Crohn’s Disease and Qualifying for Disability Benefits

Summary: Can I get disability benefits if I am suffering from the effects of Crohn’s Disease?

It is estimated that approximately three million Americans are affected by Crohn’s disease. Crohn’s disease is a type of inflammatory bowel disease that causes inflammation in the digestive tract, leading to abdominal pain, diarrhea, weight loss and malnutrition. The inflammation usually affects the small intestine and colon, but can affect any part of the GI tract. If you are suffering from the effects of Crohn’s disease you may qualify for disability benefits.

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What is Crohn’s Disease?

Crohn’s disease affects different parts of the digestive system in different people.

Symptoms range from mild to severe and usually develop gradually, but can also arise suddenly without warning. Some people with Crohn’s disease may experience periods of no symptoms at all.

The SSA recognizes Crohn’s disease in its Blue Book under Inflammatory bowel disease. To qualify a person must meet the requirements of the listing or prove they are unable to work.

When Crohn’s disease is active, the most common symptoms include:

•    abdominal pain and cramping
•   diarrhea
•   fatigue
•   fever
•   blood in the stool
•   reduced appetite and weight loss
•   mouth sores

These symptoms can cause you to miss work, possibly jeopardizing your ability to maintain employment.

What do I need to qualify for Social Security Disability Income?

Crohn’s disease is often a life-long problem and its impact on an individual’s daily activities can make it difficult for a person to hold a full-time job.

Social Security recognizes Crohn’s disease as an impairment under Section 5.06, Inflammatory Bowel Disease.

To qualify for Social Security Disability benefits under this listing you must have a diagnosis of Crohn’s disease and one of the following:

1.    An obstruction in the small intestine or colon requiring hospitalization or surgery, occurring at least twice, 60 days apart, within a 6-month period.

OR

2.   Two of the following complications:
   
   1.    Severe anemia documented at least twice and at least 60 days apart;
   2.    Low levels of serum albumin documented at least twice and at least 60 days apart;
   3.   Abdominal cramping, documented at least twice and at least 60 days apart, despite medication;
   4.   Perineal disease with an abscess and pain that is not controlled by medication, documented at least twice and at least 60 days apart;
   5.    Involuntary weight loss of at least 10 percent from your normal weight, documented at least twice and at least 60 days apart; or
   6.   Need for supplemental nutrition via a feeding tube or a central venous catheter.

Applicants whose primary complaint is Crohn’s disease are often initially denied; only 26% are approved.

However, 76% of applicants who appealed were approved for benefits. You will need to provide Social Security with copies of blood tests, fecal occult tests, colonoscopy and endoscopy reports, MRIs, and CT scans, as well as surgery reports. Social Security will also want to see records of your doctor visits and notes taken by your treating doctor describing your limitations, such as how long you can stand or walk, how much weight you can lift or carry, how much rest you need, and how many breaks you need to take at work.
Note that Social Security places more weight on the opinions of doctors who specialize in Crohn’s disease than general practitioners.

What if my symptoms don’t meet Social Security’s requirements?

If you don’t meet the requirements of Social Security’s listing, you may still qualify for disability benefits if you can show that your symptoms are so severe you cannot do your previous job, or any other job.

Social Security will review your medical records and doctor’s opinion and conduct a residual functional capacity (RFC) assessment to determine if you can perform your last job or any job, taking into account whether you are able to drive, your age, and your level of education.
The lower your RFC score, the more likely you will be approved for benefits. Social Security may decide that you can’t do your old job and may not expect you to learn a new job. Social Security uses a set of medical-vocational grid rules to determine when an applicant can be expected to learn a new job. Applicants who are older than 50 or 55 often fall under a grid rule which means they don’t have to learn a new job. If you’re unable to work at your old job or learn a new job, it’s likely Social Security will grant you disability benefits.

Additionally, if you have another medical condition, such as osteoporosis or liver damage, you may also qualify for SSDI.

