Disability Benefits for Diabetes Patients
This overview explains how diabetes alone rarely qualifies for disability benefits, but you may qualify if you have additional medical conditions that impact your ability to earn sufficient income.
Having diabetes by itself usually will not enable you to qualify for Social Security Disability (SSDI). Many people have diabetes and are able to work normally. However, if you are unable to control blood sugar levels throughout the day, having symptoms such as dizziness, vision problems or numbness that impact your ability to perform your job will be considered when you apply for SSD. Normally, however, it is the difficulties caused by other related illnesses coupled with diabetes that may make you eligible for disability benefits. Illness such as diabetic vision loss, peripheral neuropathy, heart disease, and kidney failure can be associated with diabetes and can be disabling.
The Social Security Administration (SSA) has developed listings for various diseases that could qualify for disability benefits. They refer to this list as their Blue Book. It allows Disability Examiners (DE) to quickly reference a specific disease and compare the listing with the actual symptoms of the claimant.
The Blue Book does not list diabetes as a disease possibly qualifying for disability benefits based on a listing because by itself, it does not meet the minimum standards needed by the SSA to be listed. It must be diagnosed in conjunction with specific impairments to bring a person’s limitations up to the level required for benefits. The impairments caused by the related diseases would be evaluated on their own under that disease’s listing. These illnesses are relevant if they prevent you from working and performing substantial gainful activity (SGA), which in 2018 was the ability to earn $1,180 gross wages or net self-employment profit monthly ($1,970 if you are blind).
Illnesses Related to Diabetes
To qualify for disability benefits, you must have a doctor’s diagnosis of diabetes mellitus, either Type 1 or Type 2 in conjunction with another SSA listed illness.
Here are some examples of diseases that could be related to diabetes and may allow you to qualify for disability benefits based on the listings:
When your kidneys and lungs allow your acid levels to rise too high in your body fluids. This must be documented by blood tests at least once every two months. This may cause severe weakness and abdominal pain.
- Amputation of a limb
If you have a foot amputated due to complications of diabetes, benefits may be granted if other limitations exist.
- Cardiovascular Diseases
This includes peripheral vascular diseases, an irregular heartbeat, or chronic heart failure, which causes pain, fatigue, numbness.
- Cerebral edema and seizures
This is too much fluid in the brain tissues and can cause unconsciousness, brain injury, headaches, and pain.
- Cognitive impairments, psychological issues
Pain causes problems with thinking and the ability to focus on a problem, along with the possibility of depression or anxiety.
- Diabetic Nephropathy
You have daily dialysis because your kidneys are not filtering properly or your creatine or protein levels are too high.
- Diabetic Retinopathy
Blood vessel damage in the eyes. This leads to blindness and causes a serious loss of peripheral vision. To qualify under this disease, a person must be effectively blind.
- Peripheral Neuropathy
This is nerve damage that must impact at least two of your extremities. It must cause prolonged problems with standing or walking.
- Skin infections that are slow to heal and bacterial infections.
This includes ulcerated skin lesions that fail to heal within three months making walking or the use of your hands difficult.
It is important to note that meeting the listings is only one way to qualify for benefits based on diabetes/diabetes-related illnesses. If you have a severe condition but do not meet the listings, your work history, training, education, and age will be considered in determining whether you are able to work in any occupation that would be possible with your physical limitations. (See Residual Functional Capacity below.)
Follow Your Doctor’s Orders
Left untreated, some of the ailments listed above can lead to death. If you do not follow your doctor’s treatment plan, benefits may be denied. For example if your doctor told you to come in for regular follow-up appointments, lose weight, test your insulin level regularly, take medication or insulin shots, get physical therapy, etc., and you are not following through, the disability examiner may conclude that your symptoms are not really severe and serious enough to keep you from working.
Residual Functional Capacity
Most applicants are not granted benefits based on the listings because the requirements of the impairments are high, so there is another test to see if you would qualify. If you do not meet the impairment listings in the Blue Book, your claim will be evaluated to determine if a medical-vocational allowance can be granted.
A medical-vocational allowance review is used when your impairments do not match the exact description in the Blue Book. To assist in the review often a Residual Functional Capacity (RFC) assessment is obtained. This evaluation rates how your medical or psychiatric condition limits you. Your doctor may be asked to complete an RFC, although some doctors as a matter of policy will not make an RFC statement, or you may asked to see a physician selected Social Security for the evaluation. The RFC determines your ability to stand, walk, sit, bend, push, pull, lift, and carry objects or in the case of mental illness or impairment your ability to reason, follow directions, be around people, and cope with stressful situations.
Here are examples of how diabetes and related conditions could have an effect on your RFC. If your vision is 20/70 or more and not correctable, you will not be able to drive. If your poor circulation results in numbness in your extremities, your manual dexterity or your ability to stand or walk could be impacted. If you are not able to maintain consistent glucose levels throughout the day, you may lose your cognitive ability.
If your vision is poor or you have difficulty in controlling your blood sugar level, this may be a reason to stop driving. If driving is part of your job duties, this would prevent you from working in occupations that require driving or working around machinery with moving parts as you could place not only your own life in danger but the lives of others.
Also, because driving is such a part of American life that if you give it up and have to find another means to travel to work or to the grocery store, it would go a long way toward illustrating to the SSA how serious your problems really are. If you refuse to stop driving even though you are having these difficulties, it could damage your credibility in a Social Security hearing. This is because the judge may think your disease impairments aren’t really as serious as you claim since you continue to drive.
Your psychological state could also be affected by your disease, so your thinking ability and your capacity for focusing may be assessed. In addition to those appraisals, your medical records will be reviewed, as well as statements may be taken from friends, relatives, and co-workers.
With regard to physical capacity, the examiner determines which category your limitations best fit in: medium work, light work, or sedentary. Your residual functional capacity—what you can do— will give the examiner a basis to decide if you would be able to return to your previous job. If you cannot, your limitations are then considered along with your age, work history, schooling, skills, and job training to determine whether you can work in another occupation.
The examiner considers your limitations stemming from all your medical and mental conditions including diabetes and related illnesses to determine your vocational ability to work. The disability examiner may find that because of your impairments you are not capable of returning to your past work or any other type of job, even with on-the-job training. If so, it will be determined that you are disabled. Expectations of your ability to start new occupations are higher if you are younger than fifty than if you are fifty to fifty-five years of age and is it fairly likely that a number of other jobs you could perform will be identified. If you are older than 55, the number of jobs may be limited because you are approaching retirement age with less ability to compete for and be successful in a new occupation. Accordingly, your chances of approval are a bit stronger than those of younger applicants.
The requirements to obtain Social Security Disability for diabetes or related conditions are very high. This is why first-time claimants are often denied benefits. However, it is possible to appeal the initial finding. If you obtain the assistance of an attorney who specializes in Social Security Disability claims, your chances of winning an appeal increase. If your first appeal is denied, you can seek a hearing in front of an administrative law judge.
Using an experienced Social Security disability attorney allows you to take advantage of their knowledge and skills to put together a compelling case to obtain benefits. Your lawyer might bring in experts, neighbors, or co-workers to explain in more detail how your limitations severely disrupt your life. Your attorney may also be able to cross-examine Social Security’s experts to show the weaknesses in their conclusion. Although you can appeal your denial by yourself, it would be to your advantage to have a disability benefits attorney represent you to present the best case to obtain a reversal of your benefit denial.