CHRONIC LIVER DISEASE & DISABILITY
WHAT IS CHRONIC LIVER DISEASE?
Chronic liver disease is a medical condition that affects the structure and function of your liver. Over time, damage and inflammation of your liver cells leads to liver damage. There are a number of causes of chronic liver disease. These include viral infections, such as Hepatitis B and C, drinking too much alcohol, non-alcoholic fatty liver disease (NAFLD), and genetic disease.
Chronic liver disease can lead to medical problems, such as cirrhosis, liver fibrosis, and liver cancer. These medical issues impact your liver’s ability to perform its vital functions. For example, your liver detoxifies harmful substances and produces bile. It also stores vitamins and minerals and controls the clotting of your blood. Additionally, viral hepatitis also contributes to chronic liver disease. Chronic hepatitis C, for example, affects almost 2.4 million people in the United States.
According to the Centers for Disease Control and Prevention (CDC), there has been an increase in chronic liver disease in recent years. For example, NAFLD, which occurs along with obesity and metabolic syndrome, is currently the leading cause of chronic liver disease in the United States. It is estimated that 25% of the population in the US has NAFLD.
SYMPTOMS OF CHRONIC LIVER DISEASE
Symptoms of chronic liver disease depend on the cause and the stage of the disease. However, common symptoms usually include:
- Fatigue and weakness: Chronic liver disease can lead to a feeling tired and weak. You could have a lack of energy that impacts your ability to do your daily activities.
- Jaundice: Jaundice occurs when there is a buildup of bilirubin, a yellow pigment that is produced when red blood cells break down. Your eyes and skin turn yellow because the liver is unable to process bilirubin properly. Jaundice is one of the first signs of liver disease.
- Abdominal pain: People with chronic liver disease may experience pain in the upper right side of the abdomen. The pain is caused by an enlarged liver or too much fluid in the abdomen, which is ascites.
- Easy bleeding: The liver plays a crucial role in the clotting of your blood. When the liver is damaged, clotting factors may be impaired. This leads to easy bruising, bleeding, and nosebleeds.
- Itchy skin: Accumulation of bile salts in your blood due to liver dysfunction can cause itchiness. The skin may become dry, itchy and painful.
- Changes in brain function: Liver disease can affect your brain function, leading to hepatic encephalopathy, which is brain damage. This can cause confusion, trouble with concentration, memory problems, personality changes, and in severe cases you can go into a coma.
- Fluid retention: As liver disease gets worse, fluid can cause your legs and abdomen to swell.
It’s important to note that not everyone with chronic liver disease will experience all of these symptoms. Some people may have no symptoms at all, especially in the early stages of the disease.
TREATMENT OPTIONS FOR CHRONIC LIVER DISEASE
The treatment for chronic liver disease depends on the cause and the stage of your liver disease. The main goals of treatment are to slow down liver damage. Also, treatment should manage your symptoms and prevent further damage. Here are some common treatments:
With viral hepatitis your doctor may give you medications for chronic hepatitis B or C infections. These medications reduce viral replication and slow down liver damage.
If you have alcohol related liver disease, then you must stop drinking. Abstinence from alcohol is crucial to prevent further liver damage. Supportive therapy, such as rehabilitation programs, may help you quit drinking.
Autoimmune hepatitis can be handled with medications. These medications may prevent immune system attacks on the liver.
Non-alcoholic fatty liver disease (NAFLD) is a disease that is treated with changes in your habits. For example, you should loss weight, exercise, and eat a healthy diet.
OTHER TREATMENT OPTIONS FOR LIVER DISEASE
There are other treatment options available for you liver disease. Below you will find some of the most common treatments:
- Medications: Various medications may help you handle the symptoms of chronic liver disease. These may include medications to control high blood pressure, reduce fluid retention, manage itching skin, or address other specific issues.
- Nutrition: A healthy diet that is low in sodium and fat will support your liver health and manage issues like ascites and malnutrition. In some cases, your doctor may provide a specific diet to help you.
