Can I Qualify for Disability Benefits with a Digestive Disorder?

When a disability prevents you from working, the resulting financial situation can rapidly snowball into stress, anxiety, and sleepless nights.  Your bills continue to arrive in the mailbox, but because of your health condition, you physically cannot participate in the workplace.  Is there any resource you can turn you for help?  Fortunately, there is: the SSA (Social Security Administration) offers several different types of monthly benefits to qualified applicants.  If you are one of the approximately 70 million Americans living with a digestive disorder, you could qualify, too.  But how?  What does the SSA look for when reviewing claims?

Basic Requirements for Disability Benefits

Before we start delving into the specifics of how digestive disorder claims are evaluated by SSA medical examiners, let’s take a look at some of the more general requirements for applicants.

First, the financial requirement: your income cannot be too high.  Specifically, it should not exceed $721 per month as of 2014.  (Married couples have a higher cap of $1,082.)  This number is something called the FBR, or Federal Benefit Rate, and changes on a yearly basis.

In addition to your finances, your disability itself must also pass certain criteria.  It must:

1. Pass the duration requirement of lasting (or being expected to last) no fewer than 12 months, or be expected to end in death.
2. Pass the severity requirement.  If you have a mild disability which you can easily control and manage, you will not be considered severely impaired.  The SSA wants to determine that your health actually prevents you from working.

Regarding the second point, it’s important to note that even if you cannot work in your usual job, the SSA will still not consider you disabled if you are capable of working at a different job as an alternative.  You must be considered effectively unable to work, period.

How Does the SSA Evaluate Digestive Disorders?

Each claim must be assessed on a case-by-case basis to determine whether or not the impairment in question is truly “severe.”  To make these assessments, SSA claims examiners refer to a document called the Listing of Impairments (informally known as the “Blue Book”).  The Listing supplies criteria for measuring the severity of various medical conditions.

The conditions related to the digestive system are contained in Section 5.00 of the Listing. The disorders included in Section 5.00 are:

• Gastrointestinal Hemorrhaging (5.02)
• Chronic Liver Disease (5.05)
• Inflammatory Bowel Disease (5.06)
• Short Bowel Syndrome (5.07)
• Weight Loss (5.08)
• Liver Transplant (5.09)

Needless to say, these conditions are all evaluated based on very different criteria.  Some are brief and straightforward, while others are lengthy and technical.

For example, in order to demonstrate disability based on digestive disorder-related weight loss, the claimant should show a “BMI of less than 17.50 calculated on at least two evaluations at least 60 days apart within a consecutive 6-month period” (even after treatment).  That short sentence is the extent of the Listing under 5.08.

By contrast, consider the very detailed requirements to prove disabling chronic liver disease (5.05).  The applicant should have evidence of any one of the following:

• “Hemorrhaging from esophageal, gastric, or ectopic varices or from portal hypertensive gastropathy.”
• “Ascites or hydrothorax not attributable to other causes.”
• “Spontaneous bacterial peritonitis.”
• “Hepatorenal syndrome.”
• “Hepatopulmonary syndrome.”
• “Hepatic encephalopathy.”
• “End stage liver disease.”

In turn, each of these qualifying points come with even more detailed specifications.  For example, “spontaneous bacterial peritonitis” must be accompanied by “peritoneal fluid containing an absolute neutrophil count of at least 250 cells/mm3.”  To give another example, end stage liver disease must be be accompanied by “SSA CLD scores of 22 or greater.”

If you cannot meet the often very precise and rigorous requirements contained in the Listing, you may still be able to qualify with a medical-vocational allowance.  You will be given an RFC (Residual Functional Capacity) test, which will score your ability to perform basic mental and physical tasks.  Depending on your score (which considers other factors like your age, education level, and work skills), you may be approved by the SSA.

Qualifying for monthly benefits is a challenge, but a Philadelphia disability benefits lawyer can help increase your chances of succeeding.  To schedule your free and confidential legal consultation, call the law offices of Young, Marr, Mallis & Associates at (609) 755-3115 in New Jersey or (215) 701-6519 in Pennsylvania, or contact us online today.