Facts about Crohn's Disease and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Is crohn's disease considered a disability by Social Security?
Yes, crohn's disease is considered a disability by the Social Security Disability and SSI programs. But this is in the sense of being granted a medical vocational allowance versus meeting the requirements of a listing in the impairment listing manual.
What do I mean by this? Certain mental and physical conditions are contained in the "blue book", which is the social security adminitration's impairment listing manual. For every condition that is listed, the blue book contains very specific disability criteria for approving a claim based on that condition. Many conditions are given a listing and are included in the blue book. However, not all conditions are.
In this case, crohns disease is not given a specific listing while conditions such as ulcerative colitis and regional enteritis are listed, along with the approval criteria for each.
What happens if you have a condition that is not included in the impairment listing manual? Basically, it means that, to be approved for disability, you must be given a medical vocational allowance.
A medical vocational allowance is an approval that is made after the following has occurred.
1. A claimant's medical records have been obtained, read, and evaluated.
2. It has been determined that the claimant is unable to return to their past work.
3. The determination has been made that the claimant is unable to do other work, based on their age, work skills, education, and the extent to which their condition presently limits them (this is known as residual functional capacity).
Facts about the condition
1) Crohn's disease, is also referred to as regional enteritis and granulomatous colitis. It is an autoimmune disease causing flare ups and remission, and an inflammatory bowel disease (IBD).
2) For reasons unknown, smokers have a high risk for Crohn's disease; they are three times more likely to develop the disease.
3) There is a genetic link to Crohn's disease; it is currently thought that siblings are 30 times more likely to develop the disease than those without a family history of Crohn's.
4) People who live in an industrialized nations and urban areas are more likely to develop Crohn's disease, and diet is linked to this finding.
5) Since there are no known cures for Crohn's disease, sufferers are limited to controlling individual symptoms in hopes of preventing a relapse and sustaining remission through anti-inflammatory drugs, immune system supressors, antibiotics and other medicines such as laxatives, anti-diarrheal medication, pain relievers, and vitamin and mineral supplements.
6) Symptoms can include cramping, skin disorders, abdominal pain, fever, diarrhea, bloody stool, weight loss, reduced appetite, arthritis, and fatigue.
7) Although Crohn's can appear at any age, it is most likely to present itself in the teens and early twenties. Most people are diagnosed between the ages of 20 and 30.
8) Complications that can stem from Crohn's include (but are not limited to) ulcers, malnutrition, colon cancer, bowel obstruction, fistulas, anal fissure, and a host of other complications, from arthritis and kidney stones, to gallstones and other inflammatory issues.
9) Although Crohn's disease can be a debilitating and painful disease, oftentimes those with the disease are able to lead productive lives by treating symptoms and bringing about long-term remission.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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