Getting Social Security Disability Benefits for Lymphedema

Lymphedema (lim-fuh-DEE-mah) is the medical term for swelling that occurs when a key component in your immune system called lymph fluid isn’t draining properly. Lymphedema most frequently occurs in the arms or legs, but can also affect the chest, abdomen, neck, and genitals. Symptoms can range from barely noticeable to severe enough to make walking or using your hands difficult.

While lymphedema doesn’t have its own entry in Social Security's Blue Book of listed impairments, there are several related conditions that many people with lymphedema also have that can qualify for automatic benefits. And even if you don’t have evidence of a listed impairment, you can still qualify for disability if your symptoms keep you from working full-time for a year or longer. Before you apply for benefits, it’s a good idea to become familiar with some of the basics on when you can be considered disabled.

If I Have Lymphedema, Can I Qualify for Disability Benefits?

Anybody can qualify for disability benefits if they have a medically determinable impairment that prevents them from engaging in substantial gainful activity for at least 12 months and they meet the non-medical requirements to receive SSDI or SSI. For people with lymphedema, that means needing to show that your symptoms meet or equal a disability listing or that limitations from your symptoms rule out all full-time jobs.

No matter what, you’ll need to have documentation showing a diagnosis of, and treatment for, lymphedema and any related conditions. Damage to the lymph nodes from surgery, cancer, radiation treatment, or repeated infections can result in lymphedema. Other causes range from common (like removal of lymph nodes following breast cancer) to quite rare (such as primary lymphedema, a hereditary condition where the vessels that carry lymph fluid develop abnormally).

Social Security claims examiners will be looking for evidence of these etiologies (medical causes) when reviewing your application for benefits. The agency will also be looking for any functional limitations you have as a result of lymphedema or related disorders. Mild symptoms like minor swelling probably won’t be considered limiting enough to be disabling, but very painful swelling can make the affected limb difficult or even impossible to use, greatly restricting the types of jobs you can perform.

Meeting or Equaling a Disability Listing With Lymphedema

Lymphedema isn’t a listed impairment, meaning it won’t be considered automatically disabling, but some related conditions that are often comorbid (occurring at the same time) with lymphedema are listed in the Blue Book. If your medical records contain evidence of these related conditions, you may be able to meet or equal one of the following disability listings. (Equaling a listing means you don’t meet the listing requirements exactly, but a doctor determines that your symptoms are severe enough to be medically equivalent.)

Listing 4.11, Chronic Venous Insufficiency

Chronic venous insufficiency occurs when veins are blocked or damaged and blood builds up in the veins. When blood pools in the legs, they can swell up (similar to lymphedema), making walking painful and difficult. In order for your symptoms to meet listing 4.11, you’ll need to show that:

• your lymphedema occurs in your leg and results in brawny edema (a particular type of swelling) over the majority of your leg, or
• you have recurring vein and skin problems (dermatitis, varicosities, or ulcerations) that haven’t healed despite at least three months of treatment.

You can learn more in our article on getting disability benefits for chronic venous insufficiency.

Listing 1.18, Abnormality of a Major Joint

Although lymphedema doesn’t occur in your joints, the swelling of your arms or legs can cause limited motion in your knees or elbows. Breast cancer patients in particular can find it difficult to move their arms after lymph node removal.

While you’re unlikely to meet the requirements of listing 1.18 exactly (you’d need to show damage to the bone or cartilage of the joint), If your lymphedema is severe enough that you’re finding it hard to walk without assistance or use your hands and arms independently, you might be able to equal the listing.

Your lymphedema might meet or equal other listings as well, depending on what part of your body is affected. If you think your symptoms are severe enough to qualify for disability based on a listing, you should ask your regular doctor to submit a medical source statement explaining why you satisfy the criteria of a listed impairment.

Qualifying for Disability for Lymphedema Based on a Medical-Vocational Allowance

You can still qualify for disability benefits for lymphedema without meeting or equaling a listing if you’re unable to perform any type of work in the national economy. Getting disability benefits this way is called getting a “medical-vocational allowance” because it’s based on a combination of limitations from your medical symptoms and vocational factors like your age, education, and past job skills.

To determine whether you qualify for a medical-vocational allowance, Social Security will review your medical record for any physical and mental limitations that affect your ability to work, a process known as assessing your residual functional capacity (RFC).

What Limitations Are in Your RFC?

Your RFC assessment will contain any restrictions caused by your lymphedema and any other medical conditions. For example, if you have lymphedema in your legs, your RFC may limit you from being on your feet for longer than two hours in a workday or state that you could only do a job where you’re allowed to elevate your legs (in order to relieve swelling). Or, if you have lymphedema in your arms, your RFC may limit the types of job tasks you can do that involve writing or typing, pushing, grasping, or reaching.

How Does Social Security Use Your RFC to Decide If You’re Disabled?

Social Security compares your current RFC with the duties of your past jobs to see if someone with your RFC could do that work. If not, the agency will see if other jobs exist within the limitations of your RFC that you either already know how to do or could learn to do.

For applicants younger than 50, this generally means needing to show that your lymphedema keeps you from performing even the simplest sedentary (sit-down) jobs. Applicants who are 50 years of age and older may have an easier time qualifying for benefits using a special set of rules called “the grid.” If Social Security finds that no jobs exist for somebody with your RFC, the agency will find that you’re disabled and send you a notice of award.

How Much Can I Get in Disability Benefits?

Social Security doesn’t pay benefits based on the type of disability you have, so there’s no difference in award amount for lymphedema compared with any other medical condition. Rather, the amount of money you’ll receive depends on whether you’re eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

SSDI eligibility is based on your earnings history and how many work credits you’ve acquired before you became disabled. Employment doesn’t matter for SSI eligibility, but it is a needs-based benefit subject to low income and asset limits. You can learn more (and calculate your estimated benefit amount) in our article on SSDI and SSI monthly check amounts.

Filing for Disability Benefits

Applying for SSDI or SSI is a fairly straightforward process. You can choose from one of the methods below to begin your claim.

• One easy way is to file online. You don’t have to complete the application in one sitting, and you’ll get a tracking number so you can check the status of your claim.
• You can also apply over the phone by calling Social Security at 800-772-1213 (TTY 800-325-0778) 8 a.m. to 7 p.m., Monday through Friday.
• If you prefer to file in person, you can schedule an appointment with a representative at your local Social Security field office.

Keep in mind that while few disability applicants are awarded benefits on their first try, you have the right to appeal a denial. Most people who are awarded disability don’t get approved until after a hearing with an administrative law judge, a process that can take about a year (or more, in some cases.)

Should I Get a Lawyer?

There’s no requirement that you must have an attorney in order to qualify for disability benefits, but it’s often a smart move that can increase your chances of winning. An experienced lawyer can help you gather the medical evidence you need to show that you’re disabled and can handle communications with Social Security so that you don’t miss any important appeal deadlines. Furthermore, disability attorneys work on contingency—meaning they get paid only if you win—and many offer free consultations, so it doesn’t hurt to ask around to find a lawyer you like.