Disability Determination for Diabetes

It's difficult to qualify for Social Security disability benefits for diabetes unless you have other complications.

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Diabetes, or diabetes mellitus, is a disorder in which too little insulin is produced in the body. Insulin is necessary to help convert glucose (a form of sugar) into the body's cells for energy. When not enough insulin is produced, it causes a build up of glucose in the blood. Symptoms of diabetes include fatigue, frequent urination, abnormal thirst, unusual hunger, weight loss, repeated infections, cuts that are slow to heal, and tingling or numbness in the hands and feet.

Type 1 diabetes is ordinarily diagnosed in children and younger adults, and it is a type of diabetes in which the body produces no insulin. In type 2 diabetes, or adult onset diabetes, your body's cells ignore the effects of insulin. When diabetes goes untreated and too much glucose builds up in your body, long-term complications can result. These include neuropathy in your feet (nerve damage and a loss of feeling), kidney disease (nephropathy), high blood pressure (hypertension), heart disease, stroke, gastroparesis (a type of nerve damage in which food stays too long in the stomach), eye and vision problems, peripheral arterial disease (blood vessels in your legs become blocked and blood flow is decreased), and depression.

Treatment of severe diabetes involves the careful monitoring of blood glucose levels along with taking insulin and controlling your diet. Your doctor can test you for diabetes using a fasting blood glucose test.

Qualifying for Disability Benefits with Diabetes

If you have diabetes and you have been prevented from working for at least a year (or longer), then you may be eligible for Social Security disability (SSDI/SSD) benefits or Supplement Security Income (SSI) benefits. It is generally easier to obtain disability benefits if you have developed long-term complications from your diabetes.

Meeting a Disability Listing

The Social Security Administration (SSA) has created a Listing of Impairments (the "Blue Book") that tells you how you can obtain disability benefits for a variety of medical conditions. Diabetes, however, is not included as a separate disability listing, so you cannot be found disabled under the Listing of Impairments simply by showing you have been diagnosed with diabetes. Instead, the SSA will review your medical history to determine whether you meet the requirements of any disability listings that are closely related to complications arising out of diabetes.

Chronic Hyperglycemia and Hypoglycemia

Your diabetes might have caused hyperglycemia, which is an unusually high level of glucose in your blood, or hypoglycemia, which is an unusually low level of glucose in your blood. Hyperglycemia and hypoglycemia can lead to several other conditions, such as the following:

  • Cardiac arrhythmias (Listing 4.05). You would need to show cardiac arrhythmias (irregular heart beats) that are not controlled by medical treatment, that have occurred at least three times in a 12-month period, and that have resulted in episodes of cardiac syncope (loss of consciousness) or near syncope (having altered consciousness and not feeling merely lightheaded). There should be medical documentation of these arrhythmias by electrocardiography (an EKG or ECG).
  • Diabetic retinopathy (Listing 2.00). This listing describes the requirements for visual problems, including a loss of visual acuity (unable to perform fine work) or a loss of visual fields (unable to see in your peripheral field of vision). There should be eye examinations in your medical history that use the Early Treatment Diabetic Retinopathy Study (ETDRS) test chart.
  • Amputation of an extremity (Listing 1.05). People with severe diabetes sometimes need to have a foot amputated due to nerve damage and poor circulation.
  • Coronary artery disease and peripheral vascular disease (PVD). This can include chronic heart failure, under Listing 4.02, ischemic heart disease, under Listing 4.04, and PVD, under Listing 4.12. To show PVD, generally there must be an exercise Doppler testing showing intermittent claudication (pain in your calf that occurs after walking and which goes away with rest) and proof of a certain blood pressure level reading.
  • Diabetic nephropathy (Listing 6.06). You would need to show extreme edema (swelling) for at least three months despite therapy, and a certain level of serum albumin (a plasma protein) or proteinuria (too much protein in the urine).
  • Diabetic peripheral neuropathies (Listing 11.14). You would need to show significant problems of motor function in two extremities, even with prescribed treatment.
  • Poorly healing skin and bacterial infections (Listing 8.04). You would need to show widespread ulcerating skin lesions that last for three months despite treatment. These lesions would need to make it difficult for you to walk or use your hands.

Equaling a Listing

Uncontrolled diabetes can be disabling well before neuropathy or retinopathy are actually diagnosed -- or before extreme measures like amputation have to be taken. For instance, high blood glucose can result in fatigue and low blood glucose can cause impaired brain function, resulting in light-headedness, sleepiness, confusion, and difficulty speaking. Some individuals also experience nervousness and shakiness, excessive perspiration, anxiety, and weakness when their glucose level is low. These symptoms can be compared to the fatigue associated with sleep-related breathing disorders (listing 3.10), recurrent arrhythmias (listing 4.05), or multiple sclerosis (listing 11.09). Alternatively, diabetics often experience fluctuating symptoms in the same pattern or frequency as Meniere's disease (listing 2.07) or even bipolar disorder (listing 12.04A3). To get disability for diabetes that hasn't advanced to one of the complications above, you'll probably need to hire a disability lawyer, who can creatively argue you have a disability by equaling another listing.

Determining Your Residual Functional Capacity

If your diabetes is not severe enough or has not progressed long enough to meet one of the above disability listings then the SSA will assess your residual functional capacity (RFC). Your RFC is the most that you can do in a job; for instance, you will receive an RFC for sedentary, light, medium, or heavy work. The SSA will review RFC opinions from your doctor, statements from your friends and family, your own statements, and your medical history to determine the amount of work you can perform. The SSA will also assume that you are following your treatment as prescribed, unless you provide good reasons for why you are not doing so.

To assess your RFC, the SSA will consider how well you can sit, stand, walk, use your arms and hands, get along with coworkers and the public, and follow simple instructions in a work setting. If you have neuropathy in your legs from your diabetes, you might be unable to stand and walk for long periods of time. Therefore, your RFC would likely be limited to sedentary work. If you have poor control over your glucose levels during the day, your RFC might reflect that you are unable to concentrate for long periods of time. This could affect your ability to perform a large number of jobs. Similarly, if you suffer from severe fatigue or depression, your RFC might state that you are unable to perform work on a consistent and regular basis. This information would likely support a finding of disability. If you are over age 50, it is possible to be found disabled even if you are limited to sedentary or light work.

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