Getting Social Security Disability Payments for Liver Disease

Under the old Digestive System Listing a claimant with very severe liver disease often came very close to meeting old 5.05F3. That listing required:

1. Chronic liver disease

2. Liver biopsy (showing necrosis or inflammation) and;

3. Abnormal enzymes (ALT/SGPT AST/SGOT) and prothrombin time (PTT).

Many of our clients could show all the requisites except the PTT. This test was often not requested by treating sources as it is traditionally not included in a standard liver panel. The PTT test is more often requested to check how well blood-thinning medications are working and or to detect a bleeding disorder. But a complete blood count (CBC) is often ordered along with a standard liver panel. That panel includes a platelet count (PLT). A low platelet count suggests “medication interactions antibody formation or liver disease and blood clotting problems.” As such one could argue that an abnormal PLT has the same medical significance as an abnormal PTT and successfully urge that the claimant equaled 5.05F3.

The Digestive System Listings were revised on October 19 2007 and now old 5.05F3 is gone. SSA comments that liver enzymes “may have a poor correlation with the severity of liver disease and functional ability.” Also a liver biopsy is no longer a mandatory requirement because a liver biopsy “is not a good predictor of the severity of symptoms of chronic liver disease or their effect on functioning.” Last the PTT is now replaced with the International Normalized Ration (INR) as it is a more widely used study. The old listing 5.05F3 has arguably been replaced with new 5.05B which requires:

Ascites or hydrothorax not attributable to other causes despite continuing treatment as prescribed present on at least 2 evaluations at least 60 days apart within a consecutive 6-month period. Each evaluation must be documented by:

1. Paracentesis or thoracentesis; or

2. Appropriate medically acceptable imaging or physical examination and one of the following:

a. Serum albumin of 3.0 g/dL or less; or

b. International Normalized Ratio (INR) of at least 1.5.

This listing will apply to an individual who is showing evidence of advanced liver disease as fluid in the abdominal cavity (ascites) or lung (hydrothorax) is most often caused by cirrhosis of the liver. This condition can be seen on physical examination and confirmed with supporting lab work both of which are inexpensive non-invasive and more likely to show up in the medical evidence of record than the prior criteria (liver biopsy or PTT). The physical examination and accompanying lab work should be requested when there is evidence of liver disease and symptoms suggestive of increased severity and limited access to treatment. Serum albumin is part of the standard liver panel and even if the INR is not included 5.03F3 includes a decreased platelet count (PLT) in the list of laboratory findings associated with chronic liver disease at 5.00F3c. As such the PLT can substitute for an INR to equal the listing.

One could also still argue the old criteria of 5.05F3 equals new 5.05B because the combination does still indicate a severe liver disorder even if individually each finding was a poor indicator of severity. Many medical experts would likely agree as they are still familiar with old listing 5.05F3.