatoid Arthritis or Psoriatic Arthritis, is evaluated when the disease causes persistent joint swelling and limited motion. Although often considered immune system disorders, the resulting musculoskeletal damage is assessed based on the inability to perform fine and gross movements effectively with the upper extremities. Traumatic injuries are also considered, especially amputations or fractures resulting in a long-term non-union or persistent loss of function expected to last at least 12 months.
Establishing the Level of Functional Limitation
Disability qualification requires demonstrating an extreme level of functional limitation that prevents basic work activity. This can be achieved in one of two ways: meeting the specific requirements of a medical listing. These listings describe a degree of severity that automatically presumes an inability to work and require specific objective findings.
For lower extremity impairments involving a major weight-bearing joint, meeting a listing requires an inability to ambulate effectively. This is defined by the documented medical need for a wheeled and seated mobility device, or the use of bilateral assistive devices like a walker or two crutches, which limits the use of both upper extremities. For upper extremity impairments, qualification requires involvement of a major peripheral joint in each arm, resulting in the inability to perform fine and gross movements effectively. This extreme loss of function seriously interferes with the ability to initiate, sustain, or complete work tasks.
If the condition does not meet the precise criteria of a listing, the second path to qualification involves an assessment of the Residual Functional Capacity (RFC). The RFC is an administrative determination of the individual’s maximum remaining ability to perform work-related activities. This assessment considers all functional limitations, including pain and fatigue, to determine if the person can perform their past work or any other sedentary, light, or medium work available in the national economy.
The inability to stand or walk for sustained periods, which is considered at least two hours in an eight-hour workday for sedentary work, is a frequent deciding factor. Restrictions on lifting, carrying, pushing, pulling, or even sitting for more than six hours are components of the RFC analysis. The assessment determines whether the combined physical limitations restrict the individual to a level of work that is so minimal or specialized that they are unable to engage in Substantial Gainful Activity (SGA).
Required Medical Evidence for a Successful Claim
A successful claim is built upon comprehensive objective medical evidence (OME) that substantiates functional limitations. OME is paramount, including imaging studies such as X-rays, MRIs, and CT scans to confirm anatomical abnormalities like vertebral fracture, joint space narrowing, or nerve root compression. Laboratory tests, such as those detecting inflammatory markers or rheumatoid factor, are necessary to document the severity of conditions like inflammatory arthritis.
Reports from treating physicians, especially specialists like orthopedists and rheumatologists, must provide more than a simple diagnosis. These reports should include detailed clinical findings, such as specific measurements of reduced range of motion, muscle atrophy, or documented sensory and reflex loss. A physician’s opinion on the patient’s specific functional restrictions—such as how long they can sit, stand, or the maximum weight they can lift—is persuasive evidence during the evaluation process.
A longitudinal medical record is required, demonstrating a history of compliant treatment efforts and the condition’s persistence. This history must show that the impairment has lasted or is expected to last for a continuous period of at least 12 months. Documentation of Functional Capacity Evaluations (FCEs), though not mandatory, can provide a quantified assessment of the specific physical capabilities and limitations in a work-like setting.