How to Get Disability Benefits for Primary Biliary Cirrhosis of the Liver
Primary biliary cirrhosis (PBC) is a chronic disease that leads to the eventual destruction of the bile ducts in your liver. Because the liver no longer functions properly, toxins and other harmful substances can build up and cause permanent scarring to your liver. The scarring (cirrhosis) leads to poor liver function. Unlike alcoholic cirrhosis, PBC is not caused by overuse of alcohol.
Early symptoms of primary biliary cirrhosis include dry eyes and mouth (known as sicca syndrome), itching, and fatigue. As the disease progresses and the bile duct and liver cells incur more damage, patients can experience the following symptoms: jaundice (yellowing of the skin), darkening of the skin, swelling, fatty deposits under the skin, and digestive complications.
Can I Get Disability for Primary Biliary Cirrhosis?
First, the SSA only considers for disability benefits medical conditions that are severe and are expected to last at least 12 months (or result in your death). This requires proof that your primary biliary cirrhosis is far along enough to cause a substantial impact on your ability to perform basic work activities. The 12-month duration requirement is easy to prove because PBC is a chronic disease.
Next the SSA will determine whether your PBC meets or equals a qualifying condition outlined in the SSA’s Listing of Impairments. The SSA includes PBC as a qualifying condition under Listing 5.05 (chronic liver disease). If you meet the severity criteria in the listing, you will be automatically approved for disability benefits.
What Are the Requirements of the Liver Disease Listing?
To meet the initial requirements of Listing 5.05, you must first be diagnosed with a chronic liver disease characterized by inflammation of the liver, scarring of the liver, or liver cell necrosis. PBC is one of the diseases that the listing provides as an example of chronic liver disease.
In addition to the diagnosis of PBC, you must demonstrate that you have suffered from one of the following complications:
- gastrointestinal hemorrhage
- excess fluid in the peritoneal cavity (ascites) or fluid in the pleural cavity (hydrothorax)
- bacterial peritonitis
- hepatorenal syndrome
- hepatopulmonary syndrome
- hepatic encephalopathy, or
- end-stage liver disease.
If you are unsure about whether you have suffered any of these complications as a result of your PBC, you should consult your treating physician. The detailed requirements of Listing 5.05 can be viewed at http://www.ssa.gov/disability/professionals/bluebook/5.00-Digestive-Adult.htm#5_05.
What if My PBC Doesn’t Meet the Listing 5.05 Requirements?
Even if you do not meet the requirements of Listing 5.05 for an automatic approval, you may still win your claim for disability based on your PBC. At this stage, the SSA will first determine whether, based on the symptoms of your PBC, you are able to perform your past work, or whether there is any other type of work you can do. To determine this, the SSA will consider your age, education, the type of work you used to perform, and the impact your illness has on you, such a severe fatigue.
To assess the limitations caused by your illness, the SSA will come up with a residual functional capacity (RFC) level for you (sedentary work, light work, or medium work). It is important at this stage to provide the SSA with a report by your doctor that states his or her opinion about how your PBC affects your ability to do work-related activities. For example, your RFC should reflect the limitations you have in standing, walking, lifting, and carrying. The RFC should also state whether you require frequent unscheduled breaks during work hours, or if you need to sleep during the day because of severe fatigue.
If the SSA decides there is other work you can do despite these factors, it will deny your claim. However, if the SSA decides that there are no jobs you are able to perform you will be approved. Approval at this stage is easier for older, less educated workers.
What Kind of Medical Evidence Do I Need?
It's important to provide the SSA with as much medical evidence as possible from the beginning of the claim process. The more information you provide the SSA, the more likely your claim will be approved. You should provide the SSA with the names and addresses of every physician who might have records that pertain to the treatment and diagnosis of your PBC, the addresses and dates of service for any tests performed by laboratories, hospitals or clinics, and copies of any reports form CT scans, MRIs, or blood tests. And make sure to ask your doctor to provide an RFC assessment for you -- the SSA may not request this. Note that the SSA will consider evidence only from licensed doctors, and will give the most weight to doctors who specialize in liver disease.