- Liver transplant: In cases of severe chronic liver disease, where your liver function cannot be managed, a liver transplant may be the best course of action. This means the doctor is operating to remove your diseased liver and giving you a healthy liver from a donor.
It is important for you to get medical treatment from a doctor when you have chronic liver disease. Regular monitoring, doctor visits, medications and habit changes are crucial for dealing with chronic liver disease.
APPLY FOR SSD BENEFITS FOR CHRONIC LIVER DISEASE
If you have chronic liver disease, then there are two types of benefits you can file for under the Social Security program: Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. In order to receive benefits, you must first file an application. You can do this online at Social Security’s website. Below, please find an explanation as to each type of benefit you can apply for:
Social Security Disability Insurance (SSDI):
SSDI benefits are for those who have worked in the recent past and can no longer work at any job due to a medical condition. The amount of money you will receive from SSDI benefits every month is based on how much Social Security tax you have paid during your work history. To qualify for SSDI, you must have earned enough “work credits“. A work credit is an amount of taxable income. You can earn up to 4 work credits per year. The amount of work credits you will need will depend on how old you are when you apply. If you haven’t earned enough work credits for your age at the time you apply, you will only qualify for Supplemental Security Income benefits.
Supplemental Security Income (SSI):
SSI is a needs based benefit and it is for those people with little to no income, such as children and the elderly. Anyone who makes more than a certain amount of money per month cannot receive SSI benefits. The SSA counts the income of those in your house, not just your income. If you have a spouse who earns more than $4000 a month, for example, then that income will be the factor in whether you can receive SSI benefits. You cannot qualify for SSI benefits, no matter how severe your liver disease, if you do not meet the income and asset rules for SSI.
SSA’S LISTING 105.05 FOR CHRONIC LIVER DISEASE
The following listing shows you what elements you need in order to meet SSA’s listing 105.05. You must have all of the elements in order for the SSA to pay you benefits.
105.05 Chronic liver disease, with:
A. Hemorrhaging from esophageal, gastric, or ectopic varices or from portal hypertensive gastropathy, demonstrated by endoscopy, x-ray, or other appropriate medical imaging, resulting in hemodynamic instability, and requiring hospitalization for transfusion of at least 10 cc of blood/kg of body weight. Consider under a disability for 1 year following the last documented transfusion. After that, evaluate the residual impairments.
OR
B. Ascites or hydrothorax not attributable to other causes, despite continuing treatment as prescribed, present on at least two 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 medical imaging or physical exam 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.
OR
C. Spontaneous bacterial peritonitis with peritoneal fluid containing an absolute neutrophil count of at least 250 cells/mm3.
OR
D. Hepatorenal syndrome as described in 105.00D8, with one of the following:
1. Serum creatinine elevation of at least 2 mg/dL; or
2. Oliguria with 24-hour urine output less than 1 mL/kg/hr; or
3. Sodium retention with urine sodium less than 10 mEq per liter.
OR
E. Hepatopulmonary syndrome as described in 105.00D9, with:
1. Arterial oxygenation (PaO2,) on room air of:
a. 60 mm Hg or less, at test sites less than 3000 feet above sea level, or
b. 55 mm Hg or less, at test sites from 3000 to 6000 feet, or
c. 50 mm Hg or less, at test sites above 6000 feet; or
2. Documentation of intrapulmonary arteriovenous shunting by contrast-enhanced echocardiography or macroaggregated albumin lung perfusion scan.
OR
F. Hepatic encephalopathy as described in 105.00D10, with 1 and either 2 or 3:
1. Documentation of abnormal behavior, cognitive dysfunction, changes in mental status, or altered state of consciousness (for example, confusion, delirium, stupor, or coma), present on at least two evaluations at least 60 days apart within a consecutive 6-month period; and
2. History of transjugular intrahepatic portosystemic shunt (TIPS) or any surgical portosystemic shunt; or
3. One of the following occurring on at least two evaluations at least 60 days apart within the same consecutive 6-month period as in F1:
a. Asterixis or other fluctuating physical neurological abnormalities; or
b. Electroencephalogram (EEG) demonstrating triphasic slow wave activity; or
c. Serum albumin of 3.0 g/dL or less; or
d. International Normalized Ratio (INR) of 1.5 or greater.