While one disorder may not meet the requirements of a Social Security impairment listing, if you have more than one medical condition, Social Security must consider how your health issues combined together limit your ability to hold a job and perform routine tasks.

What are the basic financial requirements for SSDI?

Even though you meet all the requirements of the listing, you won’t be approved for SSDI unless you satisfy Social Security’s basic financial requirements:

1.   You must have a disability that has lasted, or is expected to last, 12 months
2.    You must have accumulated a certain number of work credits by working long enough and recently enough in a job where you paid Social Security taxes;
   and
3.   Your income must not be more than Substantial Gainful Activity (SGA), which in 2024 is $1,550 per month for nonblind applicants and $2,590 per month for blind applicants.

How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

If your application is denied, don’t be discouraged because you will have an opportunity to appeal.

There are four steps to the appeal process:

1.   File a Request for Reconsideration with the Social Security Administration to completely review your case again.
2.    If your request for hearing is denied, you can request a hearing before an Administrative Law Judge (ALJ).
   ALJs are attorneys who work for Social Security who review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney, you should obtain legal counsel at this critical point to raise your chances for success.
3.   If an ALJ denies your claim, you can request that the Appeals Council review your case.
4.   Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.

If you are suffering from Crohn’s disease and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? just give us a call, we love to help folks just like you!

What if I don’t qualify for SSDI?

If you haven’t worked long enough to accumulate enough work credits, you may be eligible for disability benefits through Social Security Income (SSI).

SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits and is financed by general funds of the U.S. Treasury.

I have long-term disability insurance – should I file a claim?

Long-term disability insurance (LTD) is coverage to protect your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company.

Policies pay between 50-60% of your salary and benefits continue until you return to work, or for the number of years stated in the policy. If you have long-term disability insurance, you should file a claim right away. LTD coverage is good only as long as you are still employed, so do not quit your job before you file a claim.
Also, read your policy carefully and check the policy’s definition of “disabled” as each policy will state the definition of “disabled” in use. Note that LTD companies can require claimants to also apply for SSDI, and it’s possible to receive both long-term disability insurance benefits and SSDI concurrently.

Do I need a disability attorney?

If you have Crohn’s disease and it has prevented you from working, you may be eligible for Social
Security Disability benefits; however, as mentioned above, initial applications are often denied.

An experienced Social Security disability attorney can gather all your medical records, avoiding delays and costly mistakes. Even if you file your initial application yourself, it is advisable to consult an attorney at the request for reconsideration and hearing levels where an attorney can collect and submit relevant medical evidence, obtain doctors’ opinions, draft a brief to the ALJ, and prepare you for questioning by the judge. An attorney can also elicit helpful testimony from you and cross-examine vocational and medical experts, demonstrating your inability to work. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied.
If your application is denied, your chances of approval are significantly increased if you have legal representation. The most you will pay is 25% of disability backpay you are owed because fees charged by disability attorneys are regulated by federal law. There are no out-of-pocket costs – if you don’t win your case, you won’t be charged anything.

Social Security and LTD insurance companies process claims differently and define “disability” differently.

Unlike the federal government in Social Security disability cases, LTD companies are not impartial. An experienced LTD attorney who knows the laws and regulations as well as the insurance companies and their policies can help you avoid serious mistakes and possibly losing your claim.
In addition to filing your claim in a timely manner, an LTD attorney can negotiate a settlement or file an appeal for you. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits.

Author: Attorney Lloyd Bemis has been practicing law for over 35 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Bemis obtained dual board certifications from the Texas Board of Legal Specialization. Lloyd is admitted to practice in the United States District Court – all Texas Districts and has argued before the U.S. Court of Appeals, Fifth Circuit. Mr. Bemis is a member of the Travis County Bar Association. He has been active in the American Association for Justice and is a past Director of the Capital Area Trial Lawyers Association. Mr. Bemis and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.