This information may help claimants with representation, as well as claimants who are not represented by a social security lawyer. Understanding how the Social Security Disability system works can make the difference between winning the continuing disability benefits and backpay to which a person is entitled, or simply being denied. In all cases, of course, claimants should learn as much as possible about the disability process to improve their chances of winning ssi or ssd - ssdi benefits. |
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Fortunately for SSI and SSD applicants who suffer from the effects of type I diabetes or type II diabetes, diabetes is listed in the Social Security Administration's blue book (otherwise known as the medical impairment listing manual for disability claims--->note: not all conditions are specifically listed in this manual; in fact, most are not). What does the blue book have to say about diabetes? The diabetes listing is actually somewhat short. And it makes no distinction between, or reference to, type I diabetes or type II diabetes. It also makes no mention of the severe damage diabetes causes to the vascular system, the nervous system, and the renal system. Instead, the damage caused to these areas of the body is evaluated under the disability criteria set aside for these specific body systems. For example, kidney problems are evaluated under listing section 6.00, which is devoted to the genito-urinary system. As with all listings, the diabetes listing focuses on the medical aspects of diabetes which have a direct relationship to functional impairment and restriction. For the purposes of the disability program, these are neuropathy and retinopathy. And, logically, this makes sense since the actual focus of the social security disability and SSI disability program is on the "residual functional capacity" that a claimant may still possess despite the limitations that are imposed by a particular illness or disorder. 
The actual listing for diabetes indicates that a claimant must have (in order to be approved on the basis of the diabetes listing) the following: 1. A diagnosis of Diabetes Mellitus. AND 2. Evidence of Neuropathy that must be demonstrated by "significant and persistent disorganization of motor function in two extremities" (conceivably, two arms, two legs, or one arm and one leg). This neuropathy must also result in a "sustained disturbance of gross and dexterous movements, or gait and station". OR 3. Acidosis that happens, on average, no less than once every two months (this must be documented by the proper blood tests). OR 4. Diabetic retinopathy that results in a level of visual impairment equal to the criteria set aside in section 2.00 of the impairment listing manual. Essentially, this means a visual impairment that involves a significant loss of peripheral vision in the better of the two eyes, or a significant loss of visual acuity in the better of the two eyes. Note - The peripheral field loss requirements are a bit too complicated to explain (even experienced disability examiners have some trouble with this), but regarding visual acuity a claimant's vision would have to be this bad to qualify: the claimant's vision in their best eye, after best correction, would need to be 20/200 or worse. What does this really mean? Simply that most diabetes applicants will never be able to qualify for benefits based on the visual criteria alone. Because even if a claimant has 20/600 vision in one eye, but has 20/180 vision in the better eye, they will not satisfy the requirements of the listing...despite the fact that they are practically blind. Obviously, from a visual standpoint, it is very difficult for an individual with diabetes and diabetic retinopathy to qualify for social security disability or SSI benefits. But how difficult is it to be approved for either SSD or SSI benefits on the basis of diabetes in general?
Unfortunately, it is fairly difficult and relatively few claimants are approved for benefits on the basis of diabetes alone. In fact, in most cases, claimants with diabetes who are approved for disability will not be approved on the basis of meeting the diabetes listing but, instead, will be approved on the basis of a medical vocational allowance that will take into consideration a claimant's diabetes but also other conditions a claimant might have, such as hypertension, coronary artery disease, kidney dysfunction, arthritis, etc. Exactly how does a medical vocational allowance work? In this type of disability approval, a claimant's medical history (recent and past) and work history will have been reviewed and a determination will subsequently have been made that the claimant is unable to return to their past work, or perform any form of "other work". Are diabetes cases given proper consideration by the social security administration? This is certainly a loaded question; however, most disability examiners who have witnessed the denials of cases in which diabetic claimants possessed substantial neuropathies, significant visual impairment, and had sustained amputations in one or more extremities due to the progressive effects of diabetes would probably agree that the social security administration's approach to evaluating this disease is greatly lacking. As always, though, a disability claimant can maximize their chances of being approved for benefits by simply not giving up when they are denied (most claimants are initially denied for benefits), by following the appeals process, and by being fully prepared at the time of a disability hearing, if such a hearing becomes necessary. Hearing preparation, of course, will generally include having able representation and adequate medical record documentation. For more information on medical record documentation, refer to this page: Social security disability, functional limitations, and medical records For information on social security lawyers, disability hearings, and appealing denials on claims, you may wish to refer to these pages also: Questions and Answers about social security lawyers Questions and Answers about social security hearings The appeals process for disability claims Appealing disability claims Disability Advocates Help with Claims Free Case Evaluation |
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