What are the secrets to winning your Social Security disability claim if you are alleging disability based on diabetes. Diabetes mellitus is an extremely common diagnosis, and administrative law judges see these cases weekly, if not daily. As such, you need more than just a diagnosis, a record of high blood sugar, and allegations of occasional blurred vision or burning in your feet.
Here are some common characteristics of winning diabetes disability claims:
Type I Diabetes
Type I (juvenile) Diabetes – these are generally stronger claims than Type II diabetes claims. If you have Type I diabetes that has been long standing and under suboptimal control, you have a strong case for Social Security disability. Most Type I claimants have been struggling with diabetic complications for years. Often Type I claimants are insulin dependent diabetics and many of these patients have been fitted with an insulin pump.
- sugar levels and A1C levels are often not under control, even with insulin injections or an insulin pump
- claimant occasionally to often experiences episodes of low blood sugar which can lead to loss of consciousness
- blood sugar levels fluctuate unpredictably throughout the day
- frequent episodes of blurred vision
- permanent damage to blood vessels in eyes
- history of surgery to address damage to eyes
- constant or near constant burning in feet constant or near constant burning in hand
- need to urinate frequently – once an hour or more
- diagnosis of Type I diabetes more than 10 years ago
- evidence that claimant was undiagnosed diabetic for 2 or more years
Type II Diabetes
Type II Diabetes – judges see Type II diabetes cases much more frequently than Type I cases; therefore you need to document a severe level of impairment, or you need additional medical issues so that you can argue that your capacity for work has been so reduced by your diabetic complications and other medical issues that you would not be a reliable employee.
I look for the following:
- are you taking insulin shots – if your doctor is prescribing pills like metformin, Victoza or glimepiride, most judges will conclude that your diabetes is more or less under control
- do you have difficulty keeping your blood sugar under 250 even with insulin – this suggests that your diabetes is advanced and difficult to control
- do you experience large fluctuations in your blood sugar numbers? This suggests that your diabetes is not properly controlled, even with insulin
- do you need to urinate frequently – once an hour or more, and do you have urgency such that you need access to a restroom immediately
- have you been diagnosed with high blood pressure that is also not under good control
- have you been diagnosed with significant heart disease like congestive heart failure
- have you been diagnosed with vascular problems like DVT?
- If you are overweight, are you compliant with a weight loss diet?
- If you are a smoker, have you participated in a stop smoking program?
NON-MEDICAL FACTORS
In addition to the need for compelling medical and counseling evidence, disability judges consider a variety of non-medical factors:
- Age – your chances greatly improve if you are age 50 or older. Because there is no cure for diabetes (at least not yet) and complications and organ damage increase over time, claimants over age 50 have an advantage and judges often give more weight to the testimony of claimants over age 50, and even more so to those over age 55.
- Work History – your chances greatly improve if you have a long work history. This demonstrates that you have tried to work through your diabetic complications. We can also make the argument that, for example, a 58 year old with seniority at work would not leave a career close to retirement and wait at home 2+ years hoping to win disability benefits.
- Work Attempts – if you lost one or more jobs because of reliability issues arising from your diabetic complications, these employment problems are relevant evidence. Often swings in blood sugar levels from very high to very low will result in excessive unscheduled breaks. Vocational witnesses will almost always testify at hearing that even three or four unscheduled breaks per week would not be consistent with competitive work. Statements from former co-workers or supervisors about these unscheduled breaks can be very helpful.
Remember the Big Picture: What Matters to Social Security
You will win Social Security disability benefits if we can prove that complications from your diabetes make you unreliable in a work setting, 8 hours a day, 5 days a week. You would not be considered reliable if you need to take excessive unscheduled breaks because of blood sugar fluctuations, bathroom breaks or vision issues. Reliability would also be impaired if you cannot focus because of discomfort from painful burning and numbness in your hands and feet.
The best evidence we can present to win your case includes:
- a medical record that documents consistent visits with your endocrinologist, or internist with special training in diabetes
- evidence from the medical record that despite your consistent use of insulin and other medications your blood sugar cannot be controlled
- evidence from your medical record that you have suffered permanent damage to your eyes, peripheral nerves, heart or other organs, and that the functioning of these other body systems has been markedly compromised
- a statement from your internist and/or endocrinologist that you would likely experience difficulties with work activities and work reliability. This can be in the form of a narrative report or it can be in the form of a functional capacity evaluation.
What Does Not Matter to Social Security
- it does not matter that you have no transportation to a job
- it does not matter that you could not survive financially with an entry level job
- it does not matter that you believe no one would hire you