OR
G. End Stage Liver Disease, with:
1. For children 12 years of age or older, SSA CLD scores of 22 or greater calculated as described in 105.00D11a. Consider under a disability from at least the date of the first score.
2. For children who have not attained age 12, SSA CLD-P scores of 11 or greater calculated as described in 105.00D11b. Consider under a disability from at least the date of the first score.
OR
H. Extrahepatic biliary atresia as diagnosed on liver biopsy or intraoperative cholangiogram. Consider under a disability for 1 year following the diagnosis. Thereafter, evaluate the residual liver function.
HOW DOES THE SSA EVALUATE CHRONIC LIVER DISEASE?
Chronic liver disease is liver cell necrosis, inflammation, or scarring of the liver due to any cause that persists for more than 6 months. Chronic liver disease may result in portal hypertension, cholestasis, extrahepatic manifestations, or liver cancer.
Significant loss of liver function may occur along with hemorrhage from varices or portal hypertensive gastropathy, ascites, hydrothorax, or encephalopathy. There can also be lab findings that are indicative of liver disease. Liver transplant is the only cure for end stage liver disease.
Examples of chronic liver disease include, biliary atresia, chronic hepatitis, non-alcoholic steatohepatitis (NASH), primary biliary cirrhosis (PBC), autoimmune hepatitis, hemochromatosis, drug-induced liver disease, Wilson’s disease, and serum alpha-1 antitrypsin deficiency.
SYMPTOMS OF CHRONIC LIVER DISEASE
According to the SSA, liver disease symptoms may include itching, fatigue, nausea, loss of appetite, and sleep trouble. Children with liver disease can have developmental delays or poor school performance. Symptoms of chronic liver disease may have a poor correlation with the severity of liver disease. Signs may include, jaundice, enlargement of the liver and spleen, ascites, peripheral edema, and altered mental status.
Laboratory findings may include high liver enzymes, high serum total bilirubin, increased ammonia levels, decreased serum albumin, and abnormal coagulation studies, such as a high International Normalized Ratio (INR) or decreased platelet counts.
A liver biopsy may show the degree of liver cell necrosis, inflammation, fibrosis, and cirrhosis. If you have had a liver biopsy, then the SSA should review those results. However, they will not purchase a liver biopsy. Imaging studies (CAT scan, MRI) may show the size of the liver and document ascites.
GASTROINTESTINAL HEMORRHAGE AND LIVER DISEASE
Gastrointestinal hemorrhaging can result in vomiting of blood, tarry stools, or bloody stools. Under 105.02, the listing requires transfusions of at least 10 cc of blood/kg of body weight. And those transfusions must be at least 30 days apart. They must also occur at least three times during a consecutive 6 month period. If you have three fusions in a 6 month period, then the SSA will consider you eligible for benefits for 1 year following the last documented transfusion. After that, they will evaluate your liver condition.
Under 105.05A, hemodynamic instability occurs with signs such as pale skin, profuse sweating, rapid pulse, low blood pressure, postural hypotension or fainting. Hemorrhaging that results in hemodynamic instability is life threatening. Therefore, it requires going to the hospital for a blood transfusion and care. Under 105.05A, the SSA only requires one hospitalization for transfusion of at least 10 cc of blood/kg of body weight.
HEPATIC ENCEPHALOPATHY AND LIVER DISEASE
Hepatic encephalopathy is brain damage and it shows severe loss of liver function. The SSA defines hepatic encephalopathy as a chronic mental condition. It occurs along with abnormal behavior, cognitive issues, altered state of consciousness, and ultimately coma and death.
