How to Get Disability Benefits for Crohn’s Disease

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Crohn’s disease causes inflammation deep in the layers of the intestinal wall and throughout the gastrointestinal track. Sufferers may experience chronic diarrhea, rectal bleeding, fevers, weight loss, fecal incontinence and abdominal pain. Many Crohn’s patients also experience problems in areas outside the intestinal track, including arthritis, kidney disease, and disorders of the eye and skin. The SSA will consider all of your Crohn’s related symptoms when determining your eligibility for disability. 

The exact cause of Crohn’s disease is unknown though scientists believe genetics, the environment, and the patient’s own immune system play a large role. 

Can I Get Disability for Crohn’s Disease?

You may be eligible for Social Security disability benefits based on your Crohn’s disease. The Social Security Administration (SSA) has a multi-step evaluation process. First, the SSA will determine whether you are working at the Substantial Gainful Activity (SGA) level; in 2013, SGA level if $1,040 per month. If you are earning $1,040 or more per month, the SSA will deny your claim. The SSA must also determine whether your Crohn’s disease is expected to last at least a year; because Crohn’s is a life-long disease, this requirement is easily satisfied. The SSA will next determine whether your Crohn’s disease is “severe.” To be “severe,” your Crohn’s disease must substantially impact your ability to do basic work activities.    

At the next step, the SSA will look to see if your Crohn’s disease meets or equals one of the conditions set forth in the SSA’s Listing of Impairments. The SSA includes Crohn’s disease as a qualifying condition under listing 5.06, Inflammatory Bowel Disease.  If the SSA finds objective medical evidence in your medical record that demonstrates that your Crohn’s meets the criteria of listing 5.06, the SSA will automatically approve your claim for disability.

How Can I Qualify Under the Inflammatory Bowel Disease Listing? 

To meet listing 5.06, you must be diagnosed with inflammatory bowel disease (IBD)  and have documentation of one of the following:

Bowel obstruction. You must have an obstruction, other than just adhesions, of narrowed areas in the small intestine or colon, with dilation and swelling. The obstruction must be confirmed by medically acceptable imaging or by surgery and have required hospitalization or surgery to compress the intestines. The obstruction must have occurred at least twice, 60 days apart, within the same 6-month period.

OR

Other qualifying complications. You must have two of the following symptoms, despite adhering to your prescribed treatments. The two complications must happen within the same 6-month period.

  • Anemia with hemoglobin less than 10 g/dL in two blood tests at least 60 days apart
  • Serum albumin of 3.0 g/dL or less, after at least two blood tests at least 60 days apart
  • Tender abdominal mass felt on physical exam with abdominal pain or cramping that you cannot control with prescription pain medication, documented in two doctor visits at least 60 days apart
  • Perineal disease with a draining abscess or fistula, with pain that you cannot control with prescription pain medication, documented in least two doctor visits at least 60 days apart
  • Unintentional weight loss of at least 10 percent from your starting weight, documeted on two medical evaluations at least 60 days apart, or
  • Need for supplemental daily nutrition by a feeding tube in the stomach, nose, or small intestine, or by chest catheter.  

Even if your Crohn’s disease does not meet listing 5.06, you may still be found disabled under listing 5.08, weight loss due to digestive disorder.  

How Can I Qualify for Disability Under the Weight Loss Listing? 

If you have lost an excessive amount of weight because of your Crohn’s disease, you can be found disabled under listing 5.08.  To qualify under listing 5.08 you must show all of the following.

  • You have lost weight despite continuing treatment as prescribed by your doctor.
  • The weight loss resulted in a body mass index (BMI) of less than 17.50.
  • Your doctor has measured your weight on at least two occasions at least 60 days apart, within a 6-month consecutive period.

Learn more about medically qualifying for disability benefits.

What If I Don't Meet an SSA Listing?

Sometimes people with Crohn’s are too sick to work but don’t meet the SSA listing criteria for IBD or weight loss. In this case, you can still be approved for disability, but it may be more difficult. The SSA will look at your documented symptoms to determine at what level you can work: heavy work, medium work, light work, or sedentary work. This is called your residual functional capacity (RFC). The SSA will then evaluate whether you are able to do your past work with your RFC rating. If the SSA believes you can do your past work, your claim will be denied. 

If the SSA believes you are unable to do your past work, it will next consider your ability to learn and do other jobs given your RFC, and your age, education, and work background. Older, less educated people who worked more sedentary jobs are more likely to be approved at this stage.

To help the SSA assess your RFC correctly, it's helpful to provide the SSA with an analysis from your treating doctor(s) about how the Crohn’s affects your ability to work. Your doctor can fill out an RFC form to describe your limitations: how long you are able to sit, stand, walk, lift, carry, push and pull, and whether you are required to rest throughout the day and if you need frequent and unscheduled breaks. The more restrictions your RFC reflects, the more likely you are to be approved (but remember, your doctor’s opinion must always be supported by objective medical evidence).

Chronic illnesses like Crohn’s can also cause anxiety and depression. It's important to let the SSA know if you are under a doctor’s care for any emotional or mental problems. If you are seeing a psychiatrist or psychologist, you should request that the SSA do a mental RFC as well. A mental RFC will reflect your mental limitations, such as your ability to focus, follow directions, get along with others, and complete a task in an acceptable amount of time. A reduced mental RFC in combination with your physical RFC will limit the number of jobs you can be expected to do.    

What Medical Evidence Do I Need?

The more objective medical evidence you provide, the more likely the SSA is to find you disabled. You must provide copies of all tests performed that relate to your Crohn’s disease, such as blood and fecal occult tests, colonoscopy and endoscopy reports, MRIs, and CAT scans. You should also provide copies of the notes your doctor takes during your appointments, and any reports from surgeries or hospitalizations.

The SSA will only consider medical evidence from acceptable medical sources.  This includes licensed physicians (including osteopaths) and psychologist.  The medical evidence you provide should come from the doctor who treats your Crohn’s.  And although the SSA will consider evidence from a licensed general practitioner or your family doctor, it gives more weight to opinions and diagnosis that come from doctors who specialize in Crohn’s, such as gastroenterologists.

If you do not provide enough medical evidence for the SSA to make a decision, it may send you for a consultative examination (CE). Sometimes the CE is performed by the doctor who ordinarily treats you, but a CE may also be performed by another qualified physician.

by: , Contributing Author

This article is provided for informational purposes only. If you need legal advice or representation,
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