Inflammatory Bowel Disease (IBD) and SSA Disability

Inflammatory Bowel Disease (IBD) is a broad term that describes conditions that cause chronic inflammation (swelling) of the intestines, including Crohn's disease and ulcerative colitis. The Crohn’s & Colitis Foundation of America (CCFA) reported that 1.4 million Americans are affected by the disorder.

If IBD is keeping you or a loved one from being able to work, there are organizations that can help. The Social Security Administration (SSA) has different types of disability benefit programs to assist you in your time of need.

The Financial Costs of IBD

The costs of IBD vary depending on the type of disorder you have. Crohn's expenses can reach $19,000 each year for those who are uninsured, and ulcerative colitis can cost $15,000 per year, according to the CCFA. Each year, the United States spends $2.2 billion on the disease.

Though hospitalizations cost an average of $2,500 a day, they make up less than one-third of the total expenses. Much of the costs are due to medical testing, which can range from a few hundred dollars to over ten thousand. Additionally, the medication required to treat the disease can take another few hundred dollars each month.

If your IBD is severe, there's a high chance you might need surgery at some point. You may choose surgery because you stopped responding to treatment or the symptoms are unbearable, or you may need it due to complications of the disease. About 34 percent of ulcerative colitis patients and 75 percent of Crohn's disease patients will eventually require surgery, the CCFA explains, which can cost between $30,000 and $45,000.

There is no cure for IBD, but with surgery and/or the right drugs the goal is get you into remission. However, since many suffering from IBD are diagnosed before the age of thirty, the long term costs can be daunting. To make matters worse, the disorder generally requires a lot of time off work.

A study published in Inflammatory Bowel Diseases estimated that the indirect costs of IBD are also high. In 2009, those with IBD lost an estimated $5.5 billion in missed work days, which equaled about $5,228 per person.

Medically Qualifying for Benefits with the Blue Book

 

The SSA uses the Blue Book to assess all applications they receive for disability benefits. The Blue Book has over a hundred listed conditions with medical guidelines that are eligible for benefits.

IBD can be found in section 5.06—Digestive Disorders.

To qualify for benefits, the SSA requires medical evidence of Inflammatory bowel disease (IBD) one of the following:

  • Obstructed areas in the small intestine or colon caused by stenosis (scar tissue caused by inflammation) in the small intestine or colon with proximal dilatation, requiring hospitalization for intestinal decompression or for surgery, and occurring on at least two occasions at least 60 days apart within a consecutive 6-month period.
  • Two of the following despite continuing treatment as prescribed and occurring within the same consecutive 6-month period:
    • Anemia with low hemoglobin levels, present on at least two evaluations at least 60 days apart
    • Low serum albumin levels, present on at least two evaluations at least 60 days apart
    • Clinically documented tender abdominal mass detectable on physical examination with abdominal pain or cramping not controlled by prescribed medication, present on at least two evaluations at least 60 days apart
    • Perineal disease with a draining pockets of pus or abnormal organ connections, with pain not controlled by prescribed medication, present on at least two evaluations at least 60 days apart
    • Involuntary weight loss of at least 10 percent from your original weight, present on at least two evaluations at least 60 days apart
    • The need for daily supplemental nutrition via a feeding tube or a catheter into your vein.

If you think your IBD is severe enough to qualify for disability benefits, talk to your doctor as soon as possible about your chances of approval.

Qualifying Without Meeting a Medical Listing

If you don't meet any of the listings for IBD, but you and your doctor expect your condition to keep you earning less than the SSA's substantial gainful activity minimum (SGA), which is $1,130 per month in 2016, for at least 12 months, you can still be approved for benefits. The SSA also approves claims on a medical-vocational allowance, which is based on the limitations caused by the symptoms of your disease.

Using their grid rules, the SSA will take your disease and reported limitations to decide what kind of work they think you can do (sedentary, light, medium, heavy, and very heavy) and your education level and work history to determine your Residual Functional Capacity (RFC), and if there are any jobs you can do. If you are classified in the three lower levels, you'll have a much higher likelihood of approval.

Though the minimum age for the grid rules is 45 years old, it is possible to be approved for benefits if you are younger. With Crohn's disease, you could argue that its symptoms prevent you from doing even sedentary work, for reasons such as severe pain that may make standing or moving hard, having to take too much time off work, and the constant need to get up and go to the bathroom.

Those who didn't go to college, or worked physically intensive or unskilled jobs, like laborers, construction workers, retail or food service employees,,and similar jobs will have a higher chance of being approved than those with college degrees who worked in sedentary or light jobs.

How to Apply for Social Security Disability Benefits

If you working is too much while dealing with the symptoms of IBD, talk to your doctor about applying for Social Security disability, whether it's through a listed Blue Book variant or an RFC. If your doctor isn't confident in your likelihood of approval, it may be in your best interests hold off. Generally, you can't work while waited for the application to be decided on, and those decisions can take up to two years.

If you do meet a Blue Book listing, you could be approved in the initial claim stage in just a couple of months. Many denials in this stage are due to missing medical information, and so making sure you have everything you need can save both you and the SSA a headache. Check out the SSA's website, where they have a complete list of documents you'll need for your claim.

Important medical evidence for IBD will include:

  • Upper, capsule, or double-balloon endoscopy, which each show different parts of the lower gastrointestinal tract
  • Colonoscopy with biopsies
  • Medical imaging tests, such as X-rays, MRIs, small bowel cans, and CT scans
  • Blood tests for anemia and other levels
  • Fecal occult test to determine if there is blood in the stool
  • History, length, and outcomes of all prescribed treatments
  • Summaries of hospitalizations, operative reports, and any other related documents
  • Detailed reports from your primary care doctor describing the limitations of your IBD

The SSA has both online and in person applications at an SSA office. If you're applying for Social Security Disability Insurance, you do either. If you're for Supplementary Security Income, you may only apply in person at your local SSA office. Before submitting the application, online or in person, make sure to check it over one more time to catch any mistakes. Though it seems extreme, accidentally leaving out or putting wrong information can delay your claim to make the SSA deny it.

If there are any doctor's findings, surgeries, hospitalizations, new treatment regimes, or other changes in your condition while you're waiting for answer, let the SSA know as soon as possible. The more evidence you have of the severity of your IBD and how it negatively affects your life, the higher your chances are of being 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 page on Social Security Disability Insurance.