The diagnosis is shown by changes in mental status along with neurological signs, including “flapping tremor,” EEG abnormalities, or lab values that show loss of synthetic liver function. The SSA will not purchase the EEG testing described in 105.05F3b. However, if you have an EEG test at a time relevant to your SSD claim, they will make every reasonable effort to obtain the report to decide whether your liver disease meets listing 105.05F.
Make sure that you find a doctor who will submit all of the records to the SSA. Don’t make the mistake of failing to tell your doctor that you are filing for SSD benefits. You will need the support of your doctor to win your benefits.
HIRE US TO WIN SSD BENEFITS FOR LIVER DISEASE
Obviously, the symptoms of chronic liver disease disease can be hard to document and will require medical records. Therefore, many people who file Social Security applications for it are denied after they apply for benefits. In fact, only 30 percent of initial SSD applications are paid without the need for an appeal. The remaining 70 percent of people must go through the appeals process in order to win benefits.
The appeals process includes three steps. First, there is the initial application. If you lose there, you can request a new review. Finally, the third step is to request a hearing. Find out what happens at the SSA hearing.
You should not go to a hearing without an attorney. At the hearing, the judge is likely to call witnesses to testify. For example, the judge may call a vocational expert (VE) or a medical expert (ME). The ME is there to testify about your medical records. Likewise, the VE is at the hearing to testify about your past work. Also, the VE will testify about your ability to do other jobs in the national economy.
In order to win your case, you have to question these experts. This is a job for an attorney. One who has experience in Social Security Disability law. Don’t leave your future to chance. Hire an attorney to help you.
LIVER DISEASE & RESIDUAL FUNCTIONAL CAPACITY (RFC)
If you don’t meet listing 105.05, you can still win SSDI and SSI benefits through the SSA’s other rules. These rules takes your liver disease symptoms, other medical conditions, your age, work history, skills, and education into account.
When the SSA decides your residual functional capacity (RFC), they use your statements on the forms you fill out for them. For example, when you fill out forms about your past work, you state how much you had to lift on the job and how also tell them how much you stood or sat during a work day.
Your answers on these forms are often some of the most important statements you make. If you state on your Work History form that you lifted nothing on the job, then that is what the SSA assumes is correct. Frankly, there are no jobs where you lift “nothing.” But for some reason, many people write that down as an answer. Even desk jobs require some lifting. You might, for example, lift files, boxes of paper, books, or supplies. Tell the SSA about the amount of weight you lifted on the job.
Think about it. Failing to tell the SSA about the lifting you had to do at your past jobs, makes it easier for them to return you to your past jobs. In other words, you are making it easier for them to deny your case.
THE MEDICAL EXPERT TALKS ABOUT YOUR LIVER DISEASE
Medical Experts (ME) often testify at Social Security hearings. They are called by the ALJ to review your medical records for chronic liver disease. Also, they explain your medical conditions to the judge. Additionally, they testify as to whether or not your medical condition meets or equals an SSA listing, like 105.05. Similarly, an ME can be requested by your attorney. This is, however, mostly done in complex medical cases.
The medical expert who appears at the hearing is not your treating doctor. The doctor at the hearing must have never met you before. Because, the medical expert is there to give testimony about your medical records and should not be for either side of the case.
Medical experts are doctors who the SSA calls to testify about your liver disease at the hearing. Usually, the medical expert comes to the hearing. However, they can also testify by video or by telephone.
It is also possible for an ME to answer written questions after the hearing. These written questions are sent to the expert. The ME’s answers require review and possibly filing objections. If you do not know how to do this, then hire an attorney. Do not make the mistake of failing to prepare for the medical expert.
THE VOCATIONAL EXPERT AT YOUR HEARING
The VE is also an expert witness, just like the medical expert. Normally, the Social Security Judge calls a VE to testify at the hearing. The Judge calls the expert to talk about jobs that are available to you based upon your ability. VEs have training in placing people in jobs. They also understand the numbers and types of jobs that exist in the nation. They are at the hearing in order to answer questions about jobs in the national economy.
