Persistent Leg Pain Can Lead to Disability
After a long day of walking, a person's legs may be swollen and cause them pain. For most people, a good night's sleep takes care of things. But for some individuals, this is a daily occurrence from chronic venous insufficiency (CVI). CVI is when the valves in a person's leg veins do not properly work and allow blood to pool in the legs.
CVI affects a person's legs. Symptoms may manifest as:
- Swelling in legs and/or ankles
- Tight feeling calves or itchy painful legs
- Pain during walking that stops with rest
- Brown-colored skin, particularly near the ankles
- Varicose veins
- Leg ulcers that are sometimes very resistant to treatment
Obesity is one of the leading causes of CVI. Pregnancy and family history are also common causes. If an individual has had a traumatic leg injury, surgery, or a blood clot in their leg called a deep vein thrombosis, those individuals are more likely to develop CVI. Lack of exercise, smoking, high blood pressure in the leg veins due to sitting or standing for long periods of time, and phlebitis, the swelling and inflammation of a superficial vein, also cause CVI.
Many of the symptoms of chronic venous insufficiency resemble other conditions, so doctors take a complete medical history and perform a physical examination. A doctor may order a duplex ultrasound to “assess blood flow and the structure of the leg veins.” The ultrasound produces a picture of the veins and “evaluates the velocity and direction of the blood” within those veins. Another procedure doctors use to diagnose CVI is a venogram. An individual is given an “intravenous (IV) contrast dye to visualize the veins. Contrast dye causes the blood vessels to appear opaque on the X-ray image, allowing doctors to visualize the blood vessels being evaluated.”
Treatments are tailored to the individual based on age, medical history, progression of the CVI, and exhibited symptoms. Simple treatments to increase blood flow include avoiding long periods of standing or sitting, exercising regularly, losing weight, elevating the legs to reduce pressure and wearing compression stockings to help blood flow. Antibiotics are used “to clear skin infections related to CVI.” If an individual with CVI also suffers from heart failure or kidney disease, then diuretics may be prescribed to “draw excess fluid from the body through the kidneys.”
For individuals with more advanced CVI, doctors may use sclerotherapy where a doctor injects “a chemical into the affected veins, scarring the veins so they can no longer carry blood. The body reroutes the blood through other veins and the body absorbs the scarred veins.” A new technique is endovenous thermal ablation “that uses a laser or high-frequency radio waves to create intense local heat in the affected vein. This treatment closes off the problem veins, but leaves them in place so there is minimal bleeding and bruising.”
Only in about 10% of CVI cases is surgery recommended. Surgical procedures include ligation, which is tying off an affected vein and removing it, surgically repairing the vein or valve, transplanting a healthy vein from another part of the body to the affected area, or subfascial endoscopic perforator surgery, which uses an endoscope to clip and tie off affected veins.
Social Security Disability
When reviewing a Social Security Disability application claiming CVI as the disabling condition, the Social Security Administration (SSA) looks at the individual's medical records for treatments of at least 3 months, but 12 months is the preferred minimal time frame. If, despite treatments, an individual has continued blood pooling in their legs and has a brawny edema, a swelling in connective tissue that feels firm and is discolored, or “superficial varicosities (varicose veins), stasis dermatitis (inflammation and discoloration of the skin), and either recurrent ulceration or persistent ulceration that has not healed following at least 3 months of prescribed treatment,” then CVI is the qualifying disability.
Social Security Disability applications require extensive documentation on an applicant's medical condition. If you are considering applying for disability benefits, contact our experienced attorney to assist you.