How does the SSA evaluate diabetes?

Less than two years ago the SSA eliminated its Blue Book listings involving endocrine disorders. The Blue Book is what adjudicators refer to when processing a claim for Social Security Disability benefits. When an applicant has a condition that is listed in the Blue Book, it is much easier to qualify for benefits than if their disability is not included in the publication. Unfortunately, as of June 7, 2011, the SSA no longer provides qualifying criteria for endocrine disorders. Instead, applicants who suffer from diabetes must apply for benefits based on a secondary condition that is caused by the diabetes. This goal is that this secondary condition be listed in the Blue Book, making it easier to qualify for benefits. If you do not suffer from a secondary condition that is included in the Blue Book, you will need to apply for benefits based on a vocation allowance. Applying for disability benefits based on a vocational allowance means that you must prove to the SSA that you are unable to perform any type of work activity whatsoever due to your condition – a task that isn’t necessarily easy to accomplish.

How to Qualify for Social Security Disability with Diabetes

Even though diabetes itself was removed from the SSA’s Blue Book, there are still diabetes-related conditions that can qualify an individual for benefits from the SSA. If you suffer from one of the listings in the Blue Book as a result of your diabetes (for example, diabetic nephropathy), then you may still be able to qualify for disability benefits under the Blue Book guidelines. The key is to understand which Blue Book listing you should include in your application for disability benefits and what medical evidence you will need to furnish to prove that you meet the criteria of that specific listing.

What Conditions Qualify a Diabetic Applicant for SSDI or SSI Benefits?

There are a number of secondary conditions that are listed in the SSA’s Blue Book that may qualify an applicant for Social Security Disability benefits. Some of these conditions include:

  • Blue Book Listing 1.04: Amputation of an Extremity
  • Blue Book Listing 2.00: Diabetic Retinopathy
  • Blue Book Listing 4.02: Chronic Heart Failure
  • Blue Book Listing 4.04: Coronary Artery Disease
  • Blue Book Listing 4.05: Irregular Heartbeat
  • Blue Book Listing 4.12: Peripheral Vascular Disease
  • Blue Book Listing 6.06: Diabetic Nephropathy
  • Blue Book Listing 8.04: Ulcerating Skin Lesions
  • Blue Book Listing 11.14: Diabetic Peripheral Neuropathies
  • Blue Book Section 12.0: Mood or Eating Disorders

The above list includes some of the complications that may be caused by diabetes. Instead of applying for SSDI or SSI based on your diabetic condition, you would apply for benefits based on one or more of the listings above (or another Blue Book condition that was caused by your disability).

Applying for Disability Benefits

When you suffer from diabetes, the key is to determine what complications your disability has resulted in and then apply for benefits based on that Blue Book listing. For example, if your diabetes has resulted in the amputation of your foot due to nerve damage and/or poor circulation, then you would apply for benefits under Section 1.04 of the Blue Book. If your diabetes has resulted in chronic heart failure, then you would apply for benefits based on Section 4.02 of the Blue Book. Knowing what listing of the Blue Book to apply under will help you understand what evidence you need to furnish to the SSA to support your claim for disability benefits.

If a Secondary Condition is Not Present

If you cannot prove through medical documentation that you meet the qualifying criteria of a condition that has been included in the SSA’s Blue Book, the SSA will determine whether or not you are disabled by proceeding to the fourth and fifth steps in the sequential evaluation process.

Under the fourth step of the sequential evaluation process, the SSA will determine whether or not you can return to past relevant work. This is work that you have performed for three months or more in the past fifteen years and in which can result in substantial gainful activity. If it is determined that you cannot return to even the lightest of these jobs, then the process moves on to step five.

Under step five of the sequential evaluation process, the SSA will determine if you are able to perform any other type of work. This means the SSA will look at whether or not your disability will prevent you from performing any type of work in the national economy. Your age, education, residual functional capacity and transferability of job skills are taken into consideration during this step. As a general rule, if you are over the age of 55, the SSA will determine that you are not re-trainable for other types of work. In order to be approved for benefits, the SSA must find that you are unable to perform any type of work in the national economy based on the limitations of your disability.

Working with a Disability Attorney

If you are applying for Social Security Disability benefits due to diabetes, you may want to consider retaining the services of a Social Security Disability attorney. These professionals will understand which listing, if any, you may qualify under. If you do not suffer from a condition that is included in the Blue Book, a disability attorney can help you prove that you should be approved for disability benefits based on a vocational allowance.