How To Get Social Security Disability & SSI Benefits: Diabetes

Winning Your Case

Video

Diabetes - What Does Social Security Look For?

There is probably no more common basis of a Social Security disability and SSI claim than diabetes. Diabetes is a disease that occurs when the body cannot make or use insulin properly. There are three types of diabetes: Type 1 (your body does not make insulin), Type 2 (your body does not make/use insulin properly), and gestational diabetes (occurs during pregnancy and usually resolves after delivery).

It is critical to Social Security that you have a diagnostic test for your diabetes - a blood test. Diabetes is measured by daily blood sugar levels and an A1C score which is an average blood sugar level over a three month period.

Adult - Blood Sugar Levels

Type

Fasting

Before Meal

2 Hrs After Meal

A1C

Normal

70 to 99

70 to 99

100 to 140

5.6 or less

At Risk

100 to 130

100 to 130

100 to 180

5.7 to 6.4

Type 1 or 2 Diabetic

130 or more

130 or more

180 or more

6.5 or more

Child - Blood Sugar Levels

Type

Fasting

Before Meal

2 Hrs After Meal

A1C

Normal

70 to 139

70 to 139

70 to 160

7.5 or less

At Risk

140 to 180

140 to 180

140 to 200

7.6 to 8.4

Type 1 or 2 Diabetic

180 or more

180 or more

200 or more

8.5 or more

Social Security will primarily determine the severity of your diabetic disability based on your reported symptoms which are generally as follows:

1. Fatigue,
2. Feeling ill,
3. Ketoacidosis,
4. Diabetic shock,
5. Blurred vision,
6. Diabetic retinopathy, and
7. Diabetic neuropathy (usually occurring in the hands and feet).

Social Security will secondarily determine the severity of your diabetic disability based on the type and frequency of your medical treatment which will include ongoing blood tests, medications, insulin, smoking cessation, weight loss, exercise, and dietary changes. Those suffering diabetes are often treated by an endocrinologist, a specialist, but this is not necessary to win your case.

Tip - Treatment Compliance. It is especially important to Social Security that you are compliant with your diabetes treatment which nearly always means you are eating correctly, regularly checking your blood sugar levels, and taking your medications or insulin as prescribed. This is for two reasons. First, diabetes can be controlled with treatment compliance. So, if you can minimize or avoid diabetes, diabetic symptoms, and a diabetic disability, Social Security expects you to do so. Second, treatment compliance is within your control, and Social Security wants to see that you are taking a personal stake in your own health. Even if you have severe diabetes and severe symptoms, Social Security can find you are not disabled if you are non-compliant with prescribed treatment. If you are non-compliant, you need to have a very good reason for doing so, and there are really only two - 1) you do not have the money to be compliant with treatment, or 2) you do not have the mental capacity to be compliant with treatment.

Tip - Other Impairments. Diabetes is a major cause of many other health conditions and diseases. If you develop another condition as a result of diabetes, you can claim disability due to diabetes, the combination of diabetes and the other condition, or just the other condition.

The Diabetes Social Security & SSI Listings

There is no listing for diabetes itself. However, diabetes can be a cause in many medical conditions including but not limited to the following common impairments each with its own listing:

1. Diabetic peripheral neuropathy - Adult Listing 11.14, and Child Listing 111.14;
2. Diabetic nephropathy - Adult Listing 6.06, and Child Listing 106.06;
3. Diabetic retinopathy - Adult Listing 2.02, 2.03, 2.04, and Child Listing 102.02, 102.03, 102.04;
4. Skin infections - Adult Listing 8.04, and Child Listing 108.04;
5. Peripheral artery disease - Adult Listing 4.12; and
6. Amputations - Adult Listing 1.05, and Child Listing 101.05.

A Diabetes Success Story - The Importance Of A RFC (Physical Capacity) Form

Ms. Hempler lived in Dallas, TX. She was 52 years old. She suffered diabetes, diabetic neuropathy which primarily affected her hands and feet, moderate obesity, and depression. Her blood sugar levels were about 200-300 in the mornings and about 350-450 at night. Her AIC ranged from about 10 to 13. She took insulin but was casual about following a proper diabetic diet. She had pain and numbness in her hands and feet. She could only use her hands for a couple of hours off and on throughout the day, and she required a cane for standing and walking. She needed to elevate her feet throughout the day to alleviate her feet symptoms. Social Security found her depression and obesity severe at Step 2 of the Disability Evaluation Process, but it was not her primary basis for disability. Her past relevant work was as a cashier and customer service representative. She hired counsel after her reconsideration denial.

We worked at preparing for her hearing. We ordered her medical records from her primary doctor and her endocrinologist. She had seven hospital visits, all because of her irregular blood sugar levels or ketoacidosis, and we ordered those records as well. Though she had stopped going to mental health treatment, she continued to take anti-depressants. We ordered her mental health records as well. She was able to locate medical records that pre-dated her alleged onset date of disability. Counsel submitted these records as well. They did not describe her medical condition while she was disabled, but they did demonstrate Ms. Hempler's difficulty controlling her diabetes historically. Her endocrinologist and primary doctor were unwilling to speak to counsel. However, Ms. Hempler was able to get her primary doctor to address a residual functional capacity (RFC) form - an assessment of physical functioning. The primary doctor found that Ms. Hempler could sit two hours a day, stand two hours a day, and walk two hours a day. Because her abilities to sit, stand, and walk added up to only six hours a day, and a workday is eight hours a day, the doctor found Ms. Hemlper unable to work - she was disabled. Unfortunately, Ms. Hempler was not able to have someone write a letter on her behalf or testify at her hearing.

At her hearing, Ms. Hempler did a good job explaining her limitations. One of the most significant issues in her case was whether she failed to follow her medical treatment or her doctor's orders in controlling her diabetes, specifically, the issue of her diet. She, in fact, had difficulty following a diabetic diet. One of the benefits of counsel talking to her doctors was to address this issue. Since counsel could not speak to the doctors, counsel's direct questioning of Ms. Hempler focused on this issue. Ms. Hempler discussed how she tried to follow the correct diabetic diet. For the most part, she did so, but she survived on a very limited income, and she could only afford certain foods not all of which were ideal for a proper diabetic diet. Because Ms. Hempler was over age 50 with past relevant unskilled work placing her always on her feet, she only had to show she was limited to sedentary work to win her case - Grid Rule 214.10. This was our argument. We received the decision about three months after the hearing, and the ALJ found Ms. Hempler disabled.