Social Security and Diabetes

Social Security and Diabetes

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.]