Obesity is a medically determinable impairment that is often associated with disturbance
of the musculoskeletal system, and disturbance of this system can be a major cause
of disability in individuals with obesity. The combined effects of obesity with musculoskeletal
impairments can be greater than the effects of each of the impairments considered
separately. Therefore, when determining whether an individual with obesity has a listing-level
impairment or combination of impairments, and when assessing a claim at other steps
of the sequential evaluation process, including when assessing an individual's residual
functional capacity, adjudicators must consider any additional and cumulative effects
1.01 Category of Impairments, Musculoskeletal
1.02 Major dysfunction of a joint(s) (due to any cause): Characterized by gross anatomical deformity (e.g., subluxation, contracture, bony
or fibrous ankylosis, instability) and chronic joint pain and stiffness with signs
of limitation of motion or other abnormal motion of the affected joint(s), and findings
on appropriate medically acceptable imaging of joint space narrowing, bony destruction,
or ankylosis of the affected joint(s). With:
A. Involvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle),
resulting in inability to ambulate effectively, as defined in 1.00B2b;
B. Involvement of one major peripheral joint in each upper extremity (i.e., shoulder,
elbow, or wrist-hand), resulting in inability to perform fine and gross movements
effectively, as defined in 1.00B2c.
1.03 Reconstructive surgery or surgical arthrodesis of a major weight-bearing joint, with inability to ambulate effectively, as defined in 1.00B2b, and return to effective
ambulation did not occur, or is not expected to occur, within 12 months of onset.
1.04 Disorders of the spine (e.g., herniated nucleus pulposus, spinal arachnoiditis, spinal stenosis, osteoarthritis,
degenerative disc disease, facet arthritis, vertebral fracture), resulting in compromise
of a nerve root (including the cauda equina) or the spinal cord. With:
A. Evidence of nerve root compression characterized by neuro-anatomic distribution
of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle
weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is
involvement of the lower back, positive straight-leg raising test (sitting and supine);
B. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue
biopsy, or by appropriate medically acceptable imaging, manifested by severe burning
or painful dysesthesia, resulting in the need for changes in position or posture more
than once every 2 hours;
C. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings
on appropriate medically acceptable imaging, manifested by chronic nonradicular pain
and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.
1.05 Amputation (due to any cause).
A. Both hands;
B. One or both lower extremities at or above the tarsal region, with stump complications
resulting in medical inability to use a prosthetic device to ambulate effectively,
as defined in 1.00B2b, which have lasted or are expected to last for at least 12 months;
C. One hand and one lower extremity at or above the tarsal region, with inability
to ambulate effectively, as defined in 1.00B2b;
D. Hemipelvectomy or hip disarticulation.
1.06 Fracture of the femur, tibia, pelvis, or one or more of the tarsal bones. With:
A. Solid union not evident on appropriate medically acceptable imaging and not clinically
B. Inability to ambulate effectively, as defined in 1.00B2b, and return to effective
ambulation did not occur or is not expected to occur within 12 months of onset.
1.07 Fracture of an upper extremity with nonunion of a fracture of the shaft of the humerus, radius, or ulna, under continuing
surgical management, as defined in 1.00M, directed toward restoration of functional
use of the extremity, and such function was not restored or expected to be restored
within 12 months of onset.
1.08 Soft tissue injury (e.g., burns) of an upper or lower extremity, trunk, or face and head, under continuing surgical
management, as defined in 1.00M, directed toward the salvage or restoration of major
function, and such major function was not restored or expected to be restored within
12 months of onset. Major function of the face and head is described in 1.00O.