Is Your Diabetic Patient Disabled?
Persons who have been diagnosed with diabetes mellitus are considered disabled and entitled to Social Security disability benefits if they meet or equal. certain criteria in the “Listings.”
A diabetic may be “disabled” as a matter of law, if he/she has any one of four conditions resulting from diabetes:
- Neuropathy which is demonstrated by significant and persistent disorganization of motor function in two extremities (mostly likely the feet) resulting in sustained disturbance of gross and dexterous movements, or gait and station. The disorganization of motor function (due to peripheral nerve dysfunction) may take the form of paresis or paralysis, tremor or other involuntary movements, ataxia and sensory disturbances occurring singly or in various combinations; or
- Acidosis which occurs at least on the average of once every two months, documented by appropriate blood chemical tests (pH or pCO2 or bicarbonate levels); or
- Amputation at or above the tarsal level due to diabetic necrosis or peripheral arterial disease; or
- Retinitis proliferans which must be evaluated as to degree of visual impairment under the Listings for visual acuity. These include: a) as to central visual acuity, remaining vision in the better eye after best correction at 20/200or less; or b) contraction of peripheral visual fields in the better eye to 10 degrees or less from the point of fixation, or so the widest diameter subtends an angle no greater than 20 degrees, or to 20 percent or less visual field efficiency; or c) visual efficiency of the better eye after best correction 20 percent or less, based on the product of percent of remaining central visual efficiency and percent of remaining visual field efficiency.
Please keep in mind that even if your patient’s diabetes has not reached the level of any of the above criteria, your patient may still be ruled disabled if the combined effect of his/her impairments are equivalent to the degree of impairment of any of the above criteria.
That is, for example, if your diabetic patient has neuropathy (but not yet with significant, persistent disorganization of motor function resulting in sustained disturbance of movements), and also regularly tests positive for acidosis (but not as frequently as every two months), and also has diabetic necrosis (or peripheral arterial disease) which has produced ulcerous lesions but not yet to the point of amputation, the combined effect of all these considered together may be regarded as legally disabling. The question is: does the combined effect of these diabetes-related conditions taken together impair your patient as much as any one of the four conditions described above?
Stating that your patient is “disabled due to diabetes” will not help secure a favorable response to his/her application for Social Security disability benefits. That determination must be made by the judge.
The best way for you to help your diabetic patient to receive a fair and just review of his/her application for Social Security disability is to examine/test for and describe in detail all the effects of his/her diabetes mellitus. Also, if you believe these effects produce an impairment equivalent to any of those listed above, say so.
This article was prepared by Arthur W. Stevens III