Pancreatitis and Qualifying for Disability Benefits

Summary: Can I get disability benefits if I am suffering from the effects of Pancreatitis?

Pancreatitis is not listed as an impairment by the SSA, however, an individual who has pancreatitis and experienced severe weight loss or cannot work at a full-time job on a “regular and sustained” basis may qualify. Qualifying can be difficult and an experienced attorney can improve your chances for approval.

Approximately 220,000 people are affected by acute pancreatitis and 80,000 people are affected by chronic pancreatitis each year. Pancreatitis is a painful and sometimes debilitating disease that can severely limit an individual’s ability to work and may qualify for disability. Pancreatitis ranges from mild to life threatening and can seriously damage the heart, lungs and kidneys.

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The pancreas is a long, flat gland located behind the stomach that produces pancreatic juices called enzymes.

During digestion, enzymes break down sugars, fats, and starches. The pancreas also makes hormones that aid in regulating blood sugar level and appetite, stimulate stomach acids and tell the stomach when to empty. Pancreatic enzymes include lipase, protease, and amylase; hormones produced by the pancreas include insulin, glucagon, amylin and gastrin.

Pancreatitis is an inflammation of the pancreas that occurs when digestive enzymes attack the pancreas, causing severe pain, diarrhea, weight loss, and malnutrition.

There are two types of pancreatitis: acute and chronic. Both are serious, but acute pancreatitis occurs very suddenly and usually lasts only a few days while chronic pancreatitis gets worse over time and leads to permanent damage which may meet the requirements for SSDI.

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from Pancreatitis. If you have been denied disability don’t give up!

Symptoms of acute pancreatitis include:

•   Fever
•    Upper abdominal pain
•   Rapid pulse
•   Nausea and vomiting
•   Abdominal pain that radiates to the back
•   Abdominal pain that becomes worse after eating
•   Tender abdomen

Chronic pancreatitis may follow acute pancreatitis and includes the following symptoms:

•    Constant upper abdominal pain that radiates to the back
•   Diarrhea and weight loss caused by the pancreas not releasing enough enzymes
•   Upset stomach and vomiting

Any and all of these symptoms can make it hard to maintain employment.

Initial treatment of pancreatitis focuses on controlling pain, diet, nutritional support and removal of underlying causes.

Some patients may require surgery, antibiotics, and intravenous fluids while other cases may be treated with insulin and pancreatic enzymes.

Following your doctors treatment plan for you is essential to qualify for disability benefits.

Qualifying for Social Security Disability for Pancreatitis

Individuals with pancreatitis suffer with pain, diarrhea and weight loss, often making it difficult to hold full-time employment.

Unfortunately, pancreatitis is not listed as an impairment in Social Security’s Blue Book, so an applicant would not qualify for Social Security Disability benefits under that diagnosis. However, an individual who has pancreatitis and experienced severe weight loss may be eligible for disability benefits if they can meet the criteria of Section 5.08, Weight loss due to any digestive disorder.

In addition to the impairments specifically mentioned in these listings, other digestive disorders, such as esophageal stricture, pancreatic insufficiency, and malabsorption, may result in significant weight loss.

We evaluate weight loss due to any digestive disorder under 5.08 by using the Body Mass Index (BMI).

To meet the criteria of this listing, you must have experienced severe weight loss despite following prescribed treatment and have a BMI of less than 17.50 on at least two tests taken at least 60 days apart within a consecutive 6-month period.

If you haven’t experienced extreme weight loss, you may still be able to qualify for benefits if you can prove that pancreatitis makes it impossible for you to work at a full-time job on a “regular and sustained” basis.

“Regular and sustained” means you are able to perform a sit-down job for 40 hours per week without any special accommodations like frequent breaks or needing to lie down. In some cases, the severity of an applicant’s medical condition fluctuates and causes the claimant to miss work frequently. These applicants are often denied because some days they are able to do their work, while other days they are out sick or even hospitalized.

If you can prove that your pancreatitis would make you miss too much work, Social Security may approve your claim.

You will need to provide documentation and medical evidence to support your claim that you’re unable to work. You should include doctors’ notes and opinions detailing how your pancreatitis limits your activities and impacts your employment; for example, how long you are able to walk or stand and whether you are able to do sedentary, light, medium or heavy work. Social Security will also consider the effects of any medications you take and how often you need breaks for rest or bathroom breaks. It’s important to note that if you have chronic pancreatitis due to alcohol abuse and you are still drinking, the SSA may deny you benefits.

Additionally, you may be eligible for Social Security Disability benefits if you have another impairment; for example, high blood pressure or diabetes.

Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book. However, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. Social Security will also evaluate how your limitations affect your ability to work (called a medical-vocational assessment), taking into account whether or not you are able to drive, your age, and your level of education.

If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.

Social Security also has basic financial requirements.

Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements.

You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,620 per month in 2025 for nonblind applicants and $2,700 per month for blind applicants.

What if I don’t qualify for SSDI?

If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

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?

Yes, you should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) is coverage that protects 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. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.

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 initial application is denied, don’t be discouraged. Approximately 65% of initial applications are denied, but you will have the opportunity to appeal.

There are four steps to the Social Security appeal process:

1.    File a Request for Reconsideration with the Social Security Administration to completely review the case.
2.    If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
3.    If an ALJ does not grant 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.

Do I need a disability attorney for SSDI?

Qualifying for Social Security Disability benefits is problematic because the requirements of Social Security’s impairment listing are very difficult to decipher.

Your chances for approval are increased significantly if you have an experienced disability attorney who can gather your necessary medical evidence and even write a brief explaining why you qualify. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.

Do I need a disability attorney for a long-term disability insurance claim?

Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.

The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.

A client from Round Rock was diagnosed with pancreatitis.

By 2009, he was on eight medications, including Hydrocodone and Fentanyl. He could not operate a motor vehicle in the course and scope of employment, as required by his occupation, while under the influence of the narcotics he needed to take.

Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court – all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.