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 (SSD). Many people have diabetes and are able to work normally. It is the difficulties caused by other related illnesses that are coupled with diabetes which may make you eligible for disability benefits. Inability to control your blood sugar level throughout the day, or 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.
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, because by itself, it does not meet the minimum standards needed by the SSA. 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.
These illnesses are relevant if they prevent you from working and meeting the Substantial Gainful Activity (SGA) threshold. If you are unable to earn $1,170 or more per month to meet the substantial gainful activity (SGA) requirement of the SSA due to your illness, you may be able to qualify for disability benefits.
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:
When your kidneys and lungs allow your acid levels rise too high in your body’s 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, 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. Could cause unconsciousness, brain injury, headaches, 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.
Follow Your Doctor’s Orders
Left untreated, some of the ailments listed above can lead to death. You must follow your doctor’s treatment plan or 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
Because most applicants are not granted benefits because the requirements of the impairments are high, there is another test to see if you would qualify. If you do not meet the impairment listings in the Blue Book, it is common to determine if a medical vocational allowance can be granted.
A medical vocational allowance is used when your impairments do not match the exact description in the Blue Book. To be considered, a Residual Functional Capacity (RFC) assessment will be done. This rates your impairments and is completed by your doctor or an approved Social Security physician. It determines your ability to stand, walk, sit, bend, push, pull, lift, and carry objects.
Here are examples of how this disease 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, you have vision related problems, or you have difficulty in controlling your blood sugar level, this may be a reason to stop driving. Driving with such serious impairments could not only place your own life in danger but the lives of others.
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 will be assessed. In addition to those appraisals, your medical records will be reviewed, as well as statements taken from friends, relatives, and co-workers.
The RFC is considered along with your age, work history, schooling, skills, and job training. This information will give the examiner a basis to decide if you would be able to return to your previous job, even in a lesser capacity, or be retrained for another job.
After considering all of these along with your impairments, the result of the RFC will help the disability examiner to determine which category your limitations best fit in: medium work, light work, or sedentary work rating.
The disability examiner may find you are not capable of returning to your work or another type of job because of your impairments, even with retraining. If you are younger than 50 or 55 years of age, the examiner will likely determine there are a number of other jobs you could perform. If you are older than 55, the number of jobs may be limited because you are approaching retirement age and the time to be retrained and to gain experience in a new field may not be sufficient.
The requirements to obtain Social Security Disability for diabetes or related conditions are very high. This is why a majority of first-time claimants are often denied benefits. However, if you obtain the assistance of an attorney who specializes in Social Security Disability claims, it is possible to appeal the initial finding and 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.