DIABETES AND SOCIAL SECURITY DISABILITY BENEFITS
By: Pitt Dickey - Attorney
Preface: Since Social Security Disability is directed under Federal law, the information in this column will apply anywhere in the United States. However each Office of Hearings and Appeals and District Office have their own ways of doing things as does the various Federal District and Circuit Courts. I have kept this column primarily dealing the the mechanics of how the Social Security District Offices and Office of Hearings and Appeals evaluates disability claims.
- Pitt Dickey
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 benefits.
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 mellitus.
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 his urine.
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 following listings:
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
Discussion: Neuropathy 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 disease; or
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 disability benefits.
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 efficiency.
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 cabinet.
Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years. He practices with the firm of Smith, Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place and can be reached at 910-485-8020 or at . Or at the firm web site of www.smithdickey.com .
Copyright © 2002 Pitt Dickey - Used with permission
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