Disability Benefits for Deep Vein Thrombosis (DVT) or Chronic Venous Insufficiency (CVI)?

People who have deep vein thrombosis are at risk for pulmonary embolism or stroke, both life-threatening conditions, and are sometimes advised not to work. Depending on their particular condition, they may qualify for disability benefits from Social Security. A related condition is chronic venous insufficiency, which is recognized by Social Security as a condition that can be disabling.

What Is Deep Vein Thrombosis (DVT?)

Deep vein thrombosis is a blood clot that occurs deep in the veins, often in the thighs or lower legs. When a blood clot develops, it restricts the flow of blood to the area and causes painful redness and swelling. DVTs are especially dangerous because the blood clot can break loose and become stuck in various parts of the body, including the brain, lungs, and heart, causing an embolism. If a blood clot breaks loose and block blood flow in the lungs, it's called a pulmonary embolism. Blood clots are more likely to break off when they form in the thighs rather than the lower legs. Blood clots that form in veins closer to the surface are not considered DVT and aren't usually at risk of breaking loose.

People at an increased risk for DVTs are those who smoke, are on bed rest, have undergone recent surgery, are obese, are on birth control pills, have recently given birth, or who have had catheters placed through their groin.

DVTs cause redness, swelling, heat, and pain in the area where they develop. DVTs are diagnosed by x-ray, blood tests, ultra-sound, and by measuring the blood flow through the legs. DVTs are treated with blood thinners but occasionally require surgery.

Can I Get Disability for My DVT?

To be eligible for disability, you must first show that you aren't working or you're not doing "substantial gainful activity (SGA)." level. You must also show that your DVT is expected to last at least 12 months or result in your death; if you cannot prove this your claim will be denied. It may be difficult based on your DVT alone to meet this standard, because an uncomplicated DVT can be resolved effectively with treatment.

If you are able to prove that your DVT is expected to last longer than a year, the SSA will look at how your condition is affecting your life and what your functional limitations are. First, the SSA will look to your medical record to see what restrictions your doctor has placed on you, to develop an RFC (residual functional capacity) for you.

Your RFC

Your doctor's records should state how your DVT affects your ability to walk, sit, stand, push, pull, lift, and carry. For example, a DVT can cause significant pain and swelling in the affected leg. If pain and swelling make it difficult for you to walk, climb, crawl or stoop, you would be unable to fully perform many jobs. Also, because sitting for a long time can increase your risk of a stroke if you have a DVT, your doctor should report how many hours you can sit out of an eight-hour workday. If you can prove you are unable to sit for more than four hours in a day, the SSA would likely approve your claim. Also, if your DVT requires you to change positions throughout the day or take unscheduled breaks, your treating physician should report this in your RFC.

Medical Evidence to Support Your RFC

It is important to provide the SSA with objective medical evidence that supports your RFC. Some examples of the evidence you will need are lab reports, x-rays, CT scans, Doppler tests, ultrasound reports, and notes made by your doctor during your appointments. The SSA gives the most weight to evidence provided by a specialist, such as a cardiologist, who is directly responsible for your care.

Your RFC, along with your age, education level, and job skills, will be taken into account to determine if there is any work you can do. Learn how RFCs are used to determine whether you should be able to do your prior job or other work.

What if I Develop Venous Insufficiency From My DVT?

Although it's hard to win a claim for disability because of your DVT alone, it is possible to win due to complications from your DVT. One such complication is chronic venous insufficiency (CVI). CVI occurs when the DVT or varicose veins damage the veins in your legs. The damaged veins allow blood to leak backward; this prevents the proper flow of blood to the lower extremities. CVI can cause long-term pain, swelling, and cellulitis or ulcers in your legs. It can also create pain with prolonged sitting or standing and make walking difficult.

CVI is one of the qualifying conditions established in the SSA's impairment listings. If your CVI meets the criteria of the listing, you will be automatically approved for disability. To satisfy Listing 4.11, Chronic venous insufficiency, you must have been diagnosed with CVI and experience one of the following complications:

• Severe swelling of the leg caused by fluid retention that causes thickening and discoloration of the tissue (known as brawny edema), or
• Cramping, burning, or itching of the legs, scaling of the skin on the lower legs, or wounds that are recurring or non-healing, despite being treated for at least three months.

If you are unsure whether you have developed one of these complications from your DVT, you should speak to your doctor. If you have developed CVI, you must provide the SSA with your complete medical history, such as vascular ultrasounds of the lower legs, blood tests, and reports from your treating physician.

Learn more about medical eligibility for Social Security and SSI disability benefits.