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Diabetes: How to win a social security disability case before an Adjudicator or ALJ

The Social Security Administration (SSA) eliminated Medical Listing 9.08. For complications from diabetes, this listing previously resulted in a finding of disability at step three of the sequential evaluation process for social security disability claims. https://www.ssa.gov/disability/professionals/bluebook/9.00-Endocrine-Adult.htm In fact, effective June 7, 2015, there are no specific endocrine disorder listings anymore for adults. One exception is Medical Listing 109.08 for children under 6 years old, who require daily insulin. https://www.ssa.gov/disability/professionals/bluebook/109.00-Endocrine-Childhood.htm

Diabetes is a complex set of disorders characterized by abnormalities, which result in insulin deficiency. There are 29 million people total being affected by diabetes in the United States, approximately eight percent of the population. Diabetes is the most common endocrine-metabolic disorder and the seventh leading cause of death in the US. As the number of diabetes diagnoses rise, certain ethnic groups are more likely to be diagnosed with diabetes such as Native Americans 15.9 percent; African Americans 13.2 percent; and Hispanics 12.8 percent. http://www.diabetes.org/diabetes-basics/statistics/

The estimated annual medical cost of treating people with diagnosed diabetes is $116 billion. People who have diabetes incur medical expenses that are about 2.4 times higher than those who do not. http://www.ncsl.org /research/health/diabetes-prevalence-county-level.aspx

With SSA making it more difficult to be found disabled with diabetes, Dr. Jane Reusch, Director of the Diabetes Care Team at the Denver VA Medical Center, recently addressed social security disability attorneys and respresentatives at a NOSSCR convention in Denver, Colorodo. http://www.diabetes.org/about-us/who-we-are/board-of-directors/jane-eb-reusch-md.html

Dr. Reusch provided the facts and statistics for the three subdivisons of diabetes listed below:

I. Type 1 Diabetes Mellitus

• Usually younger at onset date
• Usually normal weight or thin at diagnosis
• Usually no family history
• Insulin sensitive
• Requires insulin for treatment

II. Type 2 Diabetes Mellitus

• Usually over 40 years old
• 90% of people diagnosed are obese http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity
• Positive family history
• Insulin resistant
• Usually eventually requires insulin for treatment (may not be necessary at time of onset)

III. Gestational Diabetes Mellitus

• Develops in 4% of women during the 2nd or 3rd trimester of pregnancy
• Increases fetal morbidity and mortality
• Increases chances of caesarian section
• 30- 40% of women with GDM develop diabetes within 10 years http://journal.diabetes.org/clinicaldiabetes/v16n1J-F98/pg4.htm

Social security disability lawyers seek approaches to convince Adjudicators at the Georgia Vocational Rehabilitation Services, Disability Adjudication Services (DAS), and Administrative Law Judges (ALJs) at the Office of Disability Adjudication and Review (ODAR) to award disability benefits to claimants with diabetes. One way is to prove that your diabetes meets
or medically equals a Medical Listing of another body system. https://www.kathleenflynnlaw.com/1586109502014/medical-listings-of-impairments-for-adults-and-children. A medical expert must testify at the hearing to determine if your diabetes in combination with another medical impairment(s) equals a listing. https://ssa.gov/OP_Home/hallex/I-02/I-2-5-39.html

There are some common chronic complications with diabetes mellitus addressed below, which are found in other Medical listings as follows:

1. Retinopathy- Diabetes is the leading cause of blindness in the U.S. Usually by 10 years duration of diabetes 90% of individuals will have some degree of retinopathy. Medical Listings 2.01, 2.02, and 2.03 address the effects of retinopathy. https://www.ssa.gov/disability/professionals/bluebook/2.00-SpecialSensesandSpeech-Adult.htm

2. Nephropathy- Diabetes is the leading cause of renal failure/dialysis and transplant nationwide. Even when controlled, diabetes is the most common cause of kidney failure accounting for 44% of new cases nationwide. Medical Listing 6.02, 6.03, 6.06, and 6.09 are relevant. https://www.ssa.gov/disability/professionals/bluebook/6.00-Genitourinary-Adult.htm

3. Neuropathy – Most common complication stemming from diabetes affecting over 50% of those with this medical condition. Medical Listing 11.14 addresses neuropathy. https://www.ssa.gov/disability/ professionals/bluebook/ 11.00-Neurological-Adult.htm

4. Amputation- Diabetes is the most frequent cause of non-traumatic lower limb amputation. This is a result of diabetic foot disease which impairs blood flow to the lower extremities. Amputation is found in Medical Listing 1.05. https://www.ssa.gov/disability/professionals/bluebook/1.00-Musculoskeletal-Adult.htm

5. Due to the link between diabetes and cardiovascular disease, a cardiovascular disease risk profile is also recommended for those with prediabetes. Medical Listings 4.02, 4.04, 4.05, 4.06, and 4.09 could be considered for heart complications from diabetes mellitus. https://www.socialsecurity.gov/disability/professionals/bluebook/4.00-Cardiovascular-Adult.htm It is important to note that 77 % of all hospitalizations and 80% of all mortality in diabetes is secondary to cardiovascular disease. http://www.niddk.nih.gov/about-niddk/strategic-plans-reports/Documents/Diabetes%20in%20America%202nd%20Edition/chapter19.pdf

Another way to prove that you are disabled from diabetes is at step five of the sequential evaluation process based upon the Medical-Vocational Rules https://www.ssa.gov/OP_Home/cfr20/404/404-app-p02.htm or vocational expert testimony. A treating source statement addressing exertional limitations such as how long you can sit, stand, walk, push/pull, and lift/carry, along with non-exertional limitations including but not limited to pain, difficulty stooping/bending, inability to grasp or engage in fine manipulation, is very important.

Although some people do not meet the criteria for diabetes, the American Diabetes Association Expert Committee recognizes an intermediate group whose glucose levels are too high to be considered normal.
http://www.diabetes.org/diabetes-basics/diagnosis/ The current recommendation for those with prediabetes is yearly screenings, diet and exercise changes, and, in some cases, metformin. You should take the proper steps to manage your diabetes. http://www.diabetes.org/

Call the Law office of Kathleen M Flynn, LLC at 404-479-4431 if you would like assistance with filing a claim for social security disability. We assist claimants with filing a DIB or SSI application, Request for Reconsideration, Request for Hearing, Request for Review of Hearing Decision or help in expediting your case for social security disability benefits. Also, please visit our website at www.kathleenflynnlaw.com to learn more about us.

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