Facts about GERD (reflux 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.
Facts about the condition
1) Gastroesophageal reflux disease, also known as GERD or acid reflux disease, is characterized by abnormal reflux in the esophagus that causes consumed beverages and foods to travel up through the esophagus from the stomach, instead of staying in the stomach.
2) GERD is usually caused by the lower esophageal sphincter not closing properly, allowing food to travel up the esophagus, or by obesity, hypercalcemia, Zollinger-Ellison syndrome, Scleroderma, Visceroptosis, diabetes, or a hiatal hernia. Other risk factors include asthma, dry mouth, connective tissue disorders, pregnancy, smoking and delayed stomach emptying.
3) Some symptoms of GERD are coughing, belching, heartburn, wheezing, vomiting, nausea, difficulty swallowing, regurgitation of food, and sore throat. At times there can be blood in the vomit.
4) Obstructive sleep apnea and gallstones have been linked to GERD, but the definite link is still questionable.
5) Lifestyle modifications such as limiting coffee, alcohol, tobacco, cruciferous vegetables, citrus fruits and chocolate, to weight reduction, sleeping on the left side, and avoiding smoking, may all help reduce the risk of GERD.
6) There are a number of medications that can treat GERD. While antacids can help for a very short period of time, many prescribed medications can also help, such as proton pump inhibitors and H-2 receptor blockers.
7) Sometimes surgery can help patients, though many times even surgery does not cure GERD and many patients may still need prescribed drugs after surgery to control symptoms. Surgery tactics usually include creating scar tissue in the esophagus, lowering the esophageal sphincter, and stitching the weakened sphincter to create a barrier between the esophagus and stomach acid.
8) GERD may most often be diagnosed by an endoscopy, an ambulatory acid (pH) probe test, an x-ray that shows your upper digestive tract, or a test that measures esophagus movement.
9) Some drugs, such as seasickness medications, beta blockers, sedatives, bronchodilators, tricyclic antidepressants, progestin, and calcium channel blockers, can increase risk of GERD or make symptoms worse.
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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