If you have been diagnosed with Crohn’s Disease and are unable to work, it will help to know how the SSA will evaluate your claim for disability benefits.
The Bishop Law Firm has represented Social Security Disability clients in North Carolina since 2009. We do not get paid unless we win and we offer free case reviews. Call us today, 919-615-3095, or start your free case review online now.
Social Security Disability Benefits
The first step in attaining disability benefits is to apply for them at your local Social Security office or online. You will need this information to start your application.
Before you apply, you should know the two types of benefits (SSDI and SSI) you may generally be eligible for.
Social Security Disability Insurance (SSDI benefits)
SSDI (Social Security Disability Insurance) is based on the credits from the work you have done in your life. You must be found disabled before your date last insured (DLI) to be found eligible for SSDI. Your DLI is calculated by counting your “quarters of coverage” from your earnings record. You must have 20 “quarters of coverage” of the last 40 quarters. Simply put, you must have worked 5 years of the last ten years (in general). In addition, Adult Disabled Children can be eligible for benefits off their parent’s account.
Supplemental Security Income (SSI benefits)
SSI (Supplemental Security Income) is a need-based program and you must meet income/asset standards in addition to being found disabled under the five steps above. In 2023, SSI is $914.00 per month for an individual and $1,371 for an eligible couple. SSI will be reduced by 1/3 if you are receiving financial help from others. In NC, SSI recipients are also entitled to Medicaid.
SSI is also available for disabled children and is evaluated under a different standard than adults. Children must have a medically determinable physical or mental impairment or impairments (including emotional or learning problems) which result in marked and severe functional limitations, and the impairment(s) has lasted or can be expected to last for a continuous period of at least 12 months or be expected to result in death. Child SSI terminates when the child turns 18. The claimant will then have to reapply and be evaluated under the above adult sequential evaluation.
What is Crohn’s Disease?
Crohn’s disease is a type of (autoimmune) inflammatory bowel disease that causes swelling and inflammation to the tissues of the digestive tract (Via Mayo Clinic).
The digestive tract includes the hollow organs: mouth, esophagus, stomach, small intestine, large intestine, anus and solid organs: liver, pancreas and gallbladder. Each organ plays a vital role in transforming food into fuel that your body can use.
Crohn’s disease most commonly affects the end of the small intestine (the ileum) and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus. Ulcerative colitis is limited to the colon, also called the large intestine” (Found here).
The ileum (longest part of small intestine) is responsible for absorbing most of the nutrients that you need to function (Via UPMC).
When the ileum becomes inflamed (ileitis), the absorption of fat-soluble vitamins A, D, E,K and B12 will be affected (Via C&CF). In addition to malnutrition, weight loss, fatigue, chronic diarrhea, abdominal pain, rectal bleeding and frequent (and painful) bowel movements are symptoms.
Crohn’s disease can be difficult to diagnose as it can affect different parts of the gastrointestinal tract and it has symptoms that can easily be attributed to other diseases (celiac disease, infections or anemia) (via WebMD).
It is common for Crohn’s sufferers to receive various diagnoses before being finally diagnosed with Crohn’s. Usually, a doctor can diagnose you with Crohn’s based on x-rays, colonoscopies, CT scans, biopsies or blood work.
People who have Crohn’s disease are given medications to reduce inflammation in their digestive tract. Some of the anti-inflammatory medications can cause serious side effects (e.g. prednisone) that may alone be disabling.
As Crohn’s disease progresses intestine walls can thicken resulting in bowel obstruction. If medication proves unhelpful, a bowel resection surgery may be needed (via UCSF).
Unfortunately, bowel resection surgery can leave a patient with short bowel syndrome which comes with its own set of problems.
While ileostomy and colostomy does not automatically qualify you for disability, it does demonstrate the impact of your Crohn’s disease on your digestive system.
Crohn’s disease can be very frustrating and painful. Flares may come unexpectedly and turn your world into turmoil. Crohn’s can easily be confused with other illnesses (i.e., ulcerative colitis) due to common symptoms. This can result in delays in finding the right treatment for symptoms (Via Mayo Clinic).
Digestive disorders frequently co-occur. It would be helpful to also read our post on Disability for Digestive Disorders.
