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Facts about Ulcerative Colitis 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.
Ulcerative colitis under the listings
Ulcerative colitis is covered in the disability listings under section 5.00 for adult Digestive System disorders. As SSA states, digestive system disorders include inflammatory bowel disease, liver dysfunction and gastrointestinal hemorrhage, conditions that may lead to various complications such as bowel obstructions.
If your evaluation renders evidence of a bowel obstruction in the small intestine or colon, OR two of the following conditions (see list in the following paragragh), then you may potentially be approved for disability under listing 5.06. Note: You must have two of the following despite ongoing medical treatment as prescribed by a doctor and occurring within the same consecutive 6-month period.
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 that is not completely controlled by prescribed narcotic medication, present on at least two evaluations at least 60 days apart; or
4. Perineal disease with a draining abscess or fistula, with pain that is not completely controlled by prescribed narcotic medication, present on at least two evaluations at least 60 days apart; or
5. Involuntary weight loss of at least 10 percent from baseline, as computed in pounds, kilograms, or BMI, present on at least two evaluations at least 60 days apart; or
6. Need for supplemental daily enteral nutrition via a gastrostomy or daily parenteral nutrition via a central venous catheter.
Facts about the condition
1. Ulcerative colitis is an inflammatory bowel disease that causes inflammation, scarring and ultimately thickening of tissues in the colon (large intestine).
2. Ulcerative colitis causes weight loss, fatigue, appetite problems, fever, rectal abscess and bleeding, diarrhea, constipation, and stomach cramps. The symptoms and severity of ulcerative colitis vary by individual, and severe attacks can cause bloody diarrhea in as many instances as 20 times a day.
3. Complications of ulcerative colitis are serious and can be life-threatening. These include anal abscess, rupture of the colon, colon cancer, and fistula.
4. It is unknown what causes ulcerative colitis to develop in an individual, but due to changes in the immune system many medical researchers and professionals believe the condition may be an immune disorder, triggered by a virus or bacteria.
5. Many people with ulcerative colitis have triggers such as stress or certain foods. Attacks may be brought on by spicy food, raw fruits and vegetables and milk, or by periods of high stress or emotional distress.
6. Diagnosis of the condition is straightforward with physical examination of the colon. Since ulcerative colitis has distinctive characteristics in the way an affected colon looks, it is easily identified by a doctor.
7. Treatment is individualized, and focuses on reducing inflammation to prevent attacks and serious complications. In some cases, patients may experience long-term remission from attacks and symptoms.
8. Treatments are typically anti-inflammatory and immune system suppressant drugs, sometimes simultaneously. Short term or symptomatic treatments include steroid enemas, antibiotics, anti-diarrhea medication, over-the-counter pain relievers and iron supplements.
9. Sometimes drug therapy combined with lifestyle changes may not be enough to control ulcerative colitis and surgery may be necessary. Less than half of all patients eventually require surgery. The procedure involves removing the entire colon and rectum and replacing them with a small bag or pouch, either internally or externally. This cures the condition.
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.
Return to: Social Security Disability Resource Center, or read answers to Questions
Information on the following topics can be found here: Social Security Disability Questions and in these subsections:
Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI
These pages answer some of the most basic questions for individuals who are considering filing a claim.
How to Apply for Disability - What medical conditions can you apply and qualify for?
How long does it take to be approved for SSI or Social Security disability?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it