Hepatitis and Social Security Disability

Hepatitis is a viral disease that affects over 4 million people in the United States, according to Modern Healthcare, although the Centers for Disease Control estimate there were thousands more undiagnosed cases as well. The three types of hepatitis have different effects on the body.

Hepatitis A, or infectious hepatitis, causes a mild infection in the body. Hepatitis B, or serum hepatitis, is more serious and causes symptoms ranging from a flu-like feeling to chronic liver disease or cancer. Hepatitis C, the most serious form, leads to chronic liver disease.

If you or a loved one is suffering from hepatitis and find the symptoms are interfering with your ability to work, there may be help available. The Social Security Administration (SSA) gives financial benefits for those struggling to work because of a debilitating condition.

The Financial Costs of Hepatitis

There are many costs associated with all forms of hepatitis. Hepatitis C is the most expensive, because 80 percent of those diagnosed subsequently get chronic liver disease, The C. Everett Koop Institute at Dartmouth College Medical School reported. Without a transplant, Hepatitis B and C cost over $65,000 in a patient’s lifetime.

If a liver transplant is required, the costs of the disease will skyrocket. In total, Transplant Living explained that the medical costs of a liver transplant are almost $600,000. This includes pre-transplant testing, hospital and surgical expenses, medication, rehab, and follow-up care. The source left out possible additional expenses, such as travel, childcare, and missed work.

Antiviral medications were recently developed for hepatitis C. The medications cures most people infected with the hepatitis virus, but the price of the drugs are so high, many can’t afford treatment. A single pill can cost $1,000 and an entire course of treatment can exceed $100,000, Everyday Health announced. Some patients may need also need a second course to rid themselves of the disease.

Hepatitis A is rarely serious enough for disability benefits, and type B is often only approved if you’ve contracted chronic liver disease. Hepatitis C is the most common type to be approved because of its severity.

Medically Qualifying for Benefits with the Blue Book

The Blue Book is the SSA’s complete list of disabilities that qualify for benefits, with hundreds of conditions listed. The SSA first uses the Blue Book to evaluate claims they receive to determine if the applicant may qualify for disability benefits.

Hepatitis can be found in multiple entries under section 5.00—Digestive System.

Generally, you need medical evidence that your hepatitis caused chronic liver disease, with at least one of the following:

  • a. Hemorrhaging from esophageal, stomach, or abnormal veins or from high blood pressure causing stomach diseases that result in abnormal blood circulation, that requires at least one hospitalization for transfusion of at least 2 units of blood. After 12 months following the last documented transfusion, disability will be revaluated
  • b. Buildup of fluids in the abdominal cavity membrane or lungs not attributable to other causes, despite continuing treatment as prescribed. It needs to be present on at least 2 evaluations 60 days or more apart within a consecutive 6-month period.
  • c. Sudden inflammation of the lining of the abdominal cavity due to bacteria with the fluid containing a high number of white blood cells.
  • d. Functional kidney failure not attributed to other causes with high sodium levels or severely low urine output
  • e. Deoxygenation of arteries not attributed to other causes
  • f. Loss of brain function due to the liver the body being unable to remove toxins from blood with abnormal behavior, cognitive dysfunction, changes in mental status, or altered state of consciousness (for example, confusion, delirium, stupor, or coma), present on at least two evaluations more than 60 days apart within a consecutive 6-month period; and either:
    • i. History of surgical venous shunts, especially a transjugular intrahepatic portosystemic shunt (TIPS)
    • ii. An abnormal tremor causing involuntary jerking movements and coma or other fluctuating physical neurological abnormalities, triphasic slow wave activity, usually due to chemical abnormalities that affect brain function, low blood plasma, or thin and slow clotting blood that occurs on at least two evaluations more than 60 days apart within the same consecutive 6-month period
  • g. End stage liver disease with SSA chronic liver disease scores of 22 or greater

If your hepatitis has other symptoms besides the digestive system, the SSA will evaluate the disorder under the affected body system. The listings for chronic liver disease are confusing. Talk to your doctor if you have any questions about your eligibility.

Qualifying Without Meeting a Medical Listing

If your hepatitis restricts you from doing substantial gainful activity, which is $1,130 per month in 2016, but it doesn’t meet one of the listings in the Blue Book, you can be approved for benefits another way. The SSA will determine your Residual Functional Capacity (RFC), by evaluating the limitations your conditions causes, your level of education, and work history.

RFC approvals happen just often, if not more, than Blue Book approvals. If you’re applying for disability under an RFC, as with all disability applications, your doctor needs to expect you to be unable to work for at least 12 months.

Though RFC approvals are more likely to be approved for older applicants who don’t have a college education or those with manual jobs, the symptoms can be severe enough for those with sedentary or light work experience only.

Debilitating symptoms of liver damage include kidney failure and dialysis, muscle loss, fatigue, bodily weakness, swelling or pain in the abdomen, forgetfulness, confusion, problems concentrating, constant vomiting or diarrhea, and depression.

How to Apply for Social Security Disability Benefits

If your hepatitis is severe enough and will last long enough to keep you from working, talk to your doctor about your chances of qualifying for disability benefits through either the Blue Book or through an RFC. The application process often takes up to two years, so it might not be worth the effort to apply if your chances of approval aren’t likely.

If you do meet an SSA listing, you may be approved in the initial claim stage. To ensure your claim gets answer as quickly as possible, you need to submit all of the necessary medical information as soon as possible.

Important medical evidence will include:

  • Results from other blood tests, including other liver function tests and blood antigen tests
  • Liver biopsy results
  • Results from medical imaging tests, such as CT scan, MRI, and ultrasound
  • Prothrombin time (PT) test results
  • History, length, and outcomes of all prescribed treatments
  • Detailed reports from your primary care doctor describing the severity of your hepatitis symptoms and physical limitations

The SSA allows you to apply for disability benefits both online and in person at your local SSA office. When completing either application, make sure to double check that you have all of the necessary documentation, including medical information, tax information, and a birth certificate before submitting. A full list of materials needed for the application can be found on the SSA’s website. Missing evidence or unanswered questions may force the SSA to deny you or delay your claim as they take the time to compile the evidence themselves.

If there are any changes in your condition, you have been hospitalized, or you have new tests done, the SSA needs to know immediately. The more evidence you can present to the SSA of the way your hepatitis affects you, the more likely you are to be approved.

If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance or Supplemental Security Income.