INFLAMMATORY BOWEL DISEASE & DISABILITY BENEFITS

QUALIFYING FOR SSD BENEFITS WITH INFLAMMATORY BOWEL DISEASE

Living with Inflammatory Bowel Disease can make it very difficult to work. If you can’t keep a job due to the symptoms of Inflammatory Bowel Disease (IBD), then you may qualify for Social Security Disability benefits. The Social Security Administration (SSA) recognizes the serious nature of IBD and includes it in its Listing of Impairments.

The process of filing for SSD benefits can feel overwhelming, especially when dealing with a painful medical condition. IBD often involves emergency hospital visits, medications, and testing. Many people who suffer from IBD do not realize they may meet the SSA’s definition of disability. Others may assume they have to wait until their disease is completely out of control before filing an application for benefits. Neither assumption is correct. If your IBD lasts or is expected to last at least twelve months and prevents you from working, then you may qualify for benefits now.

Our SSD law firm has helped over 20,000 clients win their SSD benefits. This includes many people who suffer from severe bowel diseases. This blog will explain how to qualify for benefits for IBD under Listing 5.06. It will discuss what evidence you need to provide to the SSA. Also, this article will discuss what to do if you do not meet the listing but are still unable to work. Understanding the SSA’s rules will help you build a strong case and increase your chances of approval. Likewise, hiring the best SSD law firm triples your chance of being awarded benefits.

TWO FORMS OF SOCIAL SECURITY BENEFITS

There are two forms of benefits for which you can file an application: Social Security Disability benefits and Supplemental Security Income benefits. You can file an application online at the Social Security’s website. Below, you can find an explanation as to each type of benefit:

Social Security Disability Insurance (SSDI):  

SSDI benefits are for those who have worked and can no longer work at any job due to a medical condition. The amount of money you receive in SSDI benefits is based on the Social Security taxes you paid during your work history. To qualify for SSDI benefits, you must have 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 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, then you can only apply for Supplemental Security Income benefits.

Supplemental Security Income (SSI):  

SSI is a needs based benefit. It is for those people with little to no income, such as children and the elderly. Anyone who makes greater than a certain income per month cannot receive SSI benefits. The SSA counts the income of those in your home with whom you share expenses, not just your income and assets.

If you have a spouse who earns more than $5000 a month, for example, then that income will prevent you from getting SSI benefits. You cannot qualify for SSI benefits, no matter how severe your medical condition, if you do not meet the income and asset rules for SSI.

UNDERSTANDING INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Disease is a term that includes two primary medical conditions: Crohn’s disease and ulcerative colitis. Both conditions involve chronic inflammation of the gastrointestinal tract. However, they affect the body differently. Crohn’s disease can impact any part of the digestive system, from the mouth to the anus. It often involves deep, patchy areas of inflammation that penetrate multiple layers of the intestine wall. Ulcerative colitis, by contrast, is confined to the colon and rectum.

These diseases are thought to result from an inappropriate immune response. While the exact cause is unknown, environmental triggers and an abnormal immune system response play a role. IBD is a condition marked by periods of exacerbation and remission. During episodes, patients may experience severe pain, diarrhea, bleeding, weight loss, and extreme fatigue. These symptoms can interfere not only with daily activities but also with the ability to work consistently.

Many people with IBD require drugs or steroids to control IBD. These medications can have side effects of their own. Those effects include increased risk of infection, bone loss, and liver problems. In some cases, surgery is needed to remove damaged portions of the intestine. Complications from IBD can include abscesses, bowel obstruction, fistulas, and malnutrition. All of these consequences may make it impossible for a person to work.

MEETING LISTING 5.06 FOR INFLAMMATORY BOWEL DISEASE

To qualify for SSD benefits under the listing in SSA’s Blue Book, you must prove your medical condition has all of the elements in the listing. For Inflammatory Bowel Disease, the listing is 5.06. This listing is highly specific. To qualify under it, you must provide medical evidence that your inflammatory bowel disease has led to serious issues, despite treatment.

