Hepatitis B is an inflammatory disease of the liver that is caused by a virus (HBV). Common symptoms of a hepatitis B infection include jaundice (yellowing of the skin and eyes), pruritis (itching), abdominal pain, joint pain, fatigue, sleep disturbances, and nausea.
People with strong immune systems who have been infected with hepatitis B are usually able to wipe out the virus and have no lasting side effects. However, some people infected with HBV have a chronic infection for life, which causes inflammation and scarring in the liver. Severe scarring of the liver, or cirrhosis, can damage the liver's ability to function and can lead to liver failure. Chronic carriers of the Hepatitis B virus are also at risk for liver cancer.
If you have a chronic infection of hepatitis B and it limits your functioning, then you might be eligible for either Social Security Disability (SSD) benefits or Supplemental Security Income (SSI) benefits under the Social Security Act. (SSD is also called Social Security disability insurance, or SSDI.)
Meeting the Chronic Liver Disease Listing Under the SSA Impairment Listings
When the Social Security Administration (SSA) receives your claim for SSD or SSI benefits, your claims examiner will order copies of medical reports from your doctor. The SSA will first want to determine whether you meet listing 5.05, Chronic Liver Disease. This listing, like many other SSA disability listings, has strict requirements that must be demonstrated through the use of medical laboratory findings. For example, you will need to show that your HBV infection has caused a serious ailment such as gastrointestinal hemorrhage or related kidney or lung problems.
Medical Evidence of Disability from Hepatitis B Infection
You might be required to produce a liver biopsy to show the degree of liver infection, imaging studies such as an MRI, CAT scan, or ultrasound to indicate whether the liver has increased in size or whether there has been any scarring of the liver, and other lab tests that reveal the level of liver enzymes and serum albumin (protein in the liver).
The SSA will also review your medical charts to see if you have undergone any treatments for hepatitis B. Common treatments are oral antiviral drugs and injections of interferon. If there has been no decrease in the level of the HBV virus despite ongoing treatment, then the SSA might consider whether your hepatitis B medically equals a disability listing (is equivalent to a listing, though it doesn't match it exactly).
The SSA will also look to see if you are suffering any side effects as a result of medications. Common side effects of treatment may include fever, fatigue, joint pain, nausea, insomnia, or other flu-like symptoms. These side effects can impact your ability to work on a regular basis. If the side effects you are experiencing are especially severe, then you might need to stop treatment or reduce your dosing level.
Assessing Your Residual Functional Capacity
Even if you do not meet or equal an official SSA disability listing, you can still be found disabled if your residual functional capacity (RFC) shows that you are unable to perform your past job or that you are unable to perform any other jobs due to your HBV infection or the side effects of your medication. The SSA will assess your RFC level based on your ability to perform basic work tasks during a 40-hour workweek.
The agency will consider the following factors in developing your RFC:
- How long you can sit, stand, and walk on a daily basis.
- How much you can lift, carry, push, or pull on a daily basis.
- How well you can understand and follow instructions.
- How well you can interact with co-workers and supervisors in a work setting, and
- How well you can respond to work stress.
It is important that the medical records from your doctor contain sufficient evidence of your symptoms from hepatitis B and evidence of limitations in your ability to do above tasks. Based on this evidence, the SSA will give you an RFC level, such as medium work, light work, or sedentary work. For example, an RFC level for a severe chronic HBV infection might be stated in these terms: limited to a sedentary level of work; can lift no more than 10 pounds at a time; walking, sitting, and standing required less than 6 hours out of an 8 hour day; limited to simple and routine tasks.
Statements you make to your doctor indicating the level of fatigue or pain that you feel during various activities can be used to support a lower RFC level. You should discuss with your doctor such topics as whether you need to rest during the day, whether you can handle everyday household chores, whether your level of activity has changed since before you were diagnosed with hepatitis B, whether you have a good appetite, and whether you are getting enough sleep during the night.
Determining Whether You Can Perform Your Past Work or Other Jobs
Once the SSA has determined your RFC level, the SSA will evaluate whether you are able to perform your past work with your RFC. The SSA is limited to reviewing jobs that you have performed in the last 15 years. Generally, if you had a position that involved heavy physical labor or which involved very skilled work, it will be easier for you to prove that you can no longer perform this type of work.
The SSA will then look at its Medical-Vocational Guidelines to determine if you can be expected to learn and do other work based on your age, education, previous work experience, and RFC level. If you are over the age of 50, you are more likely to fall within the disabled section of the medical-vocational grid, which means you could qualify for a medical-vocational allowance.
Depression or Other Mental Symptoms
If you feeling any depression or other mental symptoms as a result of your hepatitis B, tell your doctor. If are experiencing depressive symptoms, then you might qualify for SSD or SSI benefits based on a combination of your depression and hepatitis B. You might also have mental symptoms such as an inability to stay focused or remember instructions. If you have severe mental limitations due to your medications, the SSA could give you a mental RFC, which, combined with a low physical RFC, could limit the number of jobs you could be expected to do.
Filing for Benefits
If you would like to file for SSD or SSI benefits, you can call the SSA at 1-800-772-1213. Or, you can go online at www.ssa.gov if you are filing only for SSDI benefits.
If you do not currently have medical insurance or are unable to afford a doctor, the SSA might send you to a consultative medical examination. During this exam you should explain your symptoms and follow any instructions given by the doctor. Failure to attend a scheduled exam can result in a denial of your disability benefits.
Even if you are found non-disabled after your initial application or at an early stage of review (such as a request for reconsideration), you can still request a hearing before an Administrative Law Judge, where you have the opportunity to provide additional evidence of your disability. With a disease such as hepatitis B, it is common that your symptoms will continue to worsen over time. Therefore, it is always advisable that you appeal any unfavorable decision so that you can present new evidence because the SSA might not have had your most current medical information at the time.