Disability for Crohn’s Disease
Is Crohn’s disease a disability to Social Security? Yes, it can be. As with all claims for disability benefits, the name of your impairment is not as important as the severity of your condition.
SSA requires that you have a medically determinable severe impairment which can be expected to result in death or which has lasted or will last for 12 months (duration requirement).
This simply means that if you become disabled but your condition improves within a year, you cannot receive disability benefits.
This may prove problematic for those who only experience disabling symptoms during intermittent flares.
As you will see below, in order to be found disabled, SSA requires evidence that Crohn’s disease is causing more than sporadic symptoms.
The Social Security Administration can evaluate a claim for disability benefits for Crohn’s disease in three different ways. The first method is under Listing 5.06, Inflammatory Bowel Disease or 5.08 Weight loss due to any digestive disorder; under the Grid Rules and lastly based on the determination that the combination of your symptoms from all your impairments eliminates your ability to engage in substantial gainful activity.
5.06 Inflammatory bowel disease (IBD) (see 5.00D) documented by endoscopy, biopsy, imaging, or operative findings, and demonstrated by A, B, or C:
A. Obstruction of stenotic areas (not adhesions) in the small intestine or colon with proximal dilatation, confirmed by imaging or in surgery, requiring two hospitalizations for intestinal decompression or for surgery, within a consecutive 12-month period and at least 60 days apart.
OR
B. Two of the following occurring within a consecutive 12-month period and at least 60 days apart:
1. Anemia with hemoglobin of less than 10.0 g/dL, present on at least two evaluations at least 60 days apart; or
2. Serum albumin of 3.0 g/dL or less, present on at least two evaluations at least 60 days apart; or
3. Clinically documented tender abdominal mass palpable on physical examination with abdominal pain or cramping; or
4. Perianal disease with a draining abscess or fistula; or
5. Need for supplemental daily enteral nutrition via a gastrostomy, duodenostomy, or jejunostomy, or daily parenteral nutrition via a central venous catheter.
OR
C. Repeated complications of IBD (see 5.00D5a), occurring an average of 3 times a year, or once every 4 months, each lasting 2 weeks or more, within a consecutive 12-month period, and marked limitation (see 5.00D5c) in one of the following:
1. Activities of daily living (see 5.00D5d); or
2. Maintaining social functioning (see 5.00D5e); or
3. Completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace (see 5.00D5f).
This listing requires obstructions relatively close in time OR two of the following: anemia, decreased serum albumin, abdominal masses, perineal disease, involuntary weight loss or the need for daily supplemental enteral nutrition.
In addition to Listing 5.06, Listing 5.08 Weight Loss due to any digestive disorder can be used.
5.08 Weight loss due to any digestive disorder (see 5.00F), despite adherence to prescribed medical treatment, with BMI of less than 17.50 calculated on at least two evaluations at least 60 days apart within a consecutive 12-month period.
SSA can also use The Grid Rules (Medical Vocational Guidelines) to find you disabled if you are 50 years of age or older and are limited to sedentary work due to your Crohn’s disease.
Lastly, and most relevant I believe, is the combination of impairments argument. Crohn’s is known to cause digestive problems and frequently is accompanied by other autoimmune disorders.
The combination of symptoms from all your impairments may eliminate your ability to work. Frequent trips to the restroom, pain, fatigue, medication side effects, malnutrition and symptoms from co-occurring autoimmune disorders can eliminate work.
In my clients with Crohn’s disease and other autoimmune disorders, mental illness (such as depression and anxiety) is common.
If you meet the above listings (5.06 and 5.08), work has long since stopped being an option for you. I advise clients not to worry about meeting listings. If you are unable to work because of your health and you are doing all that you can to get well and still can’t work, you need to apply for disability benefits as soon as possible.
Do you need a Disability Lawyer?
Attaining Social Security Disability Benefits for Crohn’s disease can be tough (but this is generally true for all impairments with Social Security) as you need medical evidence documenting that you have Crohn’s and clear evidence of how your symptoms prevent you from working.
A Social Security Disability Lawyer can appeal DDS denials and keep your case on track to the hearing in front of an Administrative Law Judge where you have your best chance statistically of being approved.
In addition, providing the SSA with the information in the way that they need to see it to make the right decision is imperative to getting you closer to receiving disability benefits.