Listing 1.21 covers serious soft tissue injuries or abnormalities (e.g., burns, necrotizing infections, severe lacerations) that require ongoing surgical management over an extended period. Even with multiple procedures or continuing wound care, if the individual cannot regain effective function in the affected area—resulting in an inability to ambulate or use the upper extremities effectively—then they may qualify at Step 3 of the evaluation process.
Listing 1.21
1.21 Soft tissue injury or abnormality under continuing surgical management, directed toward the salvage, restoration, or expected recovery of functioning of the affected region, and with an inability to ambulate effectively, as defined in 1.00C6, or an inability to perform fine and gross movements effectively, as defined in 1.00C7, or both, while under continuing surgical management.
(Source: 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 1.21. Effective April 2, 2021.)
Key Elements
- Ongoing Surgical Management
- The claimant must still be in an active phase of surgical intervention or post-surgical treatment aimed at salvaging or restoring function (e.g., repeated skin grafts, debridements, or other complex procedures).
- Inability to Ambulate Effectively
- For lower-body injuries, the claimant cannot walk independently or safely for everyday tasks (see Listing 1.00C6).
- OR Inability to Perform Fine and Gross Movements
- For upper-body or hand injuries, the claimant has a marked inability to handle objects or perform routine arm-hand tasks (Listing 1.00C7).
- Expectation of 12+ Months Duration
- The condition and required surgical interventions must continue for at least 12 consecutive months, preventing effective function in the interim.
Tips on Proving the Claimant Meets Listing 1.21
- Operative and Hospital Records
- Provide detailed surgical notes verifying each procedure (e.g., skin grafting, reconstructive surgeries) and the medical rationale for ongoing management.
- Wound Care/Follow-Up Notes
- Show repeated need for debridement, bandage changes, infection control, or other advanced care—confirming that the injured area has not stabilized enough for normal function.
- Specialized Examinations
- Orthopedic or plastic surgeons should document the lack of healing or persistent deficits in range of motion, strength, or structural integrity.
- Photographic Evidence (If Available in Medical Records)
- Sometimes photos of the injury can help illustrate the severity and prolonged need for surgical management—especially for severe burns or open wounds.
- Demonstrating Functional Loss
- For lower extremities: Emphasize the claimant’s reliance on a walker, crutches, or wheelchair and inability to safely walk across a room or navigate stairs.
- For upper extremities: Confirm the inability to perform fine (e.g., writing, buttoning shirts) and gross (e.g., lifting, reaching) manipulations over a sustained period.
- Duration Requirement
- Keep consistent records over 12+ months showing no appreciable improvement or ongoing procedures needed—this distinguishes short-lived post-surgical recovery from listing-level severity.
Listing 1.21 applies when a severe soft tissue injury or abnormality demands continued surgical intervention for at least 12 months, and the claimant cannot ambulate or use their upper limbs effectively in day-to-day life. Documenting repeated surgeries, persistent wound care, and marked functional loss is crucial for a Social Security Disability lawyer to help meet the listing at Step 3.