Social Security Disability Attorneys: Riverside, North San Diego & Orange Counties
Avascular Necrosis (AVN) is sometimes referred to by the terms Aseptic Necrosis or Osteonecrosis. It is a disorder of microcirculation within the bone that causes the involved portion of the bone to die (“necrosis”). It can affect any bone in the body. When it occurs, it causes collapse of the bone, and when that's close to a joint, the nearby joint also collapses, with the development of degenerative arthritis (osteoarthritis) in that joint.
The hip is the most common area for AVN, followed by the knee, shoulder, ankle, elbow and wrist. When AVN occurs in a vertebral body, it is called “Kummel's disease.” AVN can also occur in the jawbone related to treatment for osteoporosis with medications such as Fosamax, Boniva, Reclast, and Prolia. No one knows why that happens.
The exact cause of AVN is not known. However, it has been associated with injury (fracture, dislocation), corticosteroid medications (especially with high doses), smoking, alcohol, pregnancy, radiation, chemotherapy, leukemia, lupus, diabetes, inflammatory bowel disease (IBD), and Caisson's disease (the “bends”) from rapid decompression. All these conditions appear to disrupt the normal microcirculation inside a bone that then leads to the development of AVN.
AVN affects both men and women, usually in the 30-50 age group. It is a relatively rare condition, with approximately 10,000 to 20,000 Americans affected on a yearly basis.
In the early stage of AVN, there may be little or no symptoms. However, as the bone weakens and begins to collapse, pain in the area and in the adjacent joint (e.g., the hip) occurs and gradually progresses. AVN may involve only one joint (if from injury) or multiple joints (if from a systemic disorder such as lupus). The most common presenting sign in AVN is the development of hip pain, with the progression to osteoarthritis of one or both hips.
X-rays and imaging studies (e.g., MRI) is how the diagnosis of AVN is usually established.
Treatment of AVN includes decreasing weight bearing on the involved joint, stopping smoking and alcohol consumption, avoiding trauma to the joint, and treating any underlying systemic conditions (such as diabetes, lupus, or others) that may be present.
A surgical procedure to locally decompress the involved portion of the bone is sometimes performed in early AVN may help prevent total collapse of the joint, but the results are variable.
Once a joint (such as the hip or knee) has collapsed, the only option is to surgically replace the joint by doing a total hip or total knee replacement.
More than 50% of patients who develop AVN require total joint replacement surgery within 3 years of the diagnosis.
Under Social Security Disability (SSDI) guidelines, there is no “listing” for AVN, and having AVN does not automatically entitle you to long-term disability (LTD) under SSDI or under a group disability plan provided by an employer (ERISA).
It is not until osteoarthritis develops in an involved joint from AVN, and the symptoms of pain and stiffness worsen to the point of causing functional impairment that you become eligible for LTD benefits.
Because AVN most commonly affects the hip and the knee, LTD benefits are typically awarded for AVN in accordance with Section 1.02 of the Social Security “Blue Book”, which provides benefits when there is evidence of “gross anatomical deformity”, stiffness, loss of range of motion, and pain that impairs your ability to “walk without using an assistive device and sustaining a reasonable pace while walking a sufficient distance in order to carry out your daily activities such as going to and from school or work.”
For example, if your hip or your knee has developed moderately advanced or advanced (“bone on bone”) degenerative arthritis from having AVN, and you are unable to stand or walk more than 2 hours in an 8-hour workday, you may qualify for LTD benefits.
At Law Med, we combine medical insight and legal expertise to help you get SSDI and/or ERISA disability benefits.