SOCIAL SECURITY DISABILITY AND
DIABETES IN ADULTS AND CHILDREN

by Stan Rosenberg (copyright 1996)

 

For the diabetic in middle to later stages, the question of ability to work becomes a primary query. It is the purpose herein to review the Federal Entitlement to assist those who may be eligible for benefits and are not aware. The keystone phrase for entitlement to Social Security Disability (SSD) or the companion Supplemental Security Income program for adults or children (SSI) is the existence of a "severe disability" which must be severe enough to keep a child or adult from being able to perform any type of substantial gainful employment. In simple terms, the disability must be one that does not allow you to do any type of work that you have the education or ability to perform. From birth to age 65 there may be substantial benefits for those whose diabetic condition has progressed to the point of disability.

A starting point to obtain these benefits is found in the "Appendices of the United States Code, 20 CFR 9.08 Diabetes Mellitus" with:

(A) Neuropathy demonstrated by significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross and dexterous movements or gait and station; or

(B) Acidosis occurring at least an average of once every two months documented by appropriate blood chemical tests; or Amputation at or above the tarsal region due to diabetic necrosis or peripheral arterial disease; or

(D) Retinitis Proliferans (evaluate the visual impairment under the criteria in 2.02, 2.04). The foregoing means that if you meet any of the listings you are entitled immediately to an award of benefits, or the Social Security Administration must prove that you can work despite the impairment depending on your age.

If you have worked for at least ten of the last 40 quarters and paid into Social Security during that period during the last five years, you can get from $240 to $1,500 per month and receive a check for benefits back to the date that you can prove you became disabled. If you do not meet the listings you can still prove that you are disabled through testimony by report from a qualified treating endocrinologist or other physician who states you are totally disabled as a result of any combinations from diabetes and other conditions that combine to equal or exceed a listing. In other words, if you think you cannot work and your doctor agrees, you can win benefits. You can also win a Medicare card that will pay for all of your medical expenses covered under Medicare entitlement. If you are in a strong HMO state, you can use the Medicare card to obtain HMO membership and possibly have the HMO pay for everything including insulin, needles and meters, alcohol swabs, prescriptions and the trip to the doctor along with any hospital expenses.

For a close look, consider the actual case of Arthur A., who was 29 years old on August 23, 1991, when he filed for Social Security Disability (SSD). He had a 12th grade equivalent education as an auto mechanic. In the decision of the Federal Administrative Law Judge, the language states, "Claimant has the following impairment which is considered to be 'severe' under the Social Security Act: Insulin dependent diabetes mellitus with neuropathy, impaired sensation with several resultant burns that healed poorly requiring surgical intervention and grafts." Claimant was able to take care of his personal needs and it was the conclusion of the vocational expert at the hearing that Arthur could only do sedentary work, and with his neuropathy was limited so severely that there were no jobs present in the national economy that he could perform. Interestingly enough, the vision problem was not present, and benefits were still granted.

What about diabetic children or adults who do not qualify for regular Social Security? For the years from birth to age 18, the SSI program covers disabled children who cannot work, and who suffer from a condition that would disable an adult. The standards are substantially the same, but there are no requirements that the claimant has worked at any time before filing. The benefits available under SSI are around $500 per month maximum and the adult claimant cannot have significant assets over $2,500. If the disability is severe enough under diabetes or any of the juvenile onset complications, parents my apply at any age. Benefits can continue for life if the disability is severe.

Diabetic children under 18, or any adult who cannot meet the requirements for regular disability my still qualify under SSI Title 16 benefits. People over 18 are adults for Social Security purposes. The child must go through the requirements of 20 CPR 416.923:

"Sequential Evaluation for Disabled Children—The sequential evaluation for children is a four-step process:

STEP 1. Is the child engaged in substantial gainful employment? If so, claim is denied; if not, go on to Step 2.

STEP 2. Is the child suffering from a severe condition? If so, go on to Step 3; if not, claim denied.

STEP 3. Does the child's impairment or combination of impairments medically meet or equal a listing, or functionally equal a listing? If yes, claim is approved. If no, go on to Step 4.

STEP 4. Does the child have an impairment of comparable severity to that which would disable an adult? If yes, claim approved; if not, claim denied."

The amount of benefits for a child who has never worked is determined by the parents' benefit account, and it varies. Diabetic children who are awarded SSI also receive a Medicaid card. In Florida, and other states, many HMOs are required to furnish all diabetic supplies to members. This varies greatly from state to state.

Finally, diabetes is a complicated disease with many symptoms. The evaluation of ability to perform substantial gainful employment is equally complex. Such things as using the fingers and fingertips to work with small objects or to see them can compromise the ability to work and the interaction of all complications such as mental, cardiovascular, weight, optical orthopedic vision problems and other disease must be considered. A qualified endocrinologist or other physician can guide you past the pitfalls and assist you to minimize the severe damage caused from high blood glucose levels. Careful management can cut symptoms by 60% or more. Since half of all diabetics are undiagnosed, blood sugar testing is critical. Diabetic education is readily available in most areas. You can reach the American Diabetes Association for more Information at 1-800-342-2383.

For more information, call the Social Security Administration at 1-800-772-1213 or visit your local office. There are no costs to apply and let the government decide if you are entitled. I would recommend that you use the services of an experienced Social Security attorney to prove the medical aspect of your case. [The author is a Social Security Disability attorney in North Miami Beach, Florida, and can be reached at (305) 932-0550.]