A diagnosis of primary biliary cirrhosis can be devastating. Eventually, the condition will cause a significant impact on one's quality of life and may lead to an inability to perform normal day-to-day activities. Understandably, many of the people who are diagnosed with primary biliary cirrhosis are unable to maintain full-time work activity. Because of this, these individuals are left with no way to pay for their daily living expenses. In cases such as these, Social Security Disability benefits are oftentimes able to alleviate some of the financial burden that has been caused by the disease. If you have been diagnosed with primary biliary cirrhosis and are wondering how the condition affects your eligibility for disability benefits from the Social Security Administration, the following information will help.
Primary Biliary Cirrhosis Condition and Symptoms
Primary biliary cirrhosis is an irritation and swelling of the bile ducts of the liver. This swelling blocks the flow of the bile and damages the body's liver cells, which leads to permanent scarring (also referred to as cirrhosis).
Bile is a fluid that is produced in your liver. Your body needs this fluid to digest fats properly and to rid your body of worn-out red blood cells, cholesterol and certain toxins. When an individual develops primary biliary cirrhosis, the resulting destruction of the bile ducts causes harmful substances to build up in the liver, which can eventually lead to permanent scarring of the liver tissue.
Primary biliary cirrhosis is a disease that develops slowly. If caught early, medication can slow the progression of the disease and the resulting liver damage. The symptoms of primary biliary cirrhosis will vary depending on the stage of the disease and the condition's severity. In the early stages of the disease, common symptoms may include: fatigue, itching and dry eyes or mouth. As the disease progresses, other symptoms will begin to appear. These symptoms include: jaundice, hyper-pigmentation, edema of the abdomen and feet, fatty deposits in the skin and digestive problems. If left untreated and symptoms become severe, complete liver failure is possible.
Unfortunately there is no cure for primary biliary cirrhosis. Treatment is focused on slowing the progression of the disease and making the patient as comfortable as possible. Understandably, many of the people who develop primary biliary cirrhosis will be unable to continue work once the disease has progressed and symptoms are severe. In these cases, the individual should apply for Social Security Disability Insurance or Supplemenetal Security Income.
Filing for Social Security Disability with Primary Biliary Cirrhosis
Primary biliary cirrhosis is a condition that is covered under the Social Security Disability guidelines under Medical Listing 5.0. While this listing addresses all chronic liver diseases, primary biliary cirrhosis is specifically mentioned under this section. However, because all cases of primary biliary cirrhosis are different and the disease can vary greatly from one stage to another, the SSA reviews all claims based on a diagnosis of primary biliary cirrhosis on a case-by-case basis.
In order to qualify for disability benefits due to primary biliary cirrhosis, you will need to prove to the Social Security Administration that your condition meets the guidelines set forth by the SSA or that you are completely unable to perform any type of work activity. In order to meet the SSA guidelines, your case of primary biliary sclerosis must result in a CLD score of 22 or higher. The CLD scoring system is a formula that the SSA now uses to determine whether or not an individual qualifies for benefits due to a chronic liver condition. To determine an individual's CLD score, the following formula is used:
9.57 x [Loge(serum creatinine mg/dL)]
+3.78 x [Loge(serum total bilirubin mg/dL)]
+11.2 x [Loge(INR)]
If your score is 22 or higher using this formula, you will qualify for benefits under the SSA's determining guidelines. If your score does not equal 22 or higher, you may still qualify for Social Security Disability benefits, but you will need to prove to the Social Security Administration that your condition prevents you from performing any type of work activity. This usually means that you will need to appear before an administrative law judge at a disability hearing.
What Are the Stages and Symptoms of PBC?
Primary biliary cirrhosis (PBC) occurs in 4 stages, which are typically based on the amount of damage that has been done to the liver. These stages are described below:
- Stage 1. This shows damage and inflammation to the walls of medium-sized bile ducts.
- Stage 2. A blockage occurs in the small bile ducts.
- Stage 3. Scarring starts to occur.
- Stage 4. Cirrhosis has developed by this stage and this involves severe permanent scarring and liver damage.
When cirrhosis has progressed so much that it meets the Social Security Administration's (SSA) Blue Book listing, you may qualify for a disability benefit. Some of the more severe symptoms of PCB are chronic belly pain, nausea, loss of weight, loss of appetite, joint, muscle, or bone pain, swollen belly from the buildup of fluid, the presence of swelling in the ankles and legs (edema), diarrhea and fractured bones.
When diagnosing PBC your doctor will question you about your medical and family history, will conduct a physical examination, order blood tests and complete other diagnostic medical tests. The blood test finds the presence of a specific substance in the blood which is called anti-mitochondrial antibody (AMA). If AMA is present it usually confirms a PCB diagnosis.
If you have any complications from PBC such as high cholesterol levels, fat soluble vitamin deficiency and a liver cancer diagnosis and your treatment still won’t allow you to work for at least 12 months you may also qualify for a disability benefit.
Primary Biliary Cirrhosis and Your Social Security Disability Case
Primary biliary cirrhosis is considered to be a chronic liver disease and, as such, is included in the SSA's disability guidelines. If you meet the specific criteria that has been set forth in these guidelines, chances are that you will be awarded Social Security Disability benefits during the initial stage of the application process. However, if you do not meet the published guidelines, you will likely need to pursue the disability appeal process in order to be awarded the benefits you need.
When you appeal the SSA's decision to deny your Social Security Disability claim, you should consider retaining the services of a qualified Social Security Disability attorney or advocate. These professionals will help you understand why your initial application for Social Security Disability benefits was denied by the Social Security Administration and they will help you gather the evidence that will be needed to prove your case during the disability appeal process. This evidence will be presented by your representative to the administrative law judge who will be hearing your case. While you are allowed to represent yourself at this hearing, statistics show that your likelihood of a favorable outcome is significantly increased with proper legal representation.
To learn more about filing for SSD benefits with primary biliary cirrhosis or to learn more about working with a Social Security Disability lawyer, simply fill out the form for a free evaluation of your Social Security Disability case.