Chronic Venous Insufficiency and Social Security Benefits

Chronic venous insufficiency (CVI) is a condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to “pool” or collect in these veins, and this pooling is called stasis. CVI most commonly occurs as the result of a blood clot in the deep veins of the legs, a disease known as deep vein thrombosis (DVT). CVI also results from pelvic tumors and vascular malformations, and sometimes occurs for unknown reasons. Failure of the valves in leg veins to hold blood against gravity leads to sluggish movement of blood out of the veins, resulting in swollen legs. Symptoms include:
  • Swelling in the lower legs and ankles, especially after extended periods of standing
  • Aching or tiredness in the legs
  • New varicose veins
  • Leathery-looking skin on the legs
  • Flaking or itching skin on the legs or feet
  • Stasis ulcers (or venous stasis ulcers)
The Social Security Administration (SSA) reviews CVI claims under a special definition of disability called a listing. The listing number for CVI is 4.11. To meet this listing, you must show that you have CVI  of a lower extremity with incompetency or obstruction of the deep venous system and one of the following: A. Extensive brawny edema (explained below) involving at least two-thirds of the leg between the ankle and knee or the distal one-third of the lower extremity between the ankle and hip. OR B. Superficial varicosities, stasis dermatitis, and either recurrent ulceration or persistent ulceration that has not healed following at least 3 months of prescribed treatment. Brawny edema is swelling that is usually dense and feels firm due to the presence of increased connective tissue; it is also associated with characteristic skin pigmentation changes. It is not the same thing as pitting edema. Brawny edema generally does not pit (indent on pressure), and the terms are not interchangeable. SSA will assess your limitations based on your symptoms together with physical findings, Doppler studies, other appropriate non-invasive studies, or angiographic findings. However, if the CVI has resulted in amputation, SSA will evaluate any limitations related to the amputation under the musculoskeletal listings, 1.00ff. One thing to be wary of is if you are suffering from lymphedema. This is a condition that can often be confused with the symptoms of CVI.  It is edema of the extremities due to a disorder of the lymphatic circulation. At its worst, it is called elephantiasis. Primary lymphedema is caused by abnormal development of lymph vessels and may be present at birth (congenital lymphedema), but more often develops during the teens (lymphedema praecox). It may also appear later, usually after age 35 (lymphedema tarda). Secondary lymphedema is due to obstruction or destruction of normal lymphatic channels due to tumor, surgery, repeated infections, or parasitic infection such as filariasis. Lymphedema most commonly affects one extremity. Lymphedema does not meet the requirements of 4.11, although it may medically equal the severity of that listing. SSA will evaluate lymphedema by considering whether the underlying cause meets or medically equals any listing or whether the lymphedema medically equals a cardiovascular listing, such as 4.11, or a musculoskeletal listing, such as 1.02A or 1.03. If no listing is met or medically equaled, SSA will evaluate any functional limitations imposed by your lymphedema when we assess your residual functional capacity. The cardiovascular listings are very complicated.  It is a good idea to find an SSI or SSDI disability attorney to help analyze your case appropriately.