Over the past three months, I have represented three different clients with Type I diabetes, each of which resulted in a favorable decision. In working on these cases I note that the issues my clients face are much different than those faced by Type II diabetics and I have adjusted my approach accordingly.
As you probably know, there are fundamental differences between Type I and Type II diabetes. An article at the medicalnewstoday.com web site explains the differences in detail but to oversimplify, my clients with Type I have usually been diagnosed as diabetic during childhood or adolescence and they almost always need insulin therapy because their bodies do not produce insulin.
Type II diabetics are usually diagnosed later in life and their bodies usually do continue to produce insulin but not enough. Many Type II diabetics are prescribed pills, only ending up on insulin later in the process. Type II diabetes can be partially controlled by diet and weight loss.
Social Security judges frequently see Type II diabetes come before them, and they now tend to see this condition as a chronic, treatable condition. Judges recognize that Type I diabetes is usually a more serious condition and they recognize that even with strict compliance with diet, medicine and weight control, disabling symptoms can develop, although the presence of Type I diabetes does not guarantee and approval.
Both classes of diabetes give rise to complications that can support a finding of disabled, includingvision loss (retinopathy)
- foot problems, including numbness, tingling and nerve pain
- hand usage problems including numbness, lack of fine motor coordination and nerve pain
- excessive urination, and thus excessive unscheduled work breaks
Ideally your treating physician should identify both the symptoms and a high level of frequency for these symptoms in a checklist form and/or narrative report.
I can tell you, however, that Social Security judges no longer rubber stamp approvals in diabetic cases even in there is extensive evidence from treating doctors about symptoms and complications. Judges expect claimants to comply fully with treatment, including diet restriction, timely consumption of medicine and weight loss, and they want evidence that prescribed treatment is not working to control symptoms.
In my experience, judges rarely approve cases solely or primarily arising from diabetes if the claimant is not taking insulin. Judges will consider vision and nerve complications associated with non-insulin dependent diabetics but you will need something more – such as a disc problem or cardiac issue.
Even Type I diabetic claimants are getting grilled – even those using insulin pumps. Judges expect to see significant complications as well as on-going problems controlling blood sugar levels.
In my Type I diabetes cases, the factors that seem to be most convincing to judges include:
- evidence of frequent (daily to several times a week) of blood sugar spikes despite the proper use of insulin
- evidence of rapid drops in blood sugar (hypoglycemia) with reduced awareness of the low blood sugar by the claimant
- wide variations in blood sugar levels – rapid swings between highs and lows often result in low energy, nausea and fatigue
- inability of an insulin pump to keep blood sugar levels steady
Judges have been especially receptive to evidence of symptoms arising from low blood sugar. Often diabetics who experience hypoglycemia do not sense that an episode is coming on and they can pass out or lose bodily function before they can react quickly enough to ingest orange juice or other glucose.
Vocational experts will testify that employers will not expect or assume liability for co-workers or supervisors to serve as unpaid medics – assisting a diabetic recover from a low blood sugar episode.
Thus, not only must diabetics present evidence of symptoms that create interference with work, but it greatly helps to also present evidence of random swings in one’s blood sugar level without timely awareness by the claimant.