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Disability benefits for Diabetes Mellitus

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What is Diabetes?


Diabetes is caused by problems with insulin. In Type I diabetes (often called “childhood” diabetes), the pancreas makes too little or no insulin, and in Type II diabetes (“adult” diabetes), the problem is “insulin resistance, “often from obesity, where the insulin doesn't work well. 

The body needs insulin to transport glucose (sugar) into the cells of the body. When there is too little insulin or there's insulin resistance, glucose cannot get into the cells of the body, and the sugar in the bloodstream becomes elevated. When glucose can't get into the cells of the body, multiple metabolic problems occur, because cells (such as muscle cells or brain cells) need glucose to generate energy.

Genetic factors play a huge role in the development of Type I diabetes. They are also important in Type II diabetes, but life-style (weight gain, lack of exercise) is also very important. 

Diagnosis of Diabetes


Diabetes is diagnosed by doing lab work and finding high levels of glucose in the blood stream. There is another test, called the A1C, that measures and averages what the blood sugar has been running for the past 3 months or so. It's a “look back” test, and it is useful in diagnosing diabetes along with a fasting glucose. 

Complications of Diabetes


Diabetes may cause retinal problems in the eyes, including blindness, neuropathy in the feet, vascular problems in the lower extremities, coronary artery disease, heart attack and stroke, increased susceptibility to infections, and kidney disease (sometimes requiring dialysis).  If the glucose in the blood rises to very high levels, that can cause “diabetic acidosis” and result in coma and death.

How to Prove Disability from Diabetes - KEY CONCEPT

It's a matter of complications. Just having diabetes is generally not enough to make you eligible for Social Security Disability benefits. Social Security knows that there are many persons who have diabetes who can work. To get disability benefits, your medical records must show you have developed serious complications from your diabetes in the tissues and organs of your body, that impair your ability to do work.

Social Security “Listing” for Diabetes

You can get disability benefits if you meet one of Social Security's Disability Listings. A child less than 6 years old will qualify under a listing for Social Security disability if he/she requires daily insulin injections. 

However, it's much more complicated for other persons to qualify for disability benefits under a listing, again, the KEY CONCEPT HERE IS that the claimant can show severe complications from diabetessuch as serious diabetic kidney disease [Listing 6.06], amputation of an extremity from diabetic vascular complications [Listing 1.05], diabetic neuropathy causing impairment in walking, standing, or using your hands [Listing 11.14], heart complications, such as severe coronary artery disease, congestive heart failure, and rhythm disturbances [Listing 4.02, 4.04, 4.05], peripheral artery disease in the lower extremities [Listing 4.12], chronic skin ulcerations [Listing 8.04], and diabetic retinal disease [Listing 2.00].

Complications (less serious than "Listing" level criteria)


The complications that you have from your diabetes do not have to meet one of the listingsfor you to qualify for disability benefits. If your diabetic complications cause enough functional impairment to prevent you from doing your job or any job that you would be qualified to do, you may qualify for benefits.

For example, in an 8-hour workday, if you have heart disease from diabetes that doesn't allow you to lift or carry 10 pounds or more, or if you are unable to stand or walk for at least 2 hours because of vascular or nerve problems in your legs, or if you are unable to sit for at least 6 hours because of fatigue related to diabetic kidney disease, then in most cases, you are likely to qualify for disability benefits. 

Essential Medical Documentation of Diabetes Needed for Disability Benefits:

If you intend to apply for Social Security disability benefits, or for long-term disability benefits under a private plan, be sure to tell your doctor(s) that you want to do that and tell discuss with your doctor not only the symptoms you have from your diabetes, but also how those symptoms impair your functional ability - how long are you able to stand, how far are you able to walk, difficulties bending/squatting/stooping/crouching, sitting for extended periods of time, etc - these are all factors that relate to the claimant's RFC (residual functional capacity) which is always a critical factor in the analysis of whether a claimant is disabled under Social Security's rules.

SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).

SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work. 

SSA has its own forms that are used for Physical RFC here and for Mental RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.

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