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Avascular necrosis (AVN), also known as osteonecrosis, is a condition in which bone tissue dies due to a lack of blood supply. As the bone dies, small fractures in the bone occur, eventually leading to more significant fractures. The fractures can occur in any bone in the body. However, avascular necrosis most often affects the hip joint, knee, shoulder, and ankle.

Avascular necrosis develops over time and progresses through several stages. In the early stages, there may be no symptoms or only mild joint pain. As the condition worsens, the affected joint may become very painful and movement may become limited. In some cases, the bone may collapse, leading to severe pain and the need for joint replacement surgery. This can result in disability. If your avascular necrosis keeps you from working for over 12 months than you should file an application for SSDI and SSI benefits.

Stages of Avascular Necrosis


A study published in the journal, Clinical Orthopaedics and Related Research, in 2019 estimated that avascular necrosis affects between 10,000 to 20,000 new individuals each year in the United States. The study notes that the number of people who have AVN can vary depending on the underlying cause of the disease. For example,  trauma and steroid use are the most common causes of AVN in the USA.

An older study from 2011, in the Journal of Bone and Joint Surgery, looked at how often avascular necrosis occurs in military personnel in the United States. The study found that the overall indidence of AVN was 2.9 cases per 10,000 people every year. It also found that the hip was most commonly affected joint in the body.

There are about 3 to 20 cases per 100,000 individuals in the general population each year who develop avascular necrosis. Worldwide, it is possible that several hundred thousand to a few million people develop AVN each year. However, it’s important to note that these are rough estimates.  The exact number of people with avascular necrosis varies  depending on factors such as age, gender, underlying health conditions, and geographic location.

It is also important to point out that avascular necrosis is a relatively rare condition compared to other musculoskeletal disorders, such as osteoarthritis and rheumatoid arthritis. Those conditions affect millions of people worldwide.


The early stages of avascular necrosis can be asymptomatic. This means that there may not be any noticeable signs or symptoms of the disease. However, there are five early symptoms that may occur:

  1. Joint pain: Joint pain is a common symptom of AVN, especially in the early stages of the disease. The pain may be localized to the affected joint and can be described as a dull ache or sharp pain. The pain may be exacerbated by activity or weight-bearing and may be relieved by rest.
  2. Limited range of motion: AVN can cause stiffness and limited range of motion in the affected joint. This may make it difficult to perform activities that require movement of the joint, such as bending or twisting.
  3. Muscle weakness: Due to pain and limited range of motion, the muscles surrounding the affected joint may become weak over time. This can lead to muscle atrophy or wasting away of the muscle tissue.
  4. Joint instability: As avascular necrosis progresses, the bone in the affected joint may become weakened and can even collapse. This can cause the joint to become unstable and feel loose or wobbly.
  5. Grinding or popping sensations: Some people with avascular necrosis may experience a grinding or popping sensation when moving the affected joint. This can be caused by the roughened surfaces of bone rubbing against each other. It can also be caused by bone fragments that are in the joint due to bone collapse.

It’s important to note that these symptoms may not all be present in every case of avascular necrosis. If you are  experiencing any of these symptoms, then you should see a doctor for treatment.


Avascular necrosis is caused by a temporary or permanent loss of blood supply to the bone. There are several factors that can cause the loss of blood supply to the bone, including:

  • Trauma: Avascular necrosis can develop after a bone injury, such as a fracture that disrupts the blood supply to the bone. This can happen because the injury damages the blood vessels that supply the bone or because the bone is compressed in a way that interferes with blood flow.
  • Steroid use: Prolonged use of corticosteroid medications, such as prednisone, can increase the risk of avascular necrosis. Steroids can interfere with your body’s ability to build and maintain healthy bone tissue and can also cause changes in the blood vessels that supply the bone, leading to decreased blood flow.
  • Alcohol consumption: Excessive alcohol consumption over a long period of time can damage blood vessels and increase the risk of avascular necrosis. Alcohol can also interfere with the body’s ability to build and maintain healthy bone tissue.
  • Medical conditions: Certain medical conditions can increase the risk of AVN by affecting the blood vessels or bone tissue. For example, sickle cell anemia can cause blockages in the small blood vessels that supply bone tissue, leading to AVN. Lupus and HIV infection can cause inflammation and damage to blood vessels, increasing the risk of avascular necrosis.
  • Radiation therapy: Radiation therapy for cancer treatment can damage bone tissue and increase the risk of avascular necrosis. The risk of AVN increases with higher doses of radiation and longer duration of treatment.
  • Genetic factors: Some people may have a genetic predisposition to avascular necrosis, which can be passed down through families. Certain genetic mutations can affect your body’s ability to maintain healthy bone tissue and blood vessels, increasing the risk of AVN.


