SHORT BOWEL SYNDROME & SSD
WHAT IS SHORT BOWEL SYNDROME?
Short bowel syndrome (SBS) is a medical condition that occurs when the small intestine is unable to absorb enough nutrients and fluids from the food you eat. It usually occurs because doctors have removed a large part of the small intestine. The small intestine is responsible for absorbing nutrients from food and breaking down liquids. If the small intestine cannot do this, then it can lead to serious problems with your health. For example, it can lead to malnutrition, dehydration, and weight loss. Additionally, without treatment, SBS can lead to severe complications such as liver failure or sepsis.
Around one million people in the United States alone have SBS, making it one of the most common intestinal diseases in the country. However, it is a rare disease worldwide. For example, throughout the world, only about 3 million people have the disease.
About 75% of cases of SBS develop after a single, massive resection of bowel. The remaining 25% occur after multiple resections. Around two-thirds of patients who develop SBS survive their initial hospital stay. A similar number survive their first year after getting short bowel syndrome. Your age and any other diseases you may have will determine your long term outcome if you have SBS.
CAUSES OF SHORT BOWEL SYNDROME
The main cause of short bowel syndrome, or short gut syndrome, is surgery to remove a portion of the small intestine. For example, a doctor could perform surgery to treat disease, injuries, or birth defects. Some children are born with an abnormally short small intestine or with part of their bowel missing, which can also cause SBS.
The conditions that lead to short bowel syndrome include:
- Congenital defects or problems due to early birth: Some children are born with defects in their intestines or experience gut problems from being born early.
- Crohn’s disease: Crohn’s disease inflammation can affect any part of your digestive tract, from your mouth to your anus. If Crohn’s disease damages your bowel, treatment can include removing sections of your small intestine.
- Vascular disease: Damage in your intestinal blood vessels can limit blood flow, leading to bowel injury.
- Cancer treatment: In order to remove tumors, a doctor may remove parts of your small intestine. Additionally, radiation therapy to treat cancer, can also damage your bowel.
SYMPTOMS OF SHORT BOWEL SYNDROME
It is important to know the signs and symptoms of short bowel syndrome so that you can seek medical care as soon as possible. Symptoms of SBS can depend on the severity of your condition. But, they usually include diarrhea, abdominal pain, nausea, weight loss, fatigue, and dehydration. If you do not get treatment, SBS can lead to other serious problems, such as liver failure or sepsis.
When you have short bowel syndrome, you may experience a number of symptoms. Each person experiences SBS differently. Your symptoms will depend on which area of your small intestine is affected.
These symptoms may include:
- Abdominal pain
- Bacterial infection
- Food allergy
- Low blood count (anemia)
- Oily or smelly stool
- Osteoporosis and bone pain
WHAT TESTS DIAGNOSE SHORT BOWEL SYNDROME?
There are many tests that your doctor might use to determine if you have short bowel syndrome.
- Abdominal CT scan: Using X-rays and special computer software, this test creates dimensional images of your intestines.
- Abdominal ultrasound: Using high-frequency sound waves, this imaging test examines organs and structures in your abdomen.
- Abdominal X-ray: A standard X-ray of your small intestine to look at problems or blockages.
- Bacterial overgrowth breath test: Examining gases in your breath can show whether you have a bacterial overgrowth in your intestines, which is common among people who have had bowel surgery or diseases that slow digestion, such as diabetes.
- Barium study: You drink a special chemical and track its journey down your intestinal tract, this produces sharp images of your bowels.
- Blood tests: Using a sample of your blood, the doctor may run a number of tests including a blood count, a kidney function panel, and albumin tests.
- Colonoscopy: Examining the entire length of your colon or just the lower part of your colon with the help of a small flexible tube and tiny camera that the doctor insert into your rectum.
- Fecal fat test: This test measures how much fat your body absorbs during digestion by measuring the amount of fat in your stool
- Stool culture: This test is a sample of your stool to test for bacteria, parasites, or viruses in your intestines. A stool culture test can also show microscopic amounts of blood, white blood cells, and evidence of food intolerances.
- Upper endoscopy: The doctor uses a small flexible tube and tiny camera to pass through your mouth and esophagus. The doctor looks at the lining of your stomach for ulcers, infection, and cancer. The doctor may also take a tissue sample and examine it under a microscope.
TREATMENTS FOR SHORT BOWEL SYNDROME
When you have short bowel syndrome, nutrition is an important part of your treatment. Doctors will help you have the best diet possible. Your diet may include:
- Medical nutrition therapy: There is no specific diet for people with SBS. A nutritionist can help you find foods that you like to eat and that your stomach can tolerate. They will design your diet to give you as much nutrition as possible.
- Multivitamins or mineral supplements: Taking vitamins or mineral supplements can help you replace lost nutrients.
- Supplemental nutrition: Your doctor can provide you extra nutrition through a special formula. Supplemental nutrition comes in many forms, including tube feeding.
- Total parenteral nutrition: You can also get all the nutrition you need from special fluids you receive through a catheter in your vein. Total parenteral nutrition can help you if your intestines need time to heal or your stomach has lost its ability to absorb nutrients from food eaten by your mouth. Those with greater than 180 cm of small bowel usually require no parenteral nutrition. For those with greater than 90 cm, they will usually require it for less than 1 year. Finally, those with less than 60 cm will usually require lifetime parenteral nutrition.
