Lymphedema and Social Security Disability

Social Security Disability Benefits for Lymphedema

If you suffer from lymphedema and it is so severe that you are unable to work, you may be eligible to receive Social Security disability benefits. The Social Security Administration (SSA) oversees the Social Security Disability Insurance (SSDI) program, which pays monthly benefits to those who meet the criteria set forth to qualify as disabled.

In order to be eligible for the SSDI program, you have had to work enough to earn sufficient credits and to pay in adequate taxes to the SSA. In most cases, that means you have had to work full-time for at least five of the last 10 years. In order to receive benefits, you must be completely disabled with a condition that will last at least a year or result in your death.

Lymphedema is swelling that occurs in your arms, legs, or both. It is the result of vessels in your lymphatic system being blocked, preventing the proper drainage of lymph fluid.

There are several causes for lymphedema, but most often, it is the result of a condition or some kind of procedure that has damaged your lymphatic system. Your lymphatic system can be damaged by cancer, lymph node surgery, parasitic infections, repeated infections, and cancer treatments.

You can suffer from a mild case of lymphedema, which is barely noticed, or you can suffer from a debilitating case of it that causes severe pain and makes use of the swollen limb almost impossible. If you have a severe case of lymphedema, you may qualify for monthly benefits for your disability.

Further Reading: What Conditions Qualify For Disability?

Your lymphedema may qualify you for disability benefits

Is Lymphedema a Disability?

Yes, lymphedema is considered a disability by the SSA if you can meet its Blue Book listing. This includes medical evidence proving your diagnosis as well as the need to prove you are unable to work for at least 12 months and have enough work credits required for eligibility for disability benefits.

What Is Lymphedema?

Lymphedema is when tissue swells that is caused by a build-up of protein-rich fluid that normally drains through the body's lymphatic system. It most often affects the arms or legs, but it may also occur in the abdomen, chest wall neck and genitals. Sometimes lymphedema is caused by cancer treatments that have required the removal or have caused damage to the lymph nodes. Any problem that blocks the drainage of lymph fluid could cause lymphedema.

In the most severe cases of lymphedema there may be limited mobility in the affected limb and there could be an increase in the risks of skin infections and sepsis, and it could also lead to skin changes and skin breakdown. Treatment may include compression bandages, massage, the use of compression stockings, sequential pneumatic pumping, careful skin care and, in rare cases, surgery to remove swollen tissue or to create new routes to allow sufficient draining to take place.

The main symptoms of lymphedema are:

  • a noticeable swelling in the leg, arm or another part of the body, which may come and go;
  • the affected area may feel heavier and tighter than usual and generally feel uncomfortable;
  • the affected limb may be difficult to move;
  • the victim may experienced repeated skin infections which could involve the pitting of the skin.

The Financial Cost of Treating Lymphedema

According to Lymph Land, lymphedema can be expensive to treat. You will require ongoing care for the condition, which will include doctor’s visits, prescriptions, hospitalizations, and therapy. Physical therapy and rehab can cost from $3,000 to $5,000 for an intensive program.

For compression bandaging, the cost ranges from $75 to $175 for each bandage, which requires replacement every six months. Garments range from $550 to $2,500 and are replaced every two years.

Other costs include compression stockings, which cost from $80 to $300 per pair, and gradient compression pumps are $5,500 each. You may not need all of these items, but on average, you can expect to pay out at least $100,000 for treatment during your lifetime.

Even with insurance the costs can add up because copays and deductibles.

Lymphedema and the Blue Book

Lymphedema doesn’t have its own section in the Blue Book but you could still qualify for benefits. This can take place if the lymphedema has caused the veins to be blocked or damaged which makes if painful to walk. This is called venous insufficiency and to meet the medical requirements for SSDI you have to show that the lymphedema occurs in your leg and results in severe swelling, known as brawny edema, which is present throughout most of your leg.