In all medical conditions, including avascular necrosis, you have the burden to prove you should be paid benefits under the SSA’s rules. Therefore, you must work closely with your doctor and your attorney to make sure that the SSA has all of your medical records. You also need to make sure that you complete all of the SSA’s paperwork. This includes your Application, Work History report, and your Activities of Daily Living Report.

The Social Security Administration will need to evaluate whether your avascular necrosis prevents you from working. The first step in this process is for the SSA to look at whether your symptoms meet the rules in SSA’s Blue Book or their listing of medical conditions. They do this be reading your medical records.

However, the SSA does not have a specific listing for avascular necrosis. This means that there is no certain rule that you can meet to win benefits. If the symptoms of your avascular necrosis are similar to those of another listing, then your condition can “equal” that listing.


The SSA has two listings under Section 1.00 – Musculoskeletal System of the Blue Book that deal with bone fractures. The first is Listing 1.19 which deals with pathologic fractures due to any cause, including avascular necrosis. Below, please read listing 1.19:

1.19 Pathologic fractures due to any cause (see 1.00J), documented by A and B:

A. Pathologic fractures that occur on three separate occasions within a 12 month period.


B. Impairment-related physical limitation of musculoskeletal functioning that has lasted, or is expected to last, for a continuous period of at least 12 months, and medical records of at least one of the following:

1. 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; or

2. An inability to use one upper extremity to independently initiate, sustain, and complete work related activities involving fine and gross movements, and a documented medical need for a one handed, hand held assistive device that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand; or

3. An inability to use both upper extremities to the extent that neither can be used to independently initiate, sustain, and complete work related activities involving fine and gross movements.


The second listing is 1.22. Listing 1.22 deals with a non-healing or complex fracture in the lower part of the body. For example, listing 1.22 applies if you have a broken or fractured femur. It is possible that your femur may not heal. Because your femur supports your body weight, if there is a non-union of the bone, you will not be able to walk or bear weight. This is the type of injury contemplated by SSA’s listing.

1.22 Non-healing or complex fracture of the femur, tibia, pelvis, or one or more of the talocrural bones, documented by A, B, and C:

A. Solid union not evident on imaging and not clinically solid.


B. Impairment-related physical limitation of musculoskeletal functioning that has lasted, or is expected to last, for a continuous period of at least 12 months.


C. 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.


The SSA can find that your avascular necrosis “equals” a listing if your symptoms are similar, but not exactly the same as a listing. To equal a listing, your condition must be equal to that listing in severity and duration.

If you have a fracture from avascular necrosis, it may equal a listing if the symptoms from it cause the same limitations as those found in listing 1.19 and 1.22.  Similarly, you can equal a listing if you have avascular necrosis and another medical condition. If the combination of your conditions are equivalent in severity to the listing, then you “equal” the listing.

Additionally, it is possible for avascular necrosis to result in arthritis. If that is the case, then you may meet or equal a listing under osteoarthritis. Find out more information about osteoarthritis and SSDI benefits here. Your attorney will review your records and decide what is the best legal argument that can be made on your behalf. If you hire an attorney with years of legal experience, they will know SSA’s rules and be able to tell you which listing best fits your avascular necrosis case.


Medical records are the most important evidence that proves you have avascular necrosis which prevents you from working. There are certain records the SSA must have in order for you to win your case. These include:

  • Progress notes from your treating doctor that detail your symptoms and the frequency of your symptoms
  • Hospital stays or other medical treatments
  • Medications, dosages, and any problems you experience from your medications
  • Statements from your treating doctor about your symptoms
  • Imaging and other test results that document your condition


If your avascular necrosis does not equal a listing, then you can still win benefits by proving your residual functional capacity keeps you from working a 40 hours a week. Residual Functional Capacity (RFC) is one of the most important concepts in your Social Security case. Your RFC can make the difference between winning or losing your SSD case. If you can prove that your RFC prevents you from working, then you can be paid benefits. So, what is your RFC?

The RFC is the medical assessment of what you can physically do in a work setting after taking into account all of your symptoms.

In order to figure out your physical RFC when you have AVN, the SSA will examine your medical records. They will take into account what your doctor states in your medical records. Also, the SSA will review any statements from your doctors. They will also review records from their own medical doctors.

The SSA will also consider descriptions about your symptoms from your family, neighbors and friends. For example, your family or friends could write a statement about your pain and symptoms of avascular necrosis. Find out more here about RFC and how it, along with age, to show that you cannot work. Also, find out more about SSA’s Medical Vocational Guidelines here.


Your medical records should contain information about when your avascular necrosis began. Likewise, your records should also document your ongoing symptoms. In some cases, an individual with avascular necrosis may undergo surgery. If that is the case for you, then we need those records.