OTHER TREATMENTS FOR SHORT BOWEL SYNDROME
- Medication: Medication can help relieve your symptoms. This includes medications for diarrhea, which can slow the movement of food through your small intestine, so it has more time to absorb nutrients.
- Pain management: Pain management means that you go to a doctor who manages your medications, acupuncture, or even mental health needs, such as stress management.
- Ostomy: This creates an opening through the skin of your abdomen to allow elimination of stool without your colon.
- Bowel rehabilitation and transplant: Doctors offer therapy through bowel rehabilitation and transplant to help your body get the nutrients it needs when your intestines are no longer able to absorb nutrients from the foods you eat.
APPLY FOR SSDI & SSI BENEFITS FOR SHORT BOWEL SYNDROME
If you have short bowel syndrome, 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 if you have SBS:
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” to qualify. 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.
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 short bowel syndrome, if you do not meet the income and asset rules for SSI.
SSA’S LISTING 5.07 FOR SHORT BOWEL SYNDROME
Social Security’s listing for short bowel syndrome (SBS) is listing 5.07. According to listing 5.07, you meet this listing if you have surgical resection of more than one half of the small intestine and you are “dependent on daily parenteral nutrition via a central venous catheter.”
The management of SBS may require parenteral nutrition with a central line. Those with SBS can also feed orally, with nutrients being absorbed through their remaining intestine. Over time, some of these people can develop additional intestinal absorptive surface. Therefore, these people may eventually be able to wean off parenteral nutrition.
Your SBS will meet listing 5.07 as long as you depend on daily parenteral nutrition via a central line for most of your needs. To document SBS, the SSA will need a copy of the intestinal resection surgery and the summary of your stays in the hospital.
You will also need to provide details of the surgical findings and imaging studies that reflect what is left of your small intestine. If the SSA cannot get one of these reports, then they will need other medical reports that detail the surgery. They will also need medical records that show you depend on daily parenteral nutrition to provide your nutritional needs.
SHORT BOWEL SYNDROME & YOUR RESIDUAL FUNCTIONAL CAPACITY (RFC)
If you don’t meet listing 5.07, you can still win SSDI and SSI benefits through the SSA’s vocational rules. This takes your short bowel syndrome 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. The SSA also wants to know the heaviest weight that you lifted on your 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 CAN TESTIFY ABOUT YOUR SHORT BOWEL SYNDROME
Medical Experts (ME) often testify at Social Security hearings. They are called by the ALJ to review your medical records for short bowel syndrome 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 13.18. 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 short bowel syndrome 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 not preparing for the medical expert.
THE VOCATIONAL EXPERT AT YOUR HEARING
The vocational expert (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 short bowel syndrome 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.
HYPOTHETICAL QUESTIONS FOR THE VOCATIONAL EXPERT
The Judge will ask questions to the VE about whether or not a person with your medical conditions can work. Typically, the Judge will use three to four different questions. These questions can include many different symptoms from your short bowel syndrome.
For example, the Judge may ask if a person cannot concentrate on the job, could they work. 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 more here about your residual functional capacity here.
Once the Judge is done asking questions, your attorney has the right to question the VE. For those who do not hire an attorney, they are left to try to ask the VE questions on their own. Obviously, most people do not know what questions to ask because they have never been to a hearing. Nor do they have the training they need in order to understand what questions to ask.
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 they 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 caused by all of your medical conditions.
HIRE US TO HELP YOU WIN BENEFITS FOR SHORT BOWEL SYNDROME
Unfortunately, if you do not hire an attorney with experience to help you, then you will probably lose your case. Most cases turn on the VE’s testimony at the hearing. If you are not capable of questioning the VE, you will not win. The judge relies on the VE’s testimony. So, you need to be able to prove, using VE testimony, that you cannot work. An attorney can make sure that all of your symptoms are taken into account in the VE’s testimony.
Also, the attorney who has experience is familiar with the jobs in the national economy. If the attorney has experience, then they also know what jobs the VE is likely to say that you can do. This part of the hearing is difficult. Trying to do it yourself will not work. If nothing else, you should hire an attorney to represent you if the Judge has called a VE to your hearing.
WHAT WE DO TO HELP YOU WIN SSDI AND SSI BENEFITS
If you have short bowel syndrome, then you need help 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 automatically pay your benefits under the Compassionate Allowance Rules
- Appeal if you receive an initial denial from Disability Determination Services
- Help you confirm your Consultative Examination
- Request a Hearing with an Administrative Law Judge (ALJ)
- Prepare you to testify at your SSA hearing
- Represent you at your hearing and question the witnesses
- Read more about vocational experts here
- Learn more about medical expert testimony here
- 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.
HIRE US FOR OUR YEARS OF LEGAL EXPERIENCE
If you have short bowel syndrome, then you need to hire a law firm with experience to help you win your benefits. Cannon Disability is one of the best Social Security law firms in the country. We are one of the best Social Security benefits firm in Las Vegas, Nevada. Also, we are one of the best Social Security law firms in Salt Lake City, Utah.
Learn more about Utah SSD benefits here. Nevada SSI Information is on this website. We also represent clients in Idaho. For Idaho benefits read here. Find out more about Colorado SSDI benefits here. Likewise, if you are from California, go here for 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 Cannon Disability Law today. We can help you win benefits for short bowel syndrome. Call us today and ask us for a free review of your case.