If you have been diagnosed with pancreatitis and it impacts your ability to work, you may be eligible for Social Security Disability benefits. Pancreatitis is a condition that involves the inflammation of the pancreas, which is a large gland located behind the stomach. Its role is to aid in producing digestive enzymes and insulin, which enables the body to control and regulate sugar levels.
Social Security Disability Insurance (SSDI) pays disability benefits to individuals who suffer from medical conditions that render them permanently and completely disabled to work. The individual has had to work enough to earn enough credits and must have paid an adequate amount of taxes in to Social Security to be eligible to receive SSDI. He or she must also meet the guidelines set forth by the Social Security Administration (SSA) to be considered disabled.
Certain dependents of the disabled individual may also be eligible to receive benefits from SSDI after the person has been declared disabled according to the SSA guidelines. Only individuals considered permanently disabled, and who cannot work for a year or longer, are eligible to receive benefits. The first six months of being disabled the individual is not eligible to receive SSDI benefits.
During the SSDI benefit application process, the SSA collects extensive information regarding your medical condition, treatment, medications and prognosis. These documents help the Disability Determination Services make a decision on your condition and whether you are eligible for benefits. The application process may involve several stages.
The Financial Costs Related to Pancreatitis
According to the National Center for Biotechnology Information (NCBI), pancreatitis can be an expensive medical condition to treat. A study was conducted to determine the medical costs directly associated with the hospitalizations caused by acute pancreatitis in the U.S. and to analyze the demographics of such patients.
According to the research, the total cost for acute pancreatitis admissions total $2.2 billion in the 2003 Healthcare Cost and Utilization Project – National Inpatient Sample for hospitalizations of individuals with a primary diagnosis of acute pancreatitis. When these figures are broken down, that was an average of $9,870 per hospital stay at a daily rate of $1,670.
Hospitalization rates are greater for those who are older than age 65 and for African Americans. Pancreatitis can be a life-threatening disease and can lead to multiple hospitalizations. Therefore, an individual diagnosed with pancreatitis can spend anywhere from $10,000 to $50,000 per year on treating the condition including medications and doctor visits.
Even patients with insurance may have to pay a significant amount out of pocket for treatment for pancreatitis because of the required copays and deductibles that accompany the treatment process. Some medications may not be covered by insurance so that will increase out of pocket expenses as well.
The SSA Evaluation and Medical Qualifications
The SSA has a Blue Book with specific guidelines for qualifying for disability for different conditions. The book lists conditions by specific body systems. There is not a specific listing for pancreatitis in the Blue Book so you may have to provide more documentation and evidence to get approved for SSDI benefits.
Pancreatitis is a very painful condition that can cause diarrhea, weight loss and other symptoms that limit an individual’s ability to work and function. If your condition has caused severe weight loss, you can ask for your condition to be evaluated under the weight loss listing.
- The SSA Blue Book defines severe weight loss as having a body mass index (BMI) lower than 17.5, which is indicated on two separate medical tests conducted at least 60 days apart within a six-month timeframe.
- If you meet these requirements, you have meet the specifications to be declared disabled by the SSA.
If severe weight loss is not a problem you have experienced, the Disability Determination Service will have to scrutinize your medical records and how the disease has impacted your functionality. There are many symptoms that can be experienced by those suffering from pancreatitis.
Meeting Disability Criteria with an RFC
A residual functioning capacity (RFC) form indicates in detail how your ability to function has been impacted by your diagnosis of pancreatitis. The RFC is for various levels of work, including sedentary, light, medium, and heavy work. The determination team will look at your past employment and which level of work that was considered as and if you have any skills that can be transferred.
Exertional limitations are specified on the RFC, such as how you are limited to standing or walking a certain number of hours. Non-exertional limitations, including frequent bathroom visits for diarrhea or rest breaks because of being fatigued also play a role in making a decision as to whether an individual is legally and fully disabled and eligible for benefits.
If the pain suffered from pancreatitis requires medication that impacts your ability to focus or makes you drowsy, it can limit your abilities to work that requires less skills or it may be unsafe to work at all. The SSA disability determination team will be to consider your age, transferrable work skills, educational level and symptoms to decide whether or not you would be able to conduct any kind of work, including transitioning to new employment.
Even if you aren’t approved for disability benefits by meeting the Blue Book requirements, you can still get approval with a detailed RFC. The RFC provides all kinds of information that plays a major role in the decision making process for determining whether or not an individual is considered disabled according to SSA guidelines.
Applying Specific Medical Tests to Your Case
Several tests are used to diagnose pancreatitis. There are three kinds of pancreatitis. Acute pancreatitis is a single episode often caused by gallstones. Chronic pancreatitis is inflammation of the pancreas continuing after the inflammation source’s removal. Hereditary pancreatitis is caused by a genetic abnormality that increases enzyme production and causes the pancreas to become inflamed.
Pancreatitis is diagnosed with laboratory tests, scans and ultrasounds. It is not uncommon for the SSA to order additional medical evaluations at their expense. These evaluations are for informational purposes only and not for medical treatment. These evaluations are to determine if the information included in your file is accurate regarding your condition(s) and your limitations.
A mental evaluation may also be ordered. This will determine if the condition has impacted your mental functioning or caused depression or anxiety. These mental problems can impact your ability to work and play a role in the disability determination process. Actually, the disability process may speed up depending on the findings of the medical evaluations ordered by and paid for by the SSA.
Why You Need a Disability Attorney to Help with Your Pancreatitis Disability Claim?
People who have already gone through the process of applying for benefits of a disability condition know how time consuming it can be. The process can be tiring and being rejected in the end is quite a common occurrence which happens to a large number of people each year.
A lot of people also get overwhelmed by the whole process and become confused by the details of everything that they need to do. These are only some of the reasons why using professional help from a disability attorney is highly recommended.
Choosing the services of an attorney to help you get your claim for disability benefits has the following advantages:
- Getting help with the application process
- Getting every question answered in detail
- Saving time and effort
- Increasing your chance of success
- Receiving moral support
As the attorney advises you and gives you all of the necessary tips, you will find yourself very quickly finishing your claim and sending it to the SSA for evaluation. The final result has a higher chance of being positive when the claim has been improved by a professional attorney. Finding an attorney is not a difficult task, it will save you a lot of time and will beneficial to the application process.