Listing 1.20 in 2026: How Social Security Decides Amputation Disability Claims Under 1.20A, 1.20B, 1.20C, and 1.20D, Why Prosthesis Function Decides Most Cases, and the Documentation That Wins at Step 3

By Anthony Albert, Benefits Research Director · Published June 15, 2026 · 14 min read

Amputation cases at Social Security look easier than they are. A claimant lost a leg, the Blue Book has a listing for amputation, the math should be obvious. It is not. SSA rewrote Listing 1.20 effective April 2, 2021, and the current version has four distinct subparts with very different rules. Two of them are automatic. Two of them require functional criteria that the claimant has to prove with assistive device documentation and prosthesis evaluations.

If you are filing an amputation claim or appealing a denial, you need to know which subpart applies to your amputation, what evidence each subpart actually demands, and where the trap doors are. This is the 2026 walkthrough of Listing 1.20.

The four subparts at a glance

Listing 1.20 covers "amputation due to any cause." The cause can be trauma, vascular disease, peripheral artery disease, diabetes, cancer surgery, infection, congenital absence, or anything else that results in the full or partial loss of an extremity. The cause does not change the analysis. The level and combination of amputation do.

Three observations come out of that table.

First, 1.20A and 1.20B are the only true automatic categories. If you lost both arms above the wrist, or you had a hemipelvectomy or hip disarticulation, the listing is met. SSA does not ask about functional criteria. The 12-month durational requirement is presumed satisfied.

Second, 1.20C and 1.20D are not automatic. Even though they cover serious amputations, the claimant still has to clear the functional criteria in section 1.00E3 of the Blue Book. That is where most 1.20 denials happen.

Third, the level matters. Below-wrist amputations (finger, partial hand) do not qualify under 1.20A. Below-ankle amputations, including Syme amputations through the ankle joint, do not qualify under 1.20D. Those claims get evaluated under section 1.00S, the catchall for atypical amputations.

1.20A: bilateral upper extremity amputation

1.20A applies when both upper extremities are amputated at any level at or above the wrists, up to and including disarticulation of the shoulder. The exact phrasing in the Blue Book is "any level at or above the wrists (carpal joints)." Wrist disarticulation counts. Mid-forearm counts. Elbow disarticulation counts. Above-elbow counts. Shoulder disarticulation counts.

What does not count under 1.20A:

• Below-wrist amputations (finger, thumb, transmetacarpal). These get evaluated under section 1.00S.
• Single upper extremity amputation. That falls under 1.20C only if combined with a lower extremity amputation, or under section 1.00S as a stand-alone.

Evidence requirements for 1.20A are minimal. You need operative reports or hospital records documenting both amputations at the qualifying level. Once those are in the file, the listing is met.

1.20B: hemipelvectomy and hip disarticulation

Hemipelvectomy involves amputation of an entire lower extremity through the sacroiliac joint. Hip disarticulation involves amputation of an entire lower extremity through the hip joint capsule with closure of the remaining musculature over the exposed acetabular bone. Both are devastating surgeries, typically reserved for malignancy, severe trauma, or infection.

Like 1.20A, 1.20B is automatic once the surgery is documented. No functional criteria. No prosthesis evaluation. The 12-month durational requirement is satisfied by the nature of the procedure.

If you had a "high above-knee amputation" that is not actually a hip disarticulation (because the femoral head is still attached), you do not qualify under 1.20B. You may qualify under 1.20D if you have residual limb complications, or under section 1.00S.

1.20C: one upper plus one lower extremity

1.20C is the first subpart where most claimants stumble. It covers amputation of one upper extremity at any level at or above the wrist plus one lower extremity at any level at or above the ankle. The combination is severe by definition, but SSA still requires functional criteria under section 1.00E3.