Once the Judge asks you questions about your medical conditions, she will decide what you are capable of doing during an 8 hour work day. The SSA calls this your RFC. Your RFC what you can physically do throughout an 8 hour work day. Therefore, your answers to the questions at the hearing are very important. Just as the important as the medical records you submit.
The Judge listens to your hearing testimony and the takes the symptoms from your medical records to determine how your liver disease symptoms impact you on the job. At the end of your hearing, the Judge will ask the VE questions. Likewise, your attorney will also ask questions. Your attorney can also question the VE. Often it is VEs testimony that determines whether you win or lose your SSD benefits.
HEARING QUESTIONS FOR THE VOCATIONAL EXPERT
The Judge will ask questions to the VE about whether or not a person with your liver disease can work. Typically, the Judge will use three to four different questions. These questions can include many different symptoms from your liver disease.
For example, the Judge may ask if pain makes it so you cannot concentrate on the job, can you do a simple job. Or, the Judge may ask what kind of work would be available to a person who cannot lift more than 20 pounds. The Judge’s questions will include your RFC. Learn about your RFC.
Once the Judge is done asking questions, then your attorney has the right to question the VE. For those who do not hire an attorney, they must ask the VE questions on their own. Obviously, most people do not know what questions to ask. Mostly, they don’t know because they have never been to a hearing. Nor do they have the training they need in order to understand the VE’s answers.
Vocational experts testify about what kinds of jobs are available to you. However, they also testify as to the number of jobs that exist in the national economy. For example, a VE may testify as to whether your work skills can be used in other work. They will also testify about the specific jobs in which you skills can be used.
A VE may also testify as to the effects of other medical conditions on the range of work you can do. Likewise, the VE can testify about the erosion of the job base due to your liver disease. An attorney is crucial for this portion of the hearing.
WHAT WE DO TO HELP YOU WIN SSDI AND SSI BENEFITS
If you have chronic liver disease, then you need to apply for Social Security benefits. You can always call our law firm and we will help you. We can help you file your application. Also, we can help you appeal every SSA denial. For example, our attorneys and staff can:
- Send you the paperwork you need to become our client
- Help you file your application for SSDI and SSI benefits
- Inform the SSA they should pay your benefits under the Compassionate Allowance Rules
- Appeal if you receive an initial denial
- Help you confirm your SSA doctor exam
- Request a Hearing with an Administrative Law Judge
- Prepare you to testify at your ALJ hearing
- Represent you at your hearing and question the expert witnesses
- Read about job expert testimony
- Learn about medical expert testimony
- Request review of an SSA decision with the Appeals Council
- Request review of an Appeals Council denial in Federal Court
If you file your application for benefits online at Social Security’s website, then you have 6 months to complete the application. Once you submit your application online, the SSA sends you an application summary in the mail. You must sign the summary and mail it back. If you don’t send it back, the SSA will not process your application. Sign it and send it back as soon as you can.
WHAT DOES IT COST TO HIRE OUR LAW FIRM?
Another important factor to consider is what it costs to hire an attorney. At our law firm, you do not pay an attorney fee until we win your case. The attorney fee comes out of your past due SSD benefit. If we do not win your case, then you will not owe an attorney fee.
Review this, if you have questions about the wait time for the SSA’s decision. We offer a “no win, no fee” payment policy. This means that you will only pay an attorney fee if we win your case. Learn information about attorney fees in disability cases. Everyone on our legal team are Social Security law experts. You can trust us to help you win benefits if you are not able to work.
How much is the attorney fee? It is 25% of your back benefit. But, the fee is capped at $9200. You do not pay more than the cap. If you win, you will pay either 25% of the back benefit or the $9200 cap. You pay whatever is the lesser amount. For example, if your back benefit is $100,000, our attorney fee would be $9200, not $25,000. Or, if your benefit is $10,000, then you would pay 25% of the back benefit. That would be $2500.
