Diabetic Neuropathy

Diabetes and How it Affects Social Security 

Diabetes is a horrible disease. If you have it, our Indiana Social Security Disability attorney cannot stress enough how important it is to manage it as well as you can by seeing doctors and complying with the medication regimen and other management activities they recommend. Diabetes can cause numerous progressive complications, including what will be the focus of this article, diabetic neuropathy. 

“Neuropathy” is a broad term but here we will be focusing on the “peripheral” neuropathy which so often results from diabetes. It causes pain, numbness, and tingling in the extremities – arms, hands, legs, and feet. It’s bad news, and the worst news is that it’s mostly irreversible. While medications like Gabapentin/Neurontin and Pregabalin/Lyrica can help reduce neuropathic pain, doctors are generally unoptimistic about reversing the damage done by diabetic neuropathy, and these medications don’t necessarily reduce the loss of function accompanying it.

Neuropathy can seriously complicate someone’s ability to work. There’s a reason that when we ask someone for help, we say, “lend me a hand.” The reason is that when we are working, we are almost always using our hands. Diabetic neuropathy in the hands can compromise or even prevent the performance of many jobs. Cashiers may notice more problems gripping coins to make change. Hand problems could make someone trying to do a picker/packer job simply unable to keep up with the required pace. At home, you may notice the symptoms of neuropathy if you are dropping dishes when washing them. You may also have trouble pouring a cup of coffee or lifting a gallon of milk. Buttons and zippers can become difficult. 

Sharp, shooting pain in the feet is also a common neuropathy symptom. Loss of sensation in the feet may be the first thing someone notices upon the development of diabetic neuropathy. This can be dangerous because it can increase the likelihood of an injury to the foot, and then diabetes can also significantly slow the wound healing process. Neuropathy in the feet can create real safety concerns in the workplace. It affects balance, creating the possibility of a dangerous fall. Many jobs involve driving or other activities requiring the use of foot controls, and loss of sensation in the feet can make these duties dangerous, as well.

Applying For Disability With Diabetic Neuropathy 

If neuropathy has advanced to the point that it leaves someone unable to work, this person should apply for disability. When evaluating peripheral neuropathy, Social Security will ask the following questions:

• Does the neuropathy result in an extreme limitation in the ability to stand up from a seated position?
• Does the neuropathy extremely limit someone’s ability to balance while standing and walking?
• Does the neuropathy create an extreme limitation in the use of the upper extremities?
• Does the neuropathy create a marked limitation in the person’s physical functioning and ability to manage activities of daily living?

If any of these are true, the person should medically qualify for Social Security Disability benefits. Depending on someone’s age and work experience, even lesser limitations could make some medically eligible for disability. As someone progresses through their fifties, the disability evaluation becomes more and more of a question of whether that person can do their past work. Usually, when we have a client who is 55 or older, the most important question in the case is can this person perform the work that they did in the past?

Someone with a heavy work history (for example, construction or heavy industrial work) may develop neuropathy which limits their ability to stand, walk, and lift. In a case like this, we should have very strong arguments as to why this person can’t do their past work, and Social Security should readily accept these arguments when medical documentation supports these limitations. In other instances, Social Security may be more reluctant to accept even well-supported rationales as to why someone can’t do their past work. An example of this would be someone with a history of office work. Neuropathy can create many problems in performing this kind of work on a full-time basis. Neuropathic pain may prevent someone from doing the extended sitting required of work like this. The side effects of the neuropathy medication can create problems with the focus and concentration required of skilled office positions. After all, these medications are designed to affect the nervous system, which includes the brain. Feeling sleepy, tired, or dizzy are noted side effects. Neuropathy in the hands could also make someone unable to keep with the required pace of office activities like typing or handling mail.

As stated at the outset of this article, it is extremely important to see doctors for diabetes and neuropathy. While this is critical for your health, it is also important if you are considering disability. Before approving someone for neuropathy, Social Security will need to see medical documentation demonstrating the severity of the impairment. A doctor will perform a clinical examination, then document the results of it. In the office, the doctor will test sensation by using a pin-prick, monofilament, and/or vibration. This is subjective, with the doctor asking the patient if they can feel the sensation. Because of the subjective nature of this testing, the skeptics at Social Security will also want to see something more objective before feeling comfortable approving a case based on neuropathy. We advise all of our clients with neuropathy to obtain an electromyogram (EMG) and/or nerve conduction velocity (NCV) test. These tests enable doctors to objectively evaluate the transmission of electrical activity in someone’s nervous system and assess the extent of the neuropathy. Social Security has trained their judges to look for these reports, so it is very important to get this kind of test.

Social Security rules are complicated. Depending on various factors (age, education, work experience), someone with a moderate case of neuropathy may actually have a greater chance of being approved for disability than someone with a more severe case. Because of this complexity, it is important to consult with a skilled Social Security attorney if you are considering applying for disability based on neuropathy. You are welcome to contact Keller & Keller for a free consultation.

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