Medical Criteria to Qualify with Peripheral Neuropathy

An estimated 20 million people in the United States suffer from some form of neuropathy, also called peripheral neuropathy. The symptoms of peripheral neuropathy vary extensively from person to person. For some people, their neuropathy may only be a minor annoyance.

For others, neuropathy may be extremely painful and debilitating, rendering the individual unable to work. If your peripheral neuropathy is so severe that you are unable to work, you may be eligible to receive assistance from the Social Security Disability Insurance Program (SSDI).

Because peripheral neuropathy affects individuals so differently, not everyone who seeks disability benefits will be awarded them.

You will need to present sufficient medical evidence that illustrates that your symptoms from peripheral neuropathy are so severe that you are unable to work now, or for the next year.

The Social Security Administration (SSA) receives millions of disability applications each year. Your ability to provide an accurate application backed with timely medical evidence will impact your chances of approval.

Is Peripheral Neuropathy a Disability?

Because peripheral neuropathy affects individuals in different ways not everyone who submits a claim for disability benefits will be successful.

You will be asked to provide adequate medical evidence that shows your symptoms are so severe that you are unable to work for at least the next 12 months.

Peripheral neuropathy needs to be listed in the Social Security Administration’s Blue Book as well. It can be found in section 11.14 of the Blue Book.

Because peripheral neuropathy is not a standalone disease it is possible that you might qualify for benefits if your peripheral neuropathy is due to diabetes.

Your physician should carefully review the endocrine section, 9.00, to see if you are eligible to qualify for disability benefits under that listing.

There are several stages to peripheral neuropathy which are the following:

  • Stage 1 is numbness and pain
  • Stage 2 is constant pain
  • Stage 3 is intense pain
  • Stage 4 is total numbness and loss of sensation

Peripheral neuropathy may be considered a disability by the SSA if you the condition is likely to be present for at least 12 months when you are unable to work and you meet the medical requirements as described in the SSA’s Blue Book.

As soon as you meet these requirements you should file your application for disability benefits including medical evidence proving peripheral neuropathy is a disability. Medical evidence from your doctors proving you are disabled is essential to winning a disability benefits claim.

The Importance of the “Blue Book”

The Social Security Blue Book is an essential reference for those applying for disability benefits. This medical guide, which was once printed with a blue cover, is now exclusively available online.

The guide includes a listing of conditions and the requirements needed to qualify under each specific condition.

Peripheral neuropathy is a neurological disorder listed in section 11.14 of the Blue Book. Peripheral neuropathy is not a single disease, but instead is nerve damage caused by other conditions.

As such, it is possible that you might qualify for benefits under another affected body system. For example, if your peripheral neuropathy is caused by diabetes, you will want to be sure that your physician carefully reviews the endocrine section, 9.00, to see if you qualify under that listing.

Medical Criteria Needed to Qualify with Peripheral Neuropathy

Evidence Needed Related to Your Peripheral Neuropathy

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your neuropathy. While there are a few specific tests for peripheral neuropathy, obtaining detailed medical records from your neurologist is of vital importance.

Records should include your presenting symptoms, the history and progression of your disease, as well as the results of a full physical examination. These may include:

  • Electrodiagnostic Testing: This includes Electromyography (EMG) and Nerve Conduction Velocity (NCV) tests
  • Quantitative Sensory Testing (QST): Test used to assess damage to nerve endings
  • Nerve Biopsy: May be done to determine the type of nerve damage
  • Autonomic testing: May include sweat tests, heart rate, tilt table, and blood pressure monitoring
  • Imaging results: CT scans or MRIs to rule out any compression, tumors, or other abnormalities.

According to the Blue Book, certain physical limitation criteria would make you eligible for disability benefits. Be sure that your neurologist documents any physical limitations including, but not limited to, the following:

  • Any difficulty that you might experience with movement of two extremities, such as your legs, arms, fingers, wrists, hands, or shoulders.
  • Any difficulty that you might experience moving from a seated position to a standing position
  • Any troubles that you might have maintaining balance standing or walking, including problems with double vision
  • Any challenges you have with using your arms, hands, shoulders or wrists that makes it difficult to perform any work-related activities
  • Any other physical functioning limitations should be carefully documented by your neurologist It is entirely possible that you are working with several doctors. As the SSA gives more weight to the opinion of a medical specialist, be sure that you work with your neurologist to gather this medical information.

Evidence Needed Related to Your Neuropathy Treatments

The treatment for peripheral neuropathy depends on the underlying disorder. The SSA will need to know exactly what treatments you have received, your response to those treatments, and most importantly if your condition has worsened despite those treatments.

Be certain that your doctor has documented the following:

  • Any and all medications that you are receiving as a result of your neuropathy, as well as your response to the medications
  • Any medical treatments, such as plasmapheresis or tens
  • Any use of casts, splints, or assistive devices such as crutches, cane, or wheelchair
  • Any physical therapy or other related therapies that you are receiving.

Many patients will not meet the specific listing for peripheral neuropathy in the Blue Book. However, you may still be unable to work due to the severity of your condition.

Providing the SSA with information on your medications, treatments, and side effects is essential. You must be able to demonstrate that you are unable to work with peripheral neuropathy and that this condition is expected to last for at least one year.

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

If you are unable to meet the listing for peripheral neuropathy, you will need to provide additional information about your health and ability to care for yourself.

Your neurologist will need to provide carefully documented physician notes speaking to your limitations and your inability to function without several accommodations.

The more specific that your doctor is about your limitations, the better your chances are of being approved for disability benefits. For example, you might experience numbness and tingling in your hands that makes it difficult for you to get dressed each day.

These are not symptoms listed in the Blue Book, but undoubtedly impact your ability to function. You may still qualify for SSDI benefits through a residual functional capacity assessment.

Steps You Can Take to Win Your Disability Claim

Your ability to provide medical evidence listed in the Blue Book is undeniably the most crucial factor in your Social Security disability claim for peripheral neuropathy.

If you are in the process of apply for disability benefits, be sure that you have all of your medical documentation in hand or easily accessible.

You may need to contact the medical records office at your hospital or your physician’s office to obtain some of this information.

As noted above, the Blue Book is now only available online. You may want to print section 11.14 out and bring it to your next doctor’s appointment with you.

Together you and your neurologist can determine what medical records you have on hand and what information you might still need.

You may also want to bring with you to this appointment a detailed list of your symptoms and side-effects so that your doctor can accurately discuss and document them in your record.

There are several ways that your neurologist or primary care physician can help including:

  • Ensuring that your full medical history related to your peripheral neuropathy is up to date
  • Documenting past treatments and responses, as well as long-term care plans
  • Documentation of your medications and their side effects

No matter where you are in the Social Security disability application process, hiring a qualified disability attorney or advocate can be very helpful to your case.

An experienced Social Security attorney will offer a free evaluation to help you determine if you have a case. Further, your representative will only get paid if you win your peripheral neuropathy claim.