The SSA requires that your diagnosis of IBD be supported by findings from endoscopy, biopsy, or other acceptable imaging. Once the diagnosis is confirmed, you must also prove you have either recurring intestinal obstructions that require hospitalization. Then, you must prove that you suffer from multiple systemic symptoms and complications within a six month period. These can include severe anemia, low serum albumin, a  tender abdominal mass with pain, draining abscesses or fistulas, significant weight loss, or the need for feeding support.

Meeting this listing is difficult for many people because it requires a high degree of medical documentation. Hospital visits, lab results, surgical records, and progress notes are all necessary to prove that your condition is severe enough to satisfy the listing. In many cases, you may experience intense symptoms but fall short of meeting the exact criteria. That does not mean you are not disabled. If your condition does not meet the listing, then the SSA will evaluate whether your condition equals a listing.

THE DETAILS OF SSA LISTING 5.06 

5.06  Inflammatory bowel disease (IBD) documented by endoscopy, biopsy, imaging, or operative findings, and demonstrated by A, B, or C:

A. Obstruction of stenotic areas (not adhesions) in the small intestine or colon with proximal dilatation, confirmed by imaging or in surgery, requiring two hospitalizations for intestinal decompression or for surgery, within a consecutive 12 month period and at least 60 days apart.

OR

B. Two of the following occurring within a consecutive 12 month period and at least 60 days apart:

1. Anemia with hemoglobin of less than 10.0 g/dL, present on at least two evaluations at least 60 days apart; or

2. Serum albumin of 3.0 g/dL or less, present on at least two evaluations at least 60 days apart; or

3. Clinically documented tender abdominal mass palpable on physical examination with abdominal pain or cramping; or

4. Perianal disease with a draining abscess or fistula; or

5. Need for supplemental daily enteral nutrition via a gastrostomy, duodenostomy, or jejunostomy, or daily parenteral nutrition via a central venous catheter.

OR

C. Repeated complications of IBD, occurring an average of 3 times a year, or once every 4 months, each lasting 2 weeks or more, within a consecutive 12 month period, and marked limitation in one of the following:

1. Activities of daily living; or

2. Maintaining social functioning; or

3. Completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

TREATMENT FOR INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Disease is a chronic illness that usually requires treatment for life. Most people with IBD start with medications. These include drugs like steroids. If those do not work, doctors may prescribe stronger drugs that weaken the immune system. These medications can help control symptoms, but they also come with serious side effects. Side effects include infections, fatigue, weight changes, bone loss, and problems with the liver or kidneys.

Some people also take newer medications that target parts of the immune system. These drugs are often given through infusions at the hospital. While they can help some people, they do not work for everyone. Many people still have symptoms like diarrhea, pain, and urgency even while on treatment.

Sometimes IBD becomes so severe that you need surgery. Surgery may remove damaged parts of the digestive system or treat problems like infections. Even after surgery, you may still need medication and ongoing care.

The SSA wants to see that you are doing everything you can to treat your condition. But treatment does not always lead to improvement. If your IBD keeps you from working despite following your treatment plan, then you may still win SSD benefits. It is important that your records show what treatments you have tried and how those treatments have failed to control your symptoms.

DOCUMENTING YOUR IBD

The SSA places heavy emphasis on medical evidence. To qualify for SSD benefits, you must have consistent treatment records that document the progress of your disease and your response to treatment. This includes not only the notes from your doctor, but also records from hospital visits, surgeries, lab work, and imaging studies. The more detailed your medical file is, the stronger your claim.

For example, a single lab report showing low hemoglobin may not be enough unless it is part of a pattern over time. The SSA wants to see that your symptoms are severe and not responding to treatment. That means you must continue to follow your treatment plan and attend your appointments. If you stop treatment or fail to follow medical advice without a good reason, then your claim may be denied.

Keeping a symptom diary can be helpful, especially if your disease flares. Noting the frequency of bathroom trips, level of pain, weight changes, and fatigue can support your hearing testimony. Make sure your doctors document all of your symptoms in the medical record. If they don’t, then the SSA may assume your condition is under control. Communication with your medical team is essential.

