The Social Security
Administration has developed a very elaborate set of guidelines to
use to determine who meets their disability guidelines and is
therefore eligible for the payment of disability insurance
These guidelines are called
"Listings". These Listings do not cover every type of
disease or injury but do cover most of the more frequently
occurring health problems that workers encounter.
The theory is to provide an
objective criteria for the SSA to use to judge whether the
claimant should receive disability payments. This column will take
a look at the Listing covering diabetes.
In my practice I have found that
one of the most common health problems faced by people in this
area seems to be diabetes. The medical name for this condition is diabetes
Normally sugar does not appear in
urine. When sugar is found in a personís urine this is a
condition called glycosuria and can indicate that the
person has diabetes mellitus. When a person has diabetes there is
excessive sugar in his bloodstream.
This condition of excessive sugar
in the blood is called hyperglycemia. A physician can
diagnose diabetes from the hyperglycemia as this condition
indicates that the sugar from the personís blood is spilling
over into his urine because the patientís kidneys are not able
to filter out all of the sugar from his blood and it passes into
The term diabetes comes from the
Greek word that means "siphon". Diabetes refers to an
inability of the kidneys to hold water in the body which causes
the water to run through the body as a through a siphon.
There are two forms of diabetes;
diabetes insipidus and diabetes mellitus. Diabetes insipidus
is a condition in which there is inadequate secretion or
resistance of the kidneys to an antidiuretic hormone (ADH).
The two major symptoms of
diabetes insipidus are excessive thirst and excessive urination.
The bodyís lack of ADH prevents water from being reabsorbed into
the body in the kidneys.
Diabetes mellitus results
from inadequate secretion or improper utilization of insulin.
Insulin is made by the pancreas. When the body does not produce
adequate insulin this condition prevents sugar from being removed
from the blood which results in hyperglycemia which is a $5 word
for too much sugar in the blood.
There are two main types of
diabetes mellitus. Type 1 diabetes is also called
insulin-dependent diabetes mellitus (IDDM). This condition
requires regular injections of insulin and is potentially much
more damaging than Type 2 diabetes.
The insulin injections are
required to maintain a normal level of glucose (sugar) in the
patientís blood. Without insulin, the sugar in the personís
blood cannot enter the bodyís cells to provide energy.
Type 2 diabetes is also
called non-insulin dependent diabetes mellitus (NIDDM). Patients
who have type 2 tend to be adults and overweight. There is not a
lack of insulin but rather less insulin than normal or some
resistance by the body to the effects of the insulin.
Treatment for type 2 is through
diet, weight reduction, exercise and if these are not successful
through the use of oral medications or ultimately insulin
injections. The oral medications tend to cause the body to produce
more insulin by the pancreas and to increase the personís
sensitivity to the effects of insulin.
COMPLICATIONS FROM DIABETES
There are a number of serious
complications that can develop from diabetes. Primary
complications can include a condition in which the body cannot
properly burn fats and ketones build up in the body. The build up
of these ketones can lead to coma when the patientís blood sugar
level gets too high or if the patient does not receive an adequate
level of insulin injection.
There are a number of long term
complications associated with diabetes which occur
through the passage of years
after a patient has developed diabetes. These include the
destruction of blood vessels in the retina of the eye. This is
called diabetic retinopathy. This can lead to loss of
visual abilities or even blindness. Diabetes can impair the
ability of the patientís kidneys to function.
This condition is called diabetic
nephropathy which can lead to the need of the patient for
dialysis or a kidney transplant. Diabetes can cause the
destruction of blood vessels in the body with a build up of plaque
blocking the blood vessels called atherosclerosis.
This condition of poor
circulation can lead to the death of parts of the extremities
called diabetic necrosis. This condition can lead to the
amputation of body parts due to lack of blood circulating through
that part of the body. People with diabetes can have very long
healing times from cuts or wounds that would not bother people who
did not have diabetes.
Diabetes can lead to the
destruction of nerves which is called diabetic neuropathy.
This nerve damage can cause chronic pain and numbness in the
personís legs, feet and hands.
SSA Listing Requirements for
Disability based on Diabetes
The SSA Listing for diabetes is
number 9.08. A person is entitled to Disability Insurance Benefits
if the SSA finds that the claimant has met at least one of the
A. neuropathy demonstrated by
significant and persistent disorganization of motor function in
two extremities resulting in sustained disturbance of gross and
dexterous movements, or gait or station.; or
means nerve damage. To meet this listing the claimant must show
that at least two of his extremities (arms or legs) have such
nerve damage that he has serious problems in using them as a
result of pain or numbness. His ability to walk or stand is also
significant in this evaluation.
B. Acidosis occurring on at least
the average of once every 2 months documented by appropriate blood
chemical tests: or
Acidosis is a condition in which
the ketones in the blood build up to a level that passes a certain
laboratory criteria. The build up of ketones causes the acid level
of the blood to increase which can lead to coma or death.
C. Amputation at, or above the
tarsal region due to diabetic necrosis or peripheral arterial
As a result of poor circulation
secondary to diabetes it can become necessary to amputate parts of
a personís body. The tarsal region refers to the ankle bones. If
a person has his foot amputated above the ankle region as a result
of complications from diabetes he will be deemed to be entitled to
D. Retinitis proliferans;
evaluate the visual impairment under the criteria which govern
blindness qualification for disability
This section refers to diabetic
retinopathy symptoms. The SSA will evaluate the personís vision
problems under the Listing for blindness. A person meets this
listing if his vision after correction in his best eye is 20/200
or less, or if his peripheral vision is 10 degrees or less from a
point of fixation in his best eye; or other technical requirements
involving his field of peripheral vision and loss of visual
LISTEN TO YOUR DOCTOR
Diabetes is a very serious
disease with multiple complications. It can usually be managed if
the person follows his doctorís advice. I have had clients who
stopped taking their insulin because they felt better. This was a
terrible mistake for them and has led to multiple serious health
problems for them. If you are on insulin take it as your doctor
recommends. It cannot help you if it is sitting in a medicine