Lymphedema and Filing for Disability
Lymphedema should be listed on an application for SSD or SSI disability. Unfortunately, while this is a common condition, it does not fall under any specific impairment listing in the SSA Blue Book.
Since there is no impairment listing for lymphatic system impairments, a person filing for disability on the basis of lymphedema may have to rely on their symptoms being medically equivalent to other impairment listings. This simply means the symptoms and limitations of a person's lymphedema are similar to the standards of another impairment listing. Some individuals have been able to equal impairment listings such as Chronic Venous Insufficiency or perhaps the criteria of Major Dysfunction of a Joint, or even a cancer impairment listing.
For example, if a person has lymphedema in their legs, their symptoms may be similar to those who suffer from chronic venous insufficiency. Impaired blood vessels cause severe leg pain. This pain makes walking and standing difficult. Similarly, individuals with lymphedema have blocked lymphatic channels that cause lymphatic fluid to build up in the legs. This buildup of fluid causes swelling and pain that may make walking and standing difficult. Sometimes the build up of fluid causes brawny edema (a type of swelling) over the most of the leg; if so, they may be able to equal the listing for chronic venous insufficiency.
If their condition affects either upper or lower extremities, they may be able to equal musculoskeletal system impairment listing, 1.02, Major Dysfunction of Joint. This can be done if lymphatic fluid build up causes significant mobility impairment of the hands or legs. Or, they may be able to equal or meet a cancer listing if their lymphedema is the result of cancer treatment. Of course, there may be other impairment listing equivalents; it really just depends on the area affected by lymphedema and the resulting limitations.
For many disability applicants, it is difficult to meet or equal an impairment listing, however those who do not may still be approved for disability. They must prove that they can no longer work at a level that Social Security considers to be substantial gainful income. This can be accomplished by providing their medical records and vocational work history. If the information shows they are no longer able to do any of their past jobs or any other kind of work due to the effects of their lymphedema, they may be approved for disability through a medical vocational allowance.
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1) Lymphedema may be either primary or secondary. Primary lymphedema is caused by issues with the development of lymph nodes and vessels, and is inherited. Secondary lymphedema is caused by damage to the lymph nodes or vessels, through infection, injury, surgery, cancer, or radiation treatments for cancer.
2) Lymphedema is characterized by abnormal swelling, usually seen in the arms and legs. Symptoms can include swelling in arms, legs, fingers, and toes, tightness, heaviness, discomfort and aching in arm or leg, as well as developing thick hard skin or experiencing restricted range of motion in leg or arm. Infections may also appear in affected area.
3) Cancer increases risk for lymphedema for a variety of reasons. Cancer cells may block lymphatic vessels or obstruct lymph fluid flow. Chemotherapy is also known to cause inflammation and scarring that restricts lymph fluid flow.
4) It is suggested that breast cancer patients wear a low compression sleeve and gauntlet that is prescribed and properly fitted when flying in aircraft. Cancer surgery and cabin pressure due to flying have been linked to the onset of secondary lymphedema.
5) When lymphedema causes a severe case of thickening of the skin, and swelling that is so bad it causes deformity, it is called elephantiasis.
6) When left untreated or allowed to become very severe, lymphedema can cause cancer. This cancer is called Lymphangiosarcoma and is quite rare. This form of cancer begins in the lymph vessels and lymph nodes, making it a soft tissue cancer.
7) There is no cure for lymphedema. Treatments include pneumatic compression, compression garments, wrapping bandages, exercises, and massage. Extreme cases may require surgery to remove tissue due to excessive swelling, but even surgery does not cure lymphedema.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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