4.11 Chronic venous insufficiency of a lower extremity with incompetency or obstruction of the deep venous system and one of the following:
Chronic (long-term) venous insufficiency (lack of proper blood flow in the veins) of the legs can be associated with many factors: severe varicose veins, prior blood clots, prior vein removal such as for heart bypass surgery, chronic fluid overload such as in heart failure and kidney failure, and obesity.
Chronic venous insufficiency allows fluid to collect in the soft tissue of the legs causing edema and producing irritation of the overlying skin. The skin does not like swelling, and stasis dermatitis (redness and scaling of skin) develops, which can lead to breakdown of the skin layers (ulceration), and can eventually result in brawny edema (thickened skin with a tree bark or darkened appearance).
Pitting edema is when compression of the skin produces an indentation. Pitting edema is not brawny edema. Often by the time brawny edema develops, the skin has become so thickened from scarring that you are not able to see pitting of the skin with compression.
Lymphedema is a term describing swelling of soft tissues, in this case, the legs, due to poor circulation of the lymphatic system. The lymphatic system is composed of lymph nodes and lymph channels found throughout the body, and is responsible for assisting in immune support and fluid drainage, along with the veins. There are numerous causes for lymphedema, though these causes can overlap with venous insufficiency; and often, it is clinically impossible to tell the difference between the two conditions.
Even though SSA says one can equal but not meet these Listings if one has lymphedema versus venous insufficiency, it doesn’t really matter. This is because as long as the conditions in Part A and Part B exist, one would be awarded disability benefits, either equalling 4.11 for lymphedema or meeting 4.12 for venous insufficiency.
This new Listing clearly defines “extensive” and makes a simple statement from your doctor a quick and easy way to get disability benefits, as long as his or her medical records supports the criteria for this Listing. This is a relatively easy Listing to meet or equal because it only requires one thing - extensive brawny edema (inevitably due to venous insufficiency or lymphedema).
Have your doctor specifically say in a letter or on an SSA form that your extensive brawny edema involves the distal 2/3 of the leg between the ankle and knee or distal 1/3 of the leg between the ankle or 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.
Part B of this Listing requires superficial varicosities (superficial varicose veins seen through the skin) AND stasis dermatitis (redness and scaling of the skin) AND EITHER recurrent leg and/or foot ulceration (recurs following 3 months of treatment) OR persistent ulceration (persists despite at least 3 months of treatment).
Some applicants may not have had 3 months of prescribed treatment, but if the condition has lasted long enough and is significant enough, SSA may decide that the condition would not significantly improve even with treatment, and would allow for disability benefits by equalling this Listing.
I have also seen this Listing equaled due to chronic leg swelling and recurrent or persistent skin ulceration not responding to therapy, even without superficial varicosities. By the time recurrent or persistent ulceration has set in, inevitably, some type of dermatitis exists.