Applying for Social Security Disability Benefits with Crohn’s Disease

 

Those who suffer from Crohn’s disease may have a difficult time continuing to work because of the disorder. If you are in this position, you may be eligible for disability benefits. The information below provides valuable insight into this condition and applying for medical benefits.

What is Crohn’s Disease?

Crohn’s disease is a condition that causes inflammation deep inside the intestines and throughout the intestinal tract. People who suffer from this condition often experience symptoms such as chronic diarrhea, bleeding of the rectum, weight loss, fevers, abdominal pain and fecal incontinence. May people suffer from additional symptoms outside the intestinal tract, such as arthritis, eye disorders, kidney disease and skin disorders.

Getting Disability for Crohn’s Disease

The Social Security Administration (SSA) has a multi-step evaluation process to help determine who is available for disability benefits because of Crohn’s disease.

Substantial Gainful Activity (SGA)

The first step of this process is to determine if the person applying for benefits, or claimant, is working at the SGA level. SGA level is the ability to consistently work at a job that pays a reasonable wage. The current level for SGA is $1,170 per month. So, to be eligible for disability benefits, you must make less than that amount every month.

Duration of Condition

The next consideration for disability eligibility is the duration of the claimant’s Crohn’s disease. To qualify for benefits, it must be expected to last for at least one full year. Normally, Crohn’s disease is a chronic, lifelong disease, so this qualification is usually met with ease.

Determining Severity

The claimant’s Crohn’s disease must be severe enough to warrant disability benefits. The SSA considers “severe” to be the inability for the claimant to do his or her job.

Listing of Impairments

The SSA has an official Listing of Impairments, commonly known as the Blue Book. The next step in qualifying for benefits is meeting one of the conditions that is stated in the Blue Book. The Blue Book lists Crohn’s disease under listing 5.06, Inflammatory Bowel Disease (IBD). So, the SSA needs to find evidence that the claimant’s Crohn’s disease meets those criteria. If it does, the claimant’s claim will be automatically approved.

Qualifying for Inflammatory Bowel Disease

To meet the listing for inflammatory bowel disease, you must first be diagnosed with the condition. You must also have documented proof of at least one of the following issues:

– Bowel obstruction

There must be an obstruction of the narrowed areas of the small intestine or colon that includes dilation or swelling. The obstruction must be confirmed by a medical imaging test or surgery and also require a hospital stay or surgery to compress the intestines. There needs to have been two obstructions at least 60 days apart and within a 6-month period or

– Have at least two of the following symptoms within a six-month period, even while following the prescribed treatments

– Anemia with a hemoglobin level of less than 10 g/dL in two separate blood tests that are conducted at least 60 days apart

– Serum albumin of 3.0 g/dL or lower after at least 2 blood tests that are conducted at least 60 days apart

– Presence of a tender mass in the abdomen that has been felt during a physical exam that is accompanied by abdominal pain or cramping that cannot be controlled with prescription pain medication that has been documented by a doctor in two visits that are at least 60 days apart

– Perineal disease with a draining abscess or fistula with pain that cannot be controlled with prescription pain medication that has been documented by a doctor in two visits that are at least 60 days apart

– Unintentional weight loss of at least 10% from your starting weight that has been documented by a doctor in two visits that are at least 60 days apart

– Requirement of supplemental nutrition by a feeding tube in the stomach, nose, small intestine, or chest by a catheter.

Qualifying for a Digestive Disorder

If a claimant does not qualify for disability benefits with inflammatory bowel disease, there is a chance he or she might qualify due to weight loss due to a digestive disorder, which is listing 5.08. If Crohn’s disease has caused a claimant to lose an excessive amount of weight, he or she may qualify for benefits if all of the following qualifications are met:

– Weight loss despite following treatments that were prescribed by a doctor

– The weight loss resulted in a body mass index (BMI of less than 17. 50

– Body weight was measured and recorded on at least two occasions that were at least 60 days apart within a six-month period.

If Neither Listing is Met

Sometimes a person with Crohn’s disease is so sick he or she cannot work, but does not meet the qualifications or either listing. In these cases, the SSA will look at all of the documented symptoms to determine the claimant’s residual functional capacity (RFC), which is level at which a claimant can work and then assign a rating of “heavy work”, “medium work”, “light work”, or “sedentary work.” If the SSA determines the assigned level can be worked beyond, the claim will be denied. But, if the claimant cannot reach the assigned RFC level, benefits will be granted.

Required Medical Evidence

The best way a claimant can have a claim accepted is to have strong medical evidence that supports the condition. The more objective evidence that is provided, the more likely it will be that the claim is accepted. All copies of all tests that related to the diagnosis of Crohn’s disease should be included, including blood tests, fecal occult tests, colonoscopy and endoscopy reports, CAT scans, and MRI scans. Other information that needs to be included with the application include doctor’s notes, surgical reports and hospitalization information. If a claimant does not provide a sufficient amount of information, the SSA will set up a consultative examination to obtain the information that is needed.