Diabetes Mellitus is one of our most serious diseases, both in Texas and through out the world. People with diabetes, both type 1 and type 2, do not always qualify for Social Security disability benefits. There must be serious problems with diabetes in order to get Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Often times, however, despite good medical care and patient compliance with treatment, diabetes prevents hard working Texans from working.
Social security analyzes all disability claims – including those based upon diabetes- using the 5-step sequential evaluation process. In June of 2011 the “Listing” for Diabetes Mellitus for adults was eliminated. Listings are specific criteria for some illnesses that mean an automatic disability approval. This removed adult diabetes listing centered on “[N]europathy demonstrated by significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross and dexterous movements, or gait and station, “[A]cidosis occurring at least on the average of once every 2 months documented by appropriate blood chemical tests (pH or pC02 or bicarbonate levels)” and “[R]etinitis proliferans”.
The elimination of the Diabetes Mellitus listing was opposed by the National Organization of Social Security Claimant Representatives (NOSSCR) and the American Diabetes Association. So, does that mean that social security disability benefits are not available now for diabetes? Absolutely not. The Listing for Diabetes Mellitus formerly found in the regulations was often difficult to meet, and usually reflected a near life threatening case of Diabetes. Good medical care usually precludes a listing level diabetes case. We have won many diabetes-based disability claims in North Texas since the elimination of the diabetes listing.
Perhaps in response to critism over the elimination of the diabetes listing, social security promised that is “would continue to recognize diabetes as a potential cause of disability” and “provide more detailed information about the types of impairments and limitations that result from diabetes” in the future. Some three years later social security issued Social Security Ruling 14-2p: Titles II and XVI: Evaluating Diabetes Mellitus.
Does SSR 14-2p provide “more detailed information” for the evaluation of adult diabetes claims as promised? In a word, “no”. Roughly half of SSR-14-2p is devoted to child’s diabetes cases. In considering adult diabetes-based disability cases, SSR 14-2p adds little of substance and nothing new. Here are the main features:
The medical facts of diabetes, and symptoms.
SSR 14-2 p discusses the features of and differences between type 1 and type 2 diabetes. Symptoms of type 1 mentioned are:
- polydipsia (increased thirst)
- polyphagia (increased appetite)
- polyuria (increased urination)
- unexplained weight loss
- fatigue or drowsinessblurred vision.
Additional symptoms of tyoe 2 diabetes include:
- cuts or bruises that are slow to hea
- numbness in the hands and feet
- recurrent infections of the skin, gums, or bladder.
SSR 14-2p does mention that type 2 diabetes is often associated with obesity and that the “first line of treatment is management of DM through diet and exercise”. SSR-14-2p also discusses the following major complications of diabetes:
- Diabetic retinopathy
- Cardiovascular disease
- Diabetic nephropathy
- Peripheral neuropathy
- Autonomic neuropathy
SSR 14-2p notes that peripheral neuropathy can cause “nerve damage that affects the feet, legs, or hands, can cause pain, numbness, and tingling in toes, feet, legs, hands, and arms, which may subsequently cause difficulty walking and holding onto objects”, and that autonomic neuropathy can cause “dizziness, fainting, nausea, vomiting, and infrequent or frequent urination” as well as “hypoglycemia unawareness”.
Assessing Residual Functional Capacity
SSR-14 restates the 5-step sequential evaluation process as applied to diabetes. The limited instructive and helfpul language is as follows:
- ” [A]dults with periphera
- sensory neuropathy may have difficulty walking, operating foot controls, or manipulating objects because they have lost the ability to sense objects with their hands or feet. “
- “Adults with chronic hyperglycemia may experience fatigue or difficulty with concentration that interferes with their ability to perform work activity on a sustained basis.”
So what is the bottom line on the elimination of the diabetes listing and the relatively new social security ruling SSR 14-2p? Here’s my take:
- There is no evidence that diabetes-based disability claim approval rates have changed since the elimination of the diabetes listing
- SSR 14-3p may represent an emphasis on lifestyle choices and obesity in type 2 diabetes (“The first line of treatment is management of [diabetes] through diet and exercise. Oral medication or daily insulin is usually required when the weight loss and diet alone fail to manage blood glucose levels.”). This could support ALJ diabetes-based claim denials for the morbidly obese who are taking no steps to control or reduce their weight.