You need to make sure the medical record is complete. But, you also need to make sure that your medical records contain an outline of your RFC. This means your doctor should write down whether or not your AVN keeps you from lifting, walking, sitting, or carrying. In order to outline your RFC, you should ask you doctor to fill out a form talking about your limits. Likewise, your doctor can write a letter about your RFC.

The RFC states how much you can lift and how many minutes you can sit at one time before you need to stand up. Also, your doctor should explain how many minutes you can stand at one time before you need to sit down. If you need to lay down during the day, your doctor should include that information. The RFC statement will obviously depend upon where your AVN is located. It is very important, however, for your doctor to discuss your limits and symptoms in the medical records.


Additionally, the ME can testify about your residual functional capacity (RFC). The ME’s testimony will be based on your medical records. Your RFC is important because if you do not meet or equal a listing, then the vocational expert will use your RFC to determine if you can work. Learn more about vocational expert testimony here.

The medical expert can ask you questions during the hearing. But, the ME’s questions usually only clarify facts in your medical history. Often, the ALJ will decide whether the ME’s questions are important to the case. If the ALJ doesn’t think so, they can refuse to let the ME ask you questions.

The ALJ may also ask the question herself or she may allow the ME to question you. The ME, however, cannot conduct any type of physical or mental exam during the hearing. If the ME tries to do so, your attorney should object.

In addition giving testimony about your RFC, a medical expert can also use records to confirm your onset date of disability. This is important because your onset date determines how much back pay you will receive.

For example, if the medical expert states your medical condition began two years prior to your application date, then you can be awarded up to one year of back pay prior to your application date.

However, it is also possible for the medical expert to testify you should not get back due benefits. The expert can claim you only recently should win benefits, even though you haven’t been working for years. That is why hiring an attorney is crucial to your case. The attorney can use the medical record to prove the ME’s testimony is wrong. Your attorney will fight for your full back benefit.


Unfortunately, if you do not hire an attorney to help you, you will probably lose your case. Most cases turn on the ME’s testimony at the hearing. An attorney can make sure that all of your symptoms are being considered by the medical expert.

You will also need an attorney to question the medical expert. You may be able to provide testimony on your own to the judge, but when it comes time to ask questions of the ME, you need knowledge of SSA’s rules. Likewise, you need to understand your medical condition and the medical record.

The rules regarding the types of jobs and how physical conditions fit into those jobs are complex. If you do not have an attorney, you can lose your hearing due to the testimony of the medical expert.

If your attorney has experience, they will also know what the ME is likely to say in response to the ALJ’s questions. They will also know how to question the ME and solicit testimony regarding your RFC. Learn more about the role of your residual functional capacity here. The RFC is crucial to the SSA  finding that you deserve benefits, especially if your mental or physical condition does not meet an SSA listing.

Cross-examination of the medical expert is difficult. Trying to do it yourself is a bad idea. Especially if you have never done it before. If nothing else, you should hire an attorney to represent you if the Judge has called a medical expert to your hearing. If you have questions about your hearing, read here.


If you want to learn more about the lawyers and staff at Cannon Disability Law you can go to our About Us page. For example, Andria Summers can help you prepare for your hearing. She has also won thousands of SSD and SSI cases. Dianna Cannon has been helping her clients win SSDI and SSI benefits for thirty years. Brett Bunkall also has significant legal experience helping people obtain their benefits.

Together, over the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. Our experts can help you apply for benefits using the SSA’s website. Likewise, if you need an appeal, we can help you do that too.

There are also many forms that will need to be filled out. Don’t worry. If you have questions about these forms, we will answer them. You can learn more about SSA’s appeal forms here. Call us for help today.

Additionally, we represent clients in many states, including Nevada, Utah, Idaho, and California. Find out more about:

If you have questions about the wait time for the SSA’s decision, read here. We offer a “no win, no fee” payment policy. This means that you will only pay an attorney fee if we win your case. Learn more information about attorney fees here.


Contact us today. Take advantage of our free review of your case. Call now. We will answer your questions. You can explain why your avascular necrosis symptoms keep you from working. We will be able to tell you if you qualify for benefits. We will also do our best to win your SSDI and SSI benefits for your avascular necrosis.

Call today. Speak to our intake staff. We will ask you many questions, but we also want to know your story. When you call, tell us what symptoms you are experiencing. If you have had multiple operations to or bone removal due to AVN, please tell us. Also, be ready to tell us about your doctors. We also want to know if you are getting treatment for mental conditions, like depression. Find out now if we can help you obtain benefits for avascular necrosis. Contact us for your free review of your case.

No matter where you live, we want to be your legal team. Also, no matter what state you live in, we can talk to you for free about your case.  Contact us today. We will do our best to answer your questions. We want you to win your benefits for avascular necrosis.

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