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Lymphedema and Social Security Disability Benefits: Do You Qualify?

 

By Molly Clarke.
Ms. Clarke is a regular contributor to the Social Security Disability Help blog where she works to promote disability awareness and assist individuals throughout the application process.

Lymphedema and Social Security Disability Benefits: Do You Qualify?

Lymphedema is a condition that occurs when vessels in the lymphatic system become blocked.  Lymphedema causes arms or legs to swell, reduces the amount of oxygen circulating the body, and affects the body’s ability to heal wounds.  Lymphedema can cause anything from mild irritation to severe disability.

If lymphedema has impaired your ability to work and earn a living, you may qualify for Social Security Disability benefits. Disability benefits can help cover everything from medical treatment to day-to-day expenses.

This article will provide you with a general overview of the different benefit options and will prepare you to begin the Social Security Disability application process.

Social Security Disability Benefits and Technical Eligibility Requirements
The Social Security Administration (SSA) offers two different types of disability benefits—Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).  To qualify for either program applicants must have a physical or mental health condition that prevents them from holding any type of job for at least one year. Each program also has its own set of technical requirements that applicants must meet.

SSDI is funded by Social Security taxes paid into the program by workers all over the country. SSDI is intended to offer financial assistance to disabled workers and their eligible dependents.  Typically, applicants must have earned income and paid Social Security taxes for at least five of the last ten years. However, this can change depending on an applicant’s age at the time they became disabled.  For more information regarding SSDI eligibility, visit the following page: http://www.disability-benefits-help.org/glossary/social-security-disability-insurance-ssdi.

SSI, on the other hand is intended for elderly, disabled, or blind individuals who earn very limited income. Eligibility for SSI is based on strict financial limitations put in place by the SSA.  For more detailed information regarding SSI technical eligibility, visit the following page: http://www.disability-benefits-help.org/glossary/supplemental-security-income-ssi.

Social Security Disability and Medical Eligibility Requirements
In addition to the SSDI and SSI technical eligibility requirements, applicants must also meet very specific medical requirements. Typically, medical requirements are listed in the SSA’s blue book. Essentially, the blue book is a publication maintained by the SSA that contains the medical criteria for all potentially disabling conditions.

Because lymphedema doesn’t always last the required 12 months, it is not listed in the SSA’s blue book.  However, individuals with severely disabling lymphedema may be able to qualify for benefits if they can meet the blue book criteria under a separate listing.

The following blue book listings may compare to the symptoms and side effects caused by lymphedema:

• Listing 1.02- Major Dysfunction of a Joint (Due to Any Cause): If lymphedema severely impairs your ability to use your arms or legs, you may qualify under this blue book listing.
• Listing 4.11—Chronic Venous Insufficiency: If lymphedema occurs in one or both of your legs and causes extreme swelling, you may be able to match this blue book listing.

If you do not match either of these blue book listings but are experiencing lymphedema as a result of cancer treatment, you may be able to qualify under the listing for your particular type of cancer.

See all blue book listings, here: http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

The Medical Vocational Allowance
If your condition does not match any blue book listings, you may still be able to qualify under something called a medical vocational allowance. Essentially, this means that based on your age, work history, and physical ability the SSA has decided that you are in fact disabled—despite failing to meet a blue book listing. 
To learn more about medical vocational allowances, visit the following page: http://www.disability-benefits-help.org/glossary/vocational-factors.

Preparing for the Social Security Disability Application Process
The initial application for Social Security Disability benefits is made up of several forms. However, before you submit your application, it is important that you collect all of the medical and non-medical documentation that the SSA will look for. Having these documents prepared ahead of time can prevent any delays in your claim and potentially speed up the application process.
Non-medical documentation may include proof of birth, proof of citizenship or alien status, records of military service, and W-2 forms for the past year.
If you are applying for SSI, you will need detailed information regarding your financial income and assets. This may include: pay stubs, tax returns, and any earning receipts. You will also be required to provide proof of your financial resources, including: bank statements, insurance records, bonds, stocks, and vehicle registration. It is also smart to collect property tax bills, rent receipts, food bills, and utility bills.

Regardless of the type of benefits you apply for, you will need thorough medical documentation to support your claim. This should include record of your diagnosis, treatments, and the progression of your illness.  Collect any documentation of physical exams, surgical records, pathology reports, progress notes, lists of prescription medications, and any medical imaging tests.

Application Process
Once you are ready to begin the Social Security Disability application process, you will be able to do so online or in person at your local Social Security field office. After submitting your application, you may not receive a decision for several months.

While waiting for your decision, it is important that you are prepared to face the possibility of a denial. Continue with your prescribed medical treatments and collect copies of any new medical evidence.
While being denied is certainly overwhelming, it is not the end of the road. You are allowed to appeal this decision within 60 days of receiving your denial letter. 
The appeals process is often a necessary step toward receiving disability benefits. In fact, many more individuals are approved during the appeals processes than during the initial application.  For more information about disability benefits, visit Social Security Disability Help (http://www.disability-benefits-help.org/blog) or contact Molly Clarke at mac@ssd-help.org.

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10 comments to Lymphedema and Social Security Disability Benefits: Do You Qualify?

  • Karen

    Your information is very helpful. Thank you for your insightful and educational information.

    Thank you

    KS

  • Was lymphedema recently added to the list of Compassionate Allowances, putting it on the “fast track” for disability determination? I seem to remember an announcement, but I cannot find it on the CAL list posted on the HHS SSDI web site.

    • Julie Dell

      Yes it was, but only applies to “Primary Lymphedema”, not “Secondary Lymphedema”. It was added to the CCACAL on December 12, 2012 and is listed under “Congenital Lymphedema”. Most lymphedema patients suffer from secondary lymphedema, which is secondary to the actual cause, i.e. cancer. Primary lymphedema is due to a congenital cause, and can affect the whole body, but mainly the legs and feet. It is quite rare. I suffer from primary lymphedema.

  • this was helpful,thank you. Has anyone been able to get a sequential compression pump thru Medicare? I have lower extremity(both legs)and trunk lymphedema and I can’t wrap these areas. Can’t got to manual therapy as treatment is capped and limited to about 15 sessions.

    • Rosalie Mcnutt

      Medicare will pay for this pump, I can’t use because you need to have someone to help you , and I don’t have any willing reatves,,

  • michelle dassylva

    where can i get help in quebec canada in french if possible..for the pump. and everything..its my arm ..i use the bandage the gouvernement cut down my help..that i need…financely..and the drainage too…for my arm …now it go down all on my body size..i had a breast cancer in 2005..its since then…

  • Beth Zuraw

    If lymphedema is occurring in my entire body, with the left shoulder & left side of the neck being the worst would I qualify? If I don’t do MLD every few hours my shoulder grows & then the fluid starts up the side of my neck. Actually had my thyroid cancer surgeon, who’d never seen lymphedema and didn’t want to touch the orange sized lump attached to my shoulder & neck, tell me that it wasn’t a quality of life problem…I informed him that breathing and being able to swallow my own spit was a very big quality of life problem for me!!

  • Tawanna Washington

    I can’t get the t

  • Tawanna Washington

    I can’t get anything done medicated want pay for it can you tell me who to see and how can I get them to pay foe iti live in Bainbridge GA

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