If there are costs in your case, then you pay for those costs. However, the costs are minimal. For example, you must pay for a copy of your medical records. The medical record costs whatever your doctor charges for them. You owe costs whether we win or lose your case. But, to hire most lawyers, you have to pay an attorney fee upfront. That doesn’t happen when you hire our law firm to help you win SSDI and SSI benefits.
WHAT WILL IT COST YOU IF YOU DON’T HIRE THE RIGHT LAWYER?
What will it cost you if you don’t hire an experienced lawyer to win your benefits? Let’s look at one example of an average person who wins SSD benefits. If you win benefits at 50 years old, then you will be paid SSD for the next 17 years, until you reach age 67. You may also win two of years of past due benefits. Therefore, if you are 50 years old, you are looking at winning 19 years of SSD payments.
Nineteen years is is 228 months. At $1200 a month (which is a lower than average monthly benefit amount), that is $273,600. Additionally, you will win a higher retirement benefit after the age of 67. Let’s say the average higher retirement benefit is $300 a month and you live to be 90 years old. That is another $82,800.
It costs 25% of your back benefit OR $9200 from your back benefit to pay your attorney. You pay us whatever is less and only if you win. If you win your case, then your attorney has just won you $356,400, plus early Medicare benefits. You attorney will be paid $9200 and you will be paid $349,200.
All attorneys charge the same fee. So, you can go it alone and not hire an attorney, but chances are you will lose your future and past benefits. Or, you can hire an attorney with over 30 years of experience and win $349,200. The choice is yours. But, we hope you can see that the cost of a lawyer with 30 years experience will be worth it for you.
WE ONLY PRACTICE SOCIAL SECURITY LAW
There are many law firms that claim they practice Social Security law. However, most of those firms do other types of cases. For example, some firms practice personal injury or Worker’s Compensation law. We don’t do that.
Our firm only takes SSDI and SSI cases. We don’t practice any other kind of law. Our firm believes it is important to focus on Social Security cases. By doing so, we have become experts in Social Security benefits. During our time in practice, we have also become familiar with many of the medical conditions that keep people from working. We have won thousands of cases for more common conditions, like spinal disease. But we have also won cases for rare conditions, such as Hypoplastic Left Heart Syndrome (HLHS).
It is hard to trust your future to a lawyer. We understand. That is why we include information about our attorneys on our website. Dianna Cannon has been helping people win benefits for the past 30 years. She has written a book about Social Security law for other lawyers. Brett Bunkall and Andria Summers have over 30 years of legal experience. They work hard for our clients every day. Find out about our lawyers and staff on our About Us page.
HIRE US FOR OUR YEARS OF LEGAL EXPERIENCE
If you have liver disease, then you should hire our law firm to help you win your SSD benefits. Hire us. We are one of the best Social Security law firms in the country. For example, our firm is one of the best Social Security benefits firm in Las Vegas, Nevada. Also, we are the best Social Security law firm in Salt Lake City, Utah.
Learn about Utah SSD benefits. Nevada SSI Information is available for you. We also represent clients in Idaho. Review information about Idaho benefits. Find out about Colorado SSDI benefits. Likewise, if you are from California, then review California SSD & SSI information.
Over the last 30 years, we have won thousands of SSDI and SSI claims. Additionally, we have won over $100 million in SSD and SSI benefits for our clients. It has become more difficult to win Social Security cases. Also, SSA’s listing rules are harder to meet. That is why you need an attorney who will help you win your case.
We recommend you do not go to your hearing without an attorney. Why? Because a lawyer can prepare you for your hearing. She can explain the judge’s questions. Preparation will help you win your case.
Those who come to the hearing without counsel are usually not successful in winning benefits. You should hire an attorney who has legal experience winning SSD and SSI benefits. Contact us today. We can help you win benefits for chronic liver disease. Call now and put our legal experience to work for you.
