Listing 1.22 addresses severe fractures in the femur, tibia, pelvis, or talocrural bones (the ankle region) that fail to heal (non-union) or are otherwise complex, requiring ongoing medical or surgical management and resulting in the inability to ambulate effectively. If, even with standard treatments (e.g., internal fixation, external fixation, bone grafts), the claimant cannot recover meaningful weight-bearing capacity within 12 months, they may qualify for a Step 3 approval.
Listing 1.22
1.22 Non-healing or complex fracture of the femur, tibia, pelvis, or talocrural bones (for example, the bones of the ankle) under continuing surgical management, with an inability to ambulate effectively, as defined in 1.00C6, and a documented medical need for a walker, bilateral canes, or bilateral crutches, or a wheeled and seated mobility device involving the use of both hands.
(Source: 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 1.22. Effective April 2, 2021.)
Key Elements
- Major Lower-Body Fracture
- Involves the femur (thigh bone), tibia (shin bone), pelvis, or talocrural (ankle) bones.
- Non-Healing or Complex Nature
- Ongoing medical or surgical management due to hardware failure, infection, bone grafting needs, or repeated interventions that have not restored normal stability or weight-bearing capacity.
- Inability to Ambulate Effectively
- Must rely on walker, bilateral canes/crutches, or wheelchair; or otherwise be unable to traverse everyday surfaces at a reasonable pace.
- Duration of 12+ Months
- Condition must persist (or be expected to persist) for at least one year, preventing normal ambulation in daily activities.
Tips on Proving the Claimant Meets Listing 1.22
- Operative and Imaging Reports
- Provide X-ray, CT, or MRI evidence of ongoing non-union or “complex” fracture (e.g., multi-fragmentary, infection, hardware displacement). Ensure surgeons’ notes explicitly confirm that healing remains incomplete or complicated.
- Evidence of Repeated Surgical Management
- Demonstrate that the claimant required multiple procedures (e.g., additional plating, bone grafts) or still has an external fixation device in place. Notes on chronic infection or hardware instability can support “complexity.”
- Functional Assessments
- Physical therapy reports showing limited range of motion or weight-bearing ability—reinforcing the inability to walk effectively. A 6-minute walk test or statements that the claimant can’t navigate uneven surfaces can be persuasive.
- Duration Requirement
- Keep consistent medical documentation over at least 12 months, showing little to no improvement in ambulation despite recommended treatments.
- Specialist Opinions
- Orthopedic surgeons or rehabilitation specialists can tie the ongoing fracture complications directly to the inability to ambulate safely without significant assistive devices.
- Daily Activity Statements
- Include claimant testimony or third-party observations about how everyday tasks (e.g., cooking, shopping) are impossible without continuous support or frequent breaks. This underscores “ineffective ambulation” in real-life contexts.
To meet Listing 1.22, you must prove a non-healing or complex fracture in the femur, tibia, pelvis, or ankle bones that demands prolonged surgical management and leaves the claimant unable to ambulate effectively for at least 12 months. Thorough operative records, imaging evidence, and functional assessments showing persistent instability and reliance on assistive devices is critical for a Social Security Disability lawyer to secure a successful listing-level claim.