Diabetes is a chronic condition that can cause a wide range of complications, impacting your ability to work and perform daily activities. For some people, diabetes can become severe enough to qualify for Social Security Disability Insurance (SSDI). However, simply having diabetes is not enough to qualify for SSDI—you must meet specific criteria set by the Social Security Administration (SSA).
In this blog, we will explore how diabetes can qualify you for SSDI, what medical evidence you need to submit, and what to expect from the SSA’s evaluation process, including the Blue Book Listing for diabetes-related conditions.
How Diabetes Can Qualify for SSDI
Diabetes by itself does not automatically qualify someone for SSDI. The SSA evaluates diabetes based on how the condition affects your ability to function and whether you experience specific complications. For many, the symptoms of diabetes—such as fatigue or high blood sugar levels—can be managed with medication and lifestyle changes. However, when diabetes leads to severe complications or is not well-controlled, it may prevent you from working full-time.
Key Factors the SSA Considers:
- Severity of the Condition: The SSA evaluates the impact of your diabetes, particularly if it results in frequent hospitalizations, chronic fatigue, or other disabling symptoms.
- Complications from Diabetes: Severe complications like neuropathy, kidney disease, vision problems (diabetic retinopathy), or cardiovascular issues can play a crucial role in qualifying for SSDI.
- Inability to Work: You must demonstrate that your diabetes prevents you from performing Substantial Gainful Activity (SGA), which means earning more than $1,470 per month in 2024.
Example:
A person with poorly controlled Type 1 diabetes who experiences frequent blood sugar fluctuations and recurrent hospitalizations for ketoacidosis may be eligible for SSDI if these episodes prevent them from maintaining consistent employment.
The SSA Blue Book Listing for Diabetes
The SSA uses its Blue Book to outline specific medical conditions that automatically qualify for SSDI if certain criteria are met. While diabetes itself is not listed as a stand-alone condition, there are several diabetes-related complications that are covered under other sections of the Blue Book. Applicants must meet the criteria for one of these conditions to qualify for benefits.
1. Diabetic Neuropathy (Blue Book Section 11.14 – Peripheral Neuropathy)
One of the most common complications of diabetes is diabetic neuropathy, which affects the nerves in the extremities, causing numbness, tingling, pain, and muscle weakness. If neuropathy is severe enough to prevent you from walking, using your hands effectively, or performing manual tasks, it may qualify under the SSA’s listing for peripheral neuropathy.
- Listing Requirements: To meet the criteria for peripheral neuropathy, you must show that you have significant and persistent disorganization of motor function in two extremities, resulting in an inability to perform movements like walking or standing without assistance.
Example:
A person with diabetic neuropathy in both legs who can no longer walk without a cane or walker may qualify for SSDI under this listing, especially if their condition severely limits their mobility.
2. Diabetic Retinopathy (Blue Book Section 2.00 – Vision Impairments)
Diabetic retinopathy is a serious eye condition that can develop due to diabetes, potentially leading to significant vision loss or blindness. If your vision impairment meets the SSA’s definition of legal blindness, you may qualify for SSDI under the vision impairment listing.
- Listing Requirements: To qualify, your corrected vision in your better eye must be 20/200 or worse, or your visual field must be severely restricted.
Example:
A person with diabetic retinopathy whose vision has deteriorated to 20/200 in their best eye may meet the criteria for SSDI under this listing, especially if their vision loss prevents them from performing job tasks that require visual acuity.
3. Diabetic Nephropathy (Blue Book Section 6.00 – Kidney Disease)
Diabetes can cause damage to the kidneys, leading to diabetic nephropathy or chronic kidney disease (CKD). If you have reached advanced stages of kidney disease or require dialysis, you may qualify for SSDI under the kidney disease listing.
- Listing Requirements: To meet this listing, you must have chronic kidney disease that results in regular dialysis, a kidney transplant, or severely reduced kidney function.
Example:
A person with Type 2 diabetes who has progressed to end-stage renal disease and requires dialysis three times a week may qualify for SSDI under this listing, as their condition severely limits their ability to work.
4. Cardiovascular Complications (Blue Book Section 4.00 – Cardiovascular System)
Diabetes can increase the risk of developing cardiovascular diseases, such as coronary artery disease or heart failure. If you have significant heart problems related to your diabetes, you may qualify under the cardiovascular system listings.
- Listing Requirements: The SSA has multiple listings for cardiovascular impairments, such as ischemic heart disease, chronic heart failure, or arrhythmias. You must show that your condition results in ongoing symptoms, hospitalizations, or limitations that prevent you from performing physical activities.
Example:
A person with diabetes who has developed coronary artery disease and experiences chest pain and shortness of breath when walking short distances may qualify for SSDI if their condition significantly limits their ability to work.
Medical Evidence You Need for a Successful SSDI Claim with Diabetes
To qualify for SSDI, it’s essential to provide comprehensive and detailed medical documentation that demonstrates the severity of your diabetes and any complications you’ve experienced. This evidence should clearly show how your condition affects your ability to work and perform daily tasks.
Key Medical Evidence for Diabetes-Related SSDI Claims:
- Doctor’s Reports: Detailed reports from your endocrinologist or primary care physician outlining your diabetes diagnosis, treatment history, and complications. This should include information about blood sugar control, medications, and any hospitalizations.
- Test Results: Lab results showing A1C levels, blood glucose measurements, kidney function tests, or imaging studies that document the impact of diabetes on your body.
- Functional Capacity Evaluations (FCEs): Reports from your doctors or specialists that describe how your diabetes limits your physical or cognitive abilities, such as walking, standing, or concentrating.
Example:
A person with diabetic neuropathy may submit reports from their neurologist documenting the nerve damage in their legs, along with a functional capacity evaluation showing that they can no longer walk or stand for long periods due to pain and weakness.
What to Expect from the SSDI Application Process
Applying for SSDI due to diabetes-related complications can be a lengthy process, but understanding what to expect can help you prepare. The SSA will review your medical records, work history, and functional limitations to determine whether your condition qualifies for disability benefits.
- Initial Application: Submit your application with comprehensive medical documentation. It’s common for the SSA to request additional records or schedule a consultative examination (CE) if more information is needed.
- Reconsideration or Appeals: If your initial application is denied, don’t be discouraged. Many diabetes-related claims are initially denied but can be approved upon reconsideration or appeal, especially if you submit additional medical evidence or a more detailed explanation of your limitations.
Example:
A person whose initial SSDI claim for diabetic nephropathy was denied due to incomplete medical records may appeal the decision by submitting more detailed reports from their nephrologist and records of their dialysis treatments.
Let Disability Law Group Help You with Your Diabetes-Related SSDI Claim
Applying for SSDI with diabetes can be challenging, especially if your condition has led to complications that affect your ability to work. At Disability Law Group, we specialize in helping individuals with diabetes and other chronic conditions navigate the SSDI process and secure the benefits they need.
If you’re struggling to work due to diabetes, contact us today for a free consultation. Our experienced attorneys can guide you through the application or appeals process and help you build a strong case for SSDI benefits.