A second way of qualifying for SSDI is by using the Blue Book listing for a major dysfunction of a joint as lymphedema can cause limited movement of the joints. If it is severe enough you may not be able to work for at least 12 months which means you may be eligible for disability benefits.

A third way of qualifying is if your lymphedema is due to cancer or cancer treatment. You can then look at the cancer listing in the Blue Book to see if your lymphedema matches any of the requirements set out in the Blue Book. If it does, then you are in a good position to apply for SSDI with lymphedema.
If you aren’t sure if you are eligible for disability benefits you should contact a lawyer who will assess your case and decide if you qualify.

Meeting the Medical Qualifications for Approval

Lymphedema can be a serious condition that impacts you throughout life. The SSA has a medical guide, which is known as the Blue Book, that lists impairments that qualify for disability benefits if the specific criteria set forth are met. The Blue Book is the list of conditions that qualify for disability.

Lymphedema is not a listed impairment, but you can still qualify for benefits. There are three ways that you can qualify for SSDI based on your lymphedema diagnosis.

Your lymphedema may cause symptoms that are the medical equivalent of the severity of chronic venous insufficiency. Venous insufficiency is the result of veins being blocked or damaged, causing blood to build up. When blood pools in the legs, your walking can become very painful and difficult, sometimes even impossible.

Lymphedema is very similar to chronic venous insufficiency because your lymphatic channels are blocked and your lymph fluid builds up. To meet the medical requirements of chronic venous insufficiency with your lymphedema, you have to show that the lymphedema occurs in your leg and results in severe swelling, known as brawny edema, that occurs across most of your leg.

Another way you may qualify is by using the listing for major dysfunction of a joint. While lymphedema does not occur in your joints, it can cause limited motion of your joints. If you have trouble moving your arms or legs because of lymphedema, your condition may meet the medical equivalency of the joint dysfunction listing.

The third way you may qualify is if your lymphedema is the result of cancer or cancer treatment. You may meet the guidelines set forth for qualifying for benefits based on your cancer.

The Blue Book has a cancer section that lists the specifics in regards to qualifying for benefits if you have a cancer diagnosis.

Meeting the Requirements of a Medical-Vocational Allowance

If you don’t meet the requirements of a medical listing to get disability approval, you may be able to qualify based on a medical-vocational allowance. This approach involves using a residual functioning capacity (RFC), which is designed to determine if you have the capacity to work.

The RFC will indicate the specific functional limitations caused by your lymphedema, and will show your inabilities and restrictions.

As an example, if you suffer from severe lymphedema in your legs and you cannot stand for more than an hour at a time that should be noted. If the swelling and pain in your legs make it impossible for you to walk more than a few feet without having to rest, that should also be indicated.

Problems bending, kneeling, or sitting for long periods of time should also be noted.

If the lymphedema is in your arms and you cannot lift, reach, or grasp, that should be indicated. You may not be able to write, type, grasp, push, pull, lift, or make any fine movements that involve your arms or hands.

Your age, work experience, transferrable skills, and educational level will also be given consideration to see if you can train for a different kind of job or perform sedentary work.

If it is determined that you are disabled per the medical-vocational allowance, you will be awarded SSDI benefits. Documentation is essential in proving your case. A disability claim can be complex and it requires a substantial amount of documentation to gain approval. Talking with your primary care provider is essential in helping to prove your case.

Applying Specific Medical Tests

As far as lymphedema goes, your medical records and physician notes are the keys to gaining approval. You have probably undergone blood tests, ultrasounds, scans, and more to determine the cause of swelling. If your lymphedema is secondary to cancer, you need to include the records regarding your cancer diagnosis and treatment records.

Providing a detailed medical history that shows all of your conditions and how they affect you is detrimental in proving your case. You can be denied benefits twice, but you can file appeals. The final step is to request a hearing before an administrative law judge for a ruling on your case. A disability lawyer can help you with your claim if it is denied.

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