Social Security Disability for Chronic Venous Insufficiency

If you suffer from chronic venous insufficiency and it has made you unable to work, you may qualify for Social Security Disability benefits. The Social Security Administration (SSA) offers a program called Social Security Disability Insurance (SSDI), which pays monthly benefits to those who are unable to work as long as they have worked to earn enough credits and to pay in enough taxes to the SSA. If you are eligible for benefits, you may have certain dependents who are also eligible to receive benefits as well.

Chronic venous insufficiency occurs when a deep vein thrombosis (DVT) or varicose veins cause damage to the veins within your legs. The end result is that blood is not allowed to flow back to the heart, so your blood pools in your veins causing numerous problems. The damaged veins will let the blood leak backward, causing restrictions of blood flow to certain areas and resulting in painful swelling and redness. Because of the condition makeup, those who have chronic venous insufficiency usually suffer from periodic DVTs.

If you suffer from DVTs, you are at a higher risk for pulmonary embolism or stroke. Because these are indeed life-threatening medical problems, your physician may advise you to no work because of the risks involved. DVTs can be very dangerous as the blood clot can break loose from its original location and move to other parts of the body, including the heart, lungs, or brain, causing an embolism. If the clot breaks loose and blocks the blood flow to your lungs, you are experiencing a pulmonary embolism.

Social Security Benefits for Chronic Venous Insufficiency

When a DVT forms in your thigh rather than your lower leg, it is much more likely to break off. Clots that are formed in veins near the surface aren’t considered a DVT and have minimal risk at breaking loose and going elsewhere. Those who smoke, are obese, are on bed rest, have recently given birth, or who are on birth control pills are at a higher risk of experiencing a DVT.

The Cost of Treating Chronic Venous Insufficiency

Treating chronic venous insufficiency is not inexpensive. Because it is a chronic disorder, you can expect to have regular doctor visits and treatment plans. According to American Health and Drug Benefits, a new chemical ablation agent known as Polidocanol foam costs $2,165 for an 8-week treatment. Radiofrequency ablation is $2,106 and endovenous laser ablation is $1,827. Multimodality treatment costs $2,844. For those who underwent surgical procedures, the initial costs were higher.

There are several treatment options for the disorder, and sometimes you may have to undergone more than one procedure during your lifetime. Therefore, the treatment costs can vary greatly, but the average patient can expect to spend about $2,000 per year on treating the painful condition with some years costing considerably more.

The SSA Evaluation and Medical Qualifications

The SSA has a medical guide, which is called the Blue Book, that has specific medical conditions listed that qualify for SSDI benefits. These conditions have stringent and detailed criteria that must be met in order to qualify for approval. Chronic venous insufficiency is listed in the Blue Book.

To prove your disability from chronic venous insufficiency, you have to be able to provide extensive, accurate documentation of your condition and how it affects you. You need to get the proper care from a medical provider so you will have evidence of the diagnosis and the severity of the condition. This condition is diagnosed by a physician reviewing the symptoms and by an ultrasound that reads the blood flow through the legs.

In order to meet the criteria specified in the Blue Book, you must experience at least one of these complications:

  • Experience severe leg swelling, involving at least two-thirds of the leg between the knee and the ankle or the distal one-third of the extremity between the hip and ankle.
  • OR

  • Experience burning, cramping, or itching of the legs, wounds that don’t heal during at least three months of prescribed treatment, or scaling of the legs.

If you have medical evidence that your condition meets one of those criteria, you can be approved for SSDI benefits much more quickly. However, if you don’t meet the criteria set forth in the Blue Book you can still qualify for SSDI benefits using the medical-vocational allowance.

Getting SSDI Benefits Using the Residual Functioning Capacity and Medical-Vocational Allowance

If you do not meet the Blue Book criteria, the SSA will look at the evidence you provide to determine if your impairment and all of your medically related symptoms are severe enough to impact your daily life and keep you from working. To determine this, they will use a residual functional capacity (RFC), which will clearly show the most that you can do in spite of all your functional limitations.

The RFC will show how much you can do and how often, such as how your leg pain and swelling may require you to readjust positions every hour-and-a-half or how you cannot walk farther than 300 or 400 feet without having to sit and rest. Perhaps you need a cane so you can stand, and that should also be noted. If your RFC is detailed and shows you are clearly limited enough, you may be declared eligible for benefits using a medical-vocational allowance.

Applying Specific Medical Tests to Your Disability Case

Chronic venous insufficiency is diagnosed by physical examinations and ultrasounds that check the blood flow of the legs. Those notes and tests should be included in your documentation provided for your SSDI claim. The more documentation that you provide, the stronger your claim. You need to provide detailed physician notes, what kind of treatment you were prescribed and how your condition responded, and any restrictions or limitations that the doctor has ordered.

The SSA may order, at their expense, a medical evaluation with the doctor they choose. This is for informational purposes only and will be used to determine the severity of your claim. Because your mental conditions must also be considered, a mental evaluation may also be ordered. It is not uncommon for those with chronic conditions to suffer from anxiety or depression.

Your SSDI claim can be a lengthy process. You may be denied benefits twice, and you can appeal both those denials. The final step is to request a hearing before an administrative law judge where evidence is presented in regards to your condition and he will rule on your case.

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