According the American Liver Foundation, an ever-rising 30 million Americans are affected by some type of liver disease. There are over 100 kinds of liver disease, and many don’t show symptoms until the liver’s damage is severe.
If liver disease is keeping you or a loved one out of work and in financial struggle, there may be help available. The Social Security Administration (SSA) has two benefit programs for those who can’t work due to a disabling condition which are Social Security Disability Insurance (SSDI) and or Supplemental Security Income (SSI).
The Financial Costs of Liver Disease
The cost of your condition will vary based on the type of liver disease you have, but the costs are high in most advanced staged disorders. For example, the Henry Ford Health System published a study on the costs of Hepatitis C, which were found to be between $17,000 and $24,000 annually depending on the stage of the disease.
Another common liver disease, cirrhosis, has a high national cost of over $13 billion annually. Most of the price tag (about $10.5 billion) is due to missed work days and lost productivity, and the remaining $2.5 billion is from healthcare expenses. Depending on the stage, the disease can cost an individual anywhere from $1,110 to $20,000 each year, the National Institutes of Health reported.
End stage liver disease, which is curable only with a transplant, is a severe condition that costs almost $60,000 per year in direct and indirection costs, Henry Ford explained. According to Transplant Living, the surgery and recovery will cost about $577,000 between the pretesting, organ delivery, hospitalization, operative and surgeon fees, outpatient fees, and medication.
Medically Qualifying for Benefits with the Blue Book
The SSA will evaluate your application for disability benefits using their official list of impairments, the Blue Book. The Blue Book has all of the disorders that qualify for Social Security benefits, and if you meet or equal a listing, you’ll automatically be approved.
Liver disease can be found in section 5.00—Digestive System Disorders.
You will need medical evidence of your chronic liver disease, with at least one of the following:
- Hemorrhaging within the digestive system that result in hemodynamic instability causing fainting, rapid pulse, and low blood pressure, and requiring hospitalization for transfusion of at least 2 units of blood.
- Fluid buildup in the abdominal cavity (ascites) or lung cavity (hydrothorax), despite continuing treatment that is present on at least two evaluations, 60 or more days apart with six months, at least 60 days apart within a consecutive 6-month period, with either fluid removal treatments or low levels of serum albumin and thin blood.
- Spontaneous infection and inflammation of the lining of the abdominal cavity.
- Kidney failure caused by chronic liver disease (hepatorenal syndrome) with high levels of serum creatinine and low urine sodium levels and output.
- Low blood oxygen caused by chronic liver disease (hepatopulmonary syndrome), with low levels of blood oxygenation or shunting.
- Loss of liver function (hepatic encephalopathy), with abnormal behavior, cognitive dysfunction, changes in mental status, or altered state of consciousness (for example, confusion or coma), history of any surgical portosystemic shunt, or fluctuating physical neurological abnormalities.
- End stage liver disease with SSA chronic liver disease scores of 22 or greater.
- Liver transplant, which is considered a disability for one year after the date of transplant. Any further disability must be based on the affected body systems.
If you can’t work because of your liver disease, talk to your doctor about applying for disability benefits.
Qualifying Without Meeting a Medical Listing
If your liver disease don’t meet any of the Blue Book guidelines, you can be approved another way. If you can’t work enough to earn the SSA’s Substantial Gainful Activity (SGA) minimum of $1,130, you may be approved under a medical-vocational allowance.
To determine if you’re eligible, the SSA will use a series of grid rules to find your Residual Functioning Capacity (RFC). Using your symptoms and limitations, the SSA will decide what kind of work they think you can do—sedentary, light, medium, heavy, and very heavy—and find a job you can do within your education level and work history. If they can’t, you could be eligible for benefits.
Liver disease can cause many complications and frequent hospitalizations that could make you unable to work. Like fatigue, vomiting, hemorrhaging, infections and fever, joint pain, internal bleeding, mental confusion, kidney failure, and shortness of breath.
Those with a college degree and sedentary job usually have a lower chance of getting approved with an RFC than individuals with a history of manual work, like construction, farming, or landscaping or those without a college education.
How to Apply for Social Security Disability Benefits
Talk to your doctor before applying for benefits, as your doctor will be crucial to the process. If your liver disease is not very severe, and your doctor does not think your chances of approval are likely, then you may not want to wait and fight for months or years only for you to be denied.
If you do meet a Blue Book listing, you should apply as soon as possible with all of the necessary medical information. For patients who have undergone a liver transplant, for example, you will be approved automatically as long as you submit everything the SSA needs with your application.
Important medical evidence for chronic liver disease may include:
- A physical examination, where your doctor might find a swollen abdomen or jaundice.
- Liver biopsy, to test your liver tissue for abnormalities.
- Blood tests, to determine your liver function, kidney function, blood oxygenation, and more.
- Imaging tests, like MRI, chest X-rays, and others to view liver damage.
- Reports of any surgeries, hospitalizations, treatments, and any other labs.
- A detailed report from your doctor explaining the limitations caused by your liver disease.
You can apply for Social Security Disability Insurance (SSDI) on the SSA’s website, as well as view a checklist of other required documents, such as a birth certificate and tax information. Applications for Supplementary Security Income (SSI) must be completed by appointment at your local SSA office. Look over your application before you submit it, either in person or online, because mistakes could cause the SSA to delay your application to figure out the problem or deny it.
If your liver disease changes after you submit the claim or you have new tests, surgeries, or treatment regimens, notify the SSA immediately. These changes could help you get approved faster.
Liver Disease and Your Social Security Disability Case
While Liver Disease can be a very serious condition, it is also very complex. Because of this, proving that your Liver Disease prevents you from being able to work may be a challenge. If you are applying for Social Security Disability benefits due to Liver Disease and your specific condition does not meet each of the Social Security Administration (SSA)'s requirements, you may want to retain the services of a Social Security Disability attorney to assist you in your claim. A Social Security Disability attorney can help you gather the medical evidence you need to submit a successful Social Security Disability application.
If, for some reason, your initial application for Social Security Disability benefits is denied, you may still be eligible for Social Security Disability benefits but you will need to appeal the decision within 60 days of the notice of denial. A qualified Social Security Disability attorney can help increase your chances of successfully filing an initial Social Security Disability claim or appealing a denied claim.