Understanding the SSA’s Criteria for Diabetes

The SSA evaluates disability claims based on whether your medical condition prevents you from engaging in substantial gainful activity (SGA). This means that your diabetes must significantly limit your ability to work.

The SSA lists diabetes mellitus in its Listing of Impairments under Endocrine Disorders (Listing 9.00). However, to qualify for benefits under this listing, your diabetes must be severe and cause serious complications.

Meeting the SSA’s Criteria for Diabetes Disability

To qualify for SSDI or SSI with diabetes, you will need to meet one of the following conditions:

• Persistent high blood sugar levels (hyperglycemia) despite medication and treatment, causing severe complications such as:
• Diabetic retinopathy (vision problems or blindness)
• Diabetic neuropathy (nerve damage, particularly in the hands or feet)
• Diabetic nephropathy (kidney damage, which may lead to kidney failure)
• Frequent hospitalizations or emergency care due to uncontrolled diabetes
• Diabetic amputations (e.g., loss of a limb or toe due to infection)
• Uncontrolled diabetes that severely limits your ability to perform basic work-related activities, such as standing, walking, or lifting.

The SSA will require medical evidence to show that your diabetes is uncontrolled or has resulted in complications severe enough to prevent you from working full-time.

Demonstrating the Impact of Diabetes on Your Ability to Work

If your diabetes doesn’t meet the SSA’s listing requirements, you may still qualify for benefits if your condition prevents you from doing your previous job or any other type of work. The SSA evaluates your ability to work using a five-step process:

• Step 1: Substantial Gainful Activity (SGA) – If you are earning above a certain amount, you may not be eligible for SSDI. In 2023, the SGA limit is $1,470 per month for non-blind individuals.
• Step 2: Severe Condition – Your diabetes must be severe enough to limit your ability to perform basic work activities. If your condition causes complications that make it hard to perform physical tasks (e.g., standing or walking) or mental tasks (e.g., concentrating), you may meet this step.
• Step 3: Listed Impairment – If your diabetes has caused complications that match the SSA’s listing for diabetes mellitus, you may automatically qualify for benefits.
• Step 4: Past Work – The SSA will assess whether you can still do your past work. If you can’t perform your previous job due to diabetes-related complications, the SSA will proceed to the next step.
• Step 5: Other Work – If you can’t perform your past job, the SSA will consider whether you can do any other type of work based on your age, education, work experience, and residual functional capacity (the ability to perform work-related activities despite your disability). If the SSA finds that you cannot do any other work, you will qualify for benefits.

Medical Documentation Required for Diabetes Disability Claims

The most important part of your diabetes disability claim is providing strong medical evidence. The SSA requires detailed documentation of your diabetes and how it affects your ability to work. Key documents include:

• Medical records: Records from your primary care physician and any specialists you’ve seen, such as an endocrinologist or neurologist.
• Treatment history: Documentation of the treatment you’ve received, including medication, insulin therapy, and any lifestyle changes recommended by your doctor.
• Test results: Blood glucose levels, A1C levels, and any other tests that show the severity and control of your diabetes.
• Complications: Evidence of complications from diabetes such as nerve damage, vision problems, kidney issues, or amputations. This is critical for showing how your diabetes impacts your ability to work.

If your diabetes has caused severe complications, the more detailed and up-to-date your medical records are, the stronger your claim will be.

What Happens if Your Diabetes Claim is Denied?

It’s common for disability claims to be denied, especially for conditions like diabetes that can be difficult to prove. If your claim is denied, you can appeal the decision. The appeals process includes:

• Request for Reconsideration: This is a review of your case by a different SSA team. You can submit additional evidence or clarify any issues that may have led to the denial.
• Hearing Before an Administrative Law Judge (ALJ): If reconsideration is denied, you can request a hearing before an ALJ, where you can present your case in person. It’s highly recommended to have legal representation at this stage.
• Appeals Council: If the ALJ denies your case, you can request the Appeals Council to review the decision.
• Federal Court: If your case is denied at all prior levels, you can file a lawsuit in federal court.