FUNCTIONAL CAPACITY AND IBD

If your IBD disease does not meet a listing, thenit is possible for the combination of your symptoms to equal a listing. Under another kind of analysis, a judge looks at all of your medical conditions and determines whether they are severe enough to equal a listing. If not, then the judge will determine your residual functional capacity (RFC).

Your physical RFC is what you can physically do during an eight hour workday. The judge will determine how many pounds you can lift and how long you can sit and stand. The judge will also consider how often you need to lie down due to pain. Also, the judge will ask if you need to take extra breaks during the course of a workday.

There are many types of evidence you can submit to the SSA to prove your RFC. For example, you could have your doctor write a letter about your ability to lift, sit, stand, walk, etc.. Another way to prove that you cannot work an eight hour day is to submit employer records that show you took extra breaks during your shifts. Or, that you lost your job because you were absent due to your IBD symptoms.

YOUR DOCTOR CAN HELP PROVE YOUR RFC

The SSA is going to read your medical records and define what they think you can physically do in an 8 hour day. The RFC defines your limits after taking into account all of your medical conditions. They will decide, based upon your testimony and medical records, what type of work you can do.

In terms of mental limits, the SSA will determine if you have trouble with memory, focus, or learning new tasks. Additionally, your mental condition can impact your ability to use your skills, such as reading or doing math. Mental illness can also impair your ability to get along with other workers, your boss, or the general public.

It will help you if your doctor also submits an RFC form for you. An RFC form can be about your physical limits and also about mental limits. The main thing to keep in mind is that the medical evidence must support the opinion of your doctor. For example, progress notes from the doctor must show the same limits as those on your RFC form. If the RFC form is different from the progress notes, then the SSA will refuse to give weight to the opinion of your doctor.

WHY SOCIAL SECURITY DENIES INFLAMMATORY BOWEL DISEASE CASES

Many people with IBD are denied SSD benefits, especially at the initial level. One of the biggest reasons is lack of medical evidence. IBD may come and go, so if your medical records don’t show how often you have attacks or how severe they are, then the SSA may think you can still work.

Another reason for denial is the lack of objective testing. Social Security wants to see lab results or imaging, not just a report of symptoms. Tests that show anemia, low albumin, or weight loss are stronger than just saying you feel tired or have pain.

If you miss doctor visits or stop taking your medication, your claim can also be denied. The SSA may assume your condition isn’t serious or that you’re not following your treatment plan. But if you can’t afford treatment or had side effects, be sure that’s in your records.

Finally, claims are often denied because the SSA believes you can still do a simple desk job. Even if you can’t do your old job, they may say you can do something easier. To fight that, you need strong medical evidence that shows you can’t work a full day or keep regular attendance. That kind of proof is key to winning at your hearing.

HIRE OUR EXPERIENCED SSD LAW FIRM TO HELP YOU WIN BENEFITS

If you are suffering from Inflammatory Bowel Disease and cannot work, then hiring an SSD attorney can triple your chances of winning benefits. The five step SSD review process is complex, and many valid claims are denied simply because the medical records do not contain the right information. An attorney who understands how the SSA evaluates IBD claims can guide you through every step of the process.

At our SSD law firm, we begin by asking you about your condition. Next, we read your medical records. Then, we identify whether you meet the criteria for Listing 5.06. If you do, then we will ensure that all necessary test results, imaging reports, and treatment records are part of your file. If your condition does not meet the listing but is still severe, we will develop evidence to demonstrate how your IBD affects your ability to work on a consistent basis. We will also gather written opinions from your medical providers, using SSA-approved forms, to describe your physical and functional limitations.

When your case proceeds to a hearing before an Administrative Law Judge, we will prepare you so you can testify with confidence. We will explain what questions the judge is likely to ask, help you describe your symptoms in concrete terms, and work with you to present your daily challenges in a way that supports your legal claim. If necessary, we will question the experts at the hearing and present closing arguments that highlight the medical evidence.

Throughout the process, we will ensure that your case complies with SSA regulations and deadlines. We will also communicate with the hearing office, submit legal briefs, and handle any appeals if your case is denied. Our goal is to help you obtain the benefits you deserve so you can focus on managing your health.