Blue Book listing 1.20
Amputation and Social Security Disability Benefits
Listing 1.20 sorts amputation claims by which limbs are lost and at what level. Loss of both arms at or above the wrists, a hemipelvectomy, or a hip disarticulation meets the listing on those facts, while other combinations also require proof of prosthesis problems or a medically needed assistive device.
In an amputation claim, the diagnosis is rarely the question. What SSA measures is the level of the loss, which limbs are involved, and how well you function with a prosthesis in place. Listing 1.20 applies to amputation from any cause, whether trauma, disease or a congenital absence.
We represent adults in Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims involving limb loss. This page sets out the four paragraphs of listing 1.20, the prosthesis evidence SSA asks for, the residual functional capacity (RFC) route for claimants outside the listing, and the gaps that undo these files.
SSA Blue Book listing
1.20
Spine, joints and pain
The criteria are set out below in plain language.
How does listing 1.20 evaluate an amputation for disability?
Duration rule
12months
Listing 1.20 has four paragraphs, and meeting any one is enough. Paragraph A is amputation of both upper extremities at any level at or above the wrists (the carpal joints), up to and including disarticulation of the shoulder. Paragraph B is a hemipelvectomy or a hip disarticulation. Neither paragraph asks anything further, and the 1.00 rules state that both satisfy the 12-month duration requirement.
Paragraph C combines the loss of one arm at or above the wrist with the loss of one leg at or above the ankle (the talocrural joint). It also needs one of three findings: a documented medical need for a walker, bilateral canes or bilateral crutches; a documented medical need for a one-handed, hand-held assistive device; or an inability to use the remaining arm to independently initiate, sustain and complete work-related fine and gross movements.
Paragraph D covers the loss of one or both legs at or above the ankle, with complications of the residual limb that have lasted or are expected to last 12 months. It then requires both an inability to use a prosthesis and a documented medical need for a walker, bilateral canes, bilateral crutches, or a wheeled and seated mobility device that takes both hands. For paragraphs C and D, the required findings generally must appear in your medical record within a consecutive 4-month period.
Prosthesis evidence in an amputation SSDI claim
Duration rule
12months
The 1.00 rules define a prosthesis as a wearable device, such as an artificial limb, that takes the place of an absent body part. When you use one, a medical source must document your ability to walk, or to perform fine and gross movements, with the prosthesis in place. That description is what SSA weighs, so a note that says only that you wear a prosthesis leaves the main question unanswered.
When you cannot use a prosthesis, the record has to show two things: the condition of your residual limb, and the medical basis for the inability. Paragraph D turns on this. Complaints of pain at the socket, without a clinical description of the limb and an explanation from a medical source of why the device cannot be worn, do not establish it.
The device requirement in paragraphs C and D uses the same definition of documented medical need as the rest of the 1.00 musculoskeletal rules. A medical source must support the need for at least 12 continuous months and describe the limitation in arm or leg function and the circumstances requiring the device. No specific prescription is required. A wheeled device is counted by the number of hands it takes.
The RFC route for amputation claims outside listing 1.20
Those limits bear directly on light work, which the federal definition describes as requiring a good deal of walking or standing.
A single leg amputation with a working prosthesis, or the loss of one arm alone, does not meet listing 1.20. When the listing is not met or medically equaled, SSA moves to the fourth and, if necessary, fifth steps and assesses your RFC, the measure it uses to decide whether you can do past work or other work.
For a leg amputation, the functional limits center on standing and walking tolerance with the prosthesis, balance, uneven ground, stairs, ladders and kneeling. Those limits bear directly on light work, which the federal definition describes as requiring a good deal of walking or standing. Sedentary work, as SSR 96-9p describes it, still asks for about 2 hours of standing or walking in an 8-hour day. A medically required hand-held assistive device, documented with the circumstances it is needed for, belongs in the RFC as well.
For an arm amputation, the limits are manipulative. SSR 96-9p says most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions. A one-handed worker loses the two-handed tasks of handling, carrying and assembly, and any limitation in the remaining hand compounds the loss.
When an amputation followed another disease, the 1.00 rules direct SSA to consider whether an impairment meets a listing in another body system. If your amputation followed diabetes, our diabetes disability page covers how SSA evaluates its other effects.
Evidence that decides an amputation disability claim
The operative report establishes the level of the amputation, and the level decides which paragraph of 1.20 can apply. SSA asks for a copy of it. If the report is unavailable, SSA needs confirmatory evidence of the procedure from a medical source. The records that carry the rest of the claim are:
- Clinic notes describing how far and how long you walk, or what you can grip and lift, with the prosthesis in place
- Records describing the condition of the residual limb, each complication, its treatment and how long it has lasted
- A medical source statement explaining why a prosthesis cannot be used, when that is the case
- Documentation of any walker, canes, crutches or wheeled device, with the circumstances requiring it
- Records of the underlying disease that led to the amputation
SSA evaluates every effect of treatment, including revision surgery, medication and therapy, over a period long enough to show the result, and generally needs a longitudinal medical record to judge severity and duration. A single post-operative visit does not show how you function a year later.
Why are amputation disability claims denied?
Duration rule
12months
The pattern we see in denied leg amputation files is a chart that says the patient ambulates with a prosthesis and nothing more. Without distance, time, terrain, falls or the need for a cane, that line is read as full function, and the RFC reflects it.
A second pattern is residual limb trouble documented in episodes. Skin problems, revisions and refittings show up as separate visits months apart, and no medical source ties them together as a complication that has lasted or is expected to last 12 months. Paragraph D needs that continuity on the page.
A third pattern is an unexplained switch from prosthesis to wheelchair. If you stopped using the prosthesis, the record must give the medical reason. When the file is thin at the start, our page on applying for disability covers how to assemble the records before you file.
Amputation Disability Claim Questions
Does SSA need to see how I walk without my prosthesis?
For a leg amputation, the 1.00 rules say a medical source does not need to evaluate your ability to walk without the prosthesis in place. The examination that counts is the one done with the prosthesis on. If you cannot use it at all, the evidence shifts to the condition of the residual limb and the medical reason the device cannot be worn.
Is a finger or partial hand amputation covered by listing 1.20?
Amputations below the wrist are not evaluated under listing 1.20A. The 1.00 rules send them to the general provisions in section 1.00S, which direct SSA to consider other listings and medical equivalence. If no listing is met or equaled, the claim moves to the RFC, where limits on fingering, handling and grip decide which jobs remain.
Do I have to wait 12 months after an amputation to apply for SSDI?
The rules measure limitations that have lasted or are expected to last 12 months, so the clock does not have to run out first. For loss of both arms at or above the wrists, and for hemipelvectomy or hip disarticulation, the 1.00 rules state the duration requirement is satisfied. Paragraph D claims rely on medical opinion about how long the residual limb complications will last.
Sources: SSA Blue Book, 1.00 Musculoskeletal Disorders (Adult); SSR 96-9p, Implications of an RFC for Less Than a Full Range of Sedentary Work; 20 CFR 404.1567, Physical exertion requirements.
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