With many thanks to Susan Hogg, Social Security attorney in Corvallis, Oregon, for bringing this issue to my attention and providing background information.
There appears to be some confusion from my previous diary about the Social Security proposal to remove diabetes from its disability listings. The confusion stems from SSA's rationale that diabetes can now be controlled and that where it is not, the listings for other ailments that result from uncontrolled diabetes will provide the same benefits. Both of these grounds are unfounded and extremely misleading.
First, the assumption that diabetes can be controlled is a fallacy of the first order; in most cases it is a lifelong condition that can only be controlled – if at all -- by expensive medical treatment involving drugs, frequent monitoring, and diagnostic tests and equipment, none of which come cheap. SSA's assumption that everyone has equal access to such costly treatment is a cruel joke.
Second, the assumption that listings for other conditions or ailments will provide the same benefits is an even crueler joke. The reality is that without the diabetes listing it would take even longer and be more difficult to be found disabled under the other listings. Furthermore, there are specific diabetes symptoms and problems covered under the current listing that would not necessarily be as well evaluated or covered, if at all, under other system listings.
An explanation of the disability determination process is in order here:
Step 1 is, "Are you working and if so, how much are you making?" If you make $980 per month gross or close to it (in reality less than $400/month), you are not disabled. End of story. If you are not working or earning anything much, you go to:
Step 2: Do you suffer from a severe impairment or impairments that has lasted or is expected to last 12 months or end in death? If yes, go to:
Step 3: Does your illness/condition "meet" or "equal" a current SSA listing ("equal" means you don't meet all the criteria but your condition is so bad in other ways that you "equal" the listing in severity)? If yes, you are disabled. No further steps necessary. If not, you will need to meet other Listings, and likely proceed to next step:
Step 4: Are you able to do your past work?
Step 5: If no to #4, is there other work in the region or nation that you can perform?
Each of those steps requires reams of proof and expert opinion, and once you get to steps 4 and 5, your age and work history and education and all kinds of other factors need to be considered, many of which are matters open to different interpretations. If all these steps fail to convince the examiners, and they declare you not disabled, then you can ask for a hearing before an administrative law judge, and if that fails you can appeal to the Appeals Council, and then go to U.S. District Court and all the way to the U.S. Supreme Court. Every stage of this process takes months or years.
Now, suppose you are diabetic and unable to work, and your diabetes is not under control because you cannot afford the treatment necessary to control it. If you suffer from any of the problems in the current Listing (e.g., acidosis, which can involve headache, sleepiness, confusion, loss of consciousness, coma, muscular weakness, seizures, shortness of breath, coughing, heart arrhythmia, increased heart rate, nausea, vomiting, and diarrhea) at the level of severity described, then you can meet the requirements of the first three steps in the process: "the presence of an impairment that meets the criteria in the Listing of Impairments (or that is of equal severity) is usually sufficient to establish that an individual who is not working is disabled." (see current listings here).
Under the current Listing, therefore, it is possible to be found disabled in the first three steps. At those lower three levels, the examiners are much more likely to approve a claim if they can look at available medical records and slot someone into a Listing. They can see that the person had a particular test result a certain number of times over a 12-month period, and was treated for acidosis at clinics or emergency rooms for relevant severe symptoms so many times – just what the listing criteria require. The current diabetes Listing thus can provide diabetics with benefits in time to prevent the systemic damage covered in other Listings.
Without the diabetes Listing, you or your representative will have to argue that you meet another listing, which is more difficult, especially if your symptoms – say passing out or vomiting, etc. -- are not among the criteria for any other possible listing. Not only will it be more difficult to "meet or equal" a different Listing, but also, if you do not do so, you must then go through steps 4 and 5, where your education, work skills, and age become relevant. The process will be more difficult, and the chances are far greater that you will have to go to the hearing level (before an administrative law judge), which means you may have to wait – survive – without medical care for three years or more instead of six months (and after all that, survive the subsequent waiting period for Medicare).
Keeping the current diabetes Listing is therefore of paramount importance to the welfare and survival of growing numbers of diabetics, who can not afford to control their symptoms adequately and may not survive the years of waiting that removing the Listing would impose.
NOTE: The comment period for this proposed rule change ends February 12, 2010. See below for ways to submit your comments:
1. Internet: We strongly recommend this method for submitting your comments. Visit the Federal eRulemaking portal at http://www.regulations.gov. Use the Search function of the webpage to find docket number SSA-2006-0114, then submit your comment. Once you submit your comment, the system will issue you a tracking number to confirm your submission. You will not be able to view your comment immediately as we must manually post each comment. It may take up to a week for your comment to be viewable.
2. Fax: Fax comments to (410) 966-2830.
3. Mail: Address your comments to the Commissioner of Social Security, P.O. Box 17703, Baltimore, Maryland 21235-7703.
4. Hand-delivery: Deliver your comments to the Office of Regulations, Social Security Administration, 137 Altmeyer Building,
6401 Security Boulevard, Baltimore, MD 21235-6401, between 8 a.m. and 4:30 p.m., Eastern Time, business days.
Comments are available for public viewing on the Federal eRulemaking portal at: http://www.regulations.gov, or in person, during regular business hours, by arranging with the contact person identified below.
FOR FURTHER INFORMATION CONTACT: Judy Hicks, Office of Medical Listings Improvement, Social Security Administration, 6401 Security Boulevard, Baltimore, Maryland 21235-6401, (410) 965-1020.
For information on eligibility or filing for benefits, call our national toll-free number, 1-800-772-1213, or TTY 1-800-325-0778, or visit our Internet site, Social Security Online, at http://www.socialsecurity.gov.