The functional criteria for 1.20C require medical documentation of at least one of these three:

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.
2. An inability to use the remaining upper extremity to independently initiate, sustain, and complete work-related activities involving fine and gross movements, plus a documented medical need for a one-handed assistive device or a wheeled mobility device involving the use of one hand.
3. An inability to use one upper extremity to independently initiate, sustain, and complete work-related activities involving fine and gross movements.

"Documented medical need" has a specific meaning under section 1.00C2b. It means there is evidence from a medical source supporting the medical need for the device for a continuous period of at least 12 months. The evidence has to describe the limitation in upper or lower extremity functioning and the circumstances under which you need the device. SSA does not require a specific prescription, but a prescription is the cleanest way to satisfy the rule.

For 1.20C in practice, you need the operative reports plus prosthetist notes plus physical therapy or rehab evaluations describing day-to-day mobility and the assistive device use.

1.20D: lower extremity amputation with complications

1.20D is the most contested subpart. It covers amputation of one lower extremity or both lower extremities at or above the ankle, with complications of the residual limb or limbs. This is the listing that captures the majority of vascular and diabetic amputation cases at SSA.

The 1.20D analysis has three layers. All three have to be satisfied.

Layer 1: amputation at or above the ankle

Below-ankle amputations do not qualify under 1.20D. That includes:

• Toe amputations
• Transmetatarsal amputations
• Lisfranc and Chopart amputations
• Syme amputations (through the ankle joint, tibia and fibula intact)

The Syme exclusion is in the Federal Register preamble to the 2021 listing revision. SSA reasoned that Syme amputations preserve the body's ability to bear weight over the distal stump, often allow ambulation with only a cane and walking boot post-surgery, and accept a prosthesis that restores near-normal function. As a result, Syme cases are evaluated under section 1.00S rather than 1.20D.

Layer 2: residual limb complications

The amputation alone is not enough under 1.20D. You need documented complications of the residual limb. The Blue Book uses examples like:

• Chronic wounds or ulcerations that prevent prosthesis use
• Stump pain, neuroma, or phantom limb pain limiting prosthesis tolerance
• Poor healing or repeated revisions
• Skin breakdown from prosthesis socket fit problems
• Vascular insufficiency in the residual limb
• Recurrent infection

The complications must have lasted or be expected to last for a continuous period of at least 12 months. A single episode of wound dehiscence that healed in three months does not satisfy this layer.

Layer 3: inability to use prosthesis plus assistive device need

The third layer is the inability to use the prosthesis combined with a documented medical need for one of the qualifying assistive devices. The Blue Book specifies:

• Walker
• Bilateral canes
• Bilateral crutches
• Wheeled and seated mobility device involving the use of both hands

Single cane is not enough under 1.20D. The list is intentionally strict. SSA wants evidence that the claimant cannot ambulate effectively even with a prosthesis attempt.

The fix for that denial is layered evidence. Prosthetist notes documenting socket fit failures. PT notes documenting falls. Wound care notes documenting stump breakdown. A treating physician statement that says "patient is unable to use her prosthesis due to chronic stump ulceration despite multiple socket adjustments, and requires bilateral forearm crutches for any household ambulation." That language fits the listing.

How SSA evaluates prosthesis function

Section 1.00C6b of the Blue Book governs prosthesis evaluation. If you have a prosthesis, SSA needs evidence from a medical source documenting your ability to walk or perform fine and gross movements with the prosthesis in place. For lower extremity amputations, SSA explicitly does not require evaluation of walking without the prosthesis. The question is whether you can walk with it.

If you cannot use your prosthesis because of complications affecting your residual limb, you need documentation of the condition of your residual limb and the medical basis for your inability to use the device. That documentation can come from:

• Prosthetist evaluations
• Treating physician notes
• Wound care specialist notes
• Physical therapy assessments
• Rehabilitation medicine consultations

Prosthetist notes carry particular weight because the prosthetist is the medical source most directly involved in fitting and adjusting the device. A prosthetist statement that says "patient has been seen six times in 9 months for socket adjustment, has been unable to tolerate sustained ambulation greater than 50 feet without skin breakdown, and we have ordered a new socket design with a planned 8-week trial" is exactly the evidence 1.20D demands.

The 12-month durational requirement

Every Social Security disability claim has to clear the 12-month durational rule under 20 CFR 404.1509. The impairment has to last or be expected to last for a continuous period of at least 12 months, or to result in death.

For 1.20A and 1.20B, the duration is automatic. The Blue Book preamble states that bilateral upper extremity amputation or hemipelvectomy or hip disarticulation satisfies the duration requirement by definition.

For 1.20C and 1.20D, the duration is met when the functional criteria have lasted or are expected to last at least 12 months. The 12-month clock starts when the functional criteria are documented, not when the amputation occurred. That distinction matters for recent amputations where the rehabilitation arc is still unfolding.

A claimant whose amputation happened 4 months ago and who has had repeated prosthesis fit failures with documented complications can still meet the durational test if the medical source statement projects continued functional criteria for at least 8 more months. The projection has to be supported by the residual limb condition, the wound care plan, and the prosthetist's outlook.

Section 1.00S: the catchall

If your amputation does not fit any 1.20 subpart, SSA evaluates under section 1.00S. That covers:

• Below-wrist amputations (single or bilateral)
• Single upper extremity amputation
• Below-ankle amputations including Syme
• Partial foot amputations
• Combinations not matching 1.20C

Section 1.00S directs adjudicators to apply the functional criteria in 1.00E3 and the rules in sections 1.00C6 (assistive devices) and 1.00C6b (prosthesis). If you meet the functional criteria, you can still get a listing-level finding through medical equivalence to 1.20C or 1.20D under 20 CFR 404.1526. That is a slower path but a real one.

RFC and Steps 4 and 5

If your amputation does not meet or equal 1.20, the case moves to Step 4 (past relevant work) and Step 5 (other work in the national economy). For amputation cases the RFC fights are about:

• Standing and walking tolerance
• Climbing, balancing, stooping, kneeling, crouching, crawling
• Reaching, handling, fingering, feeling (for upper extremity amputation)
• Need for unscheduled rest periods (for residual limb complications)
• Need for elevation of the residual limb

The grid rules at 20 CFR 404 Subpart P Appendix 2 favor older claimants with amputation. A 55-year-old claimant restricted to sedentary work with limited use of one upper extremity often grids out at Step 5. A 50-year-old claimant with the same restriction can grid out under Rule 201.14 if past work was unskilled.

How to apply this listing to your case

1. Identify which subpart your amputation fits. If 1.20A or 1.20B, the case is documentary only. If 1.20C or 1.20D, you have a functional criteria fight.
2. Pull every prosthetist note, PT note, wound care note, and treating physician statement into the file.
3. Document the assistive device. Bilateral devices satisfy the functional criteria more cleanly than single cane.
4. If you cannot use your prosthesis, get a medical source statement saying so with the reason (stump complications, vascular issues, neuroma, phantom pain, socket failures).
5. Confirm the 12-month durational projection in writing.
6. If your amputation does not fit 1.20, work the medical equivalence track under 20 CFR 404.1526 and section 1.00S.

Bottom line

Listing 1.20 is not the rubber stamp that many claimants and even some attorneys assume. 1.20A and 1.20B are automatic, but they cover narrow surgical categories. 1.20C and 1.20D require functional criteria evidence that most files do not contain at filing. The cases that win at Step 3 are the ones where the prosthetist, the treating physician, and the PT all sing the same song: this person cannot ambulate effectively or cannot use the upper extremity productively, and the assistive device need is documented.

If you are filing an amputation claim or fighting a denial, See If You Qualify and let us audit your file against the functional criteria before SSA does.

Related reading

• Listings 1.15 and 1.16 spinal disorders
• Medical equivalence under 20 CFR 404.1526
• The five-step sequential evaluation
• Building a medical record for SSA
• Disability benefits for diabetes (a frequent cause of lower-limb amputation)

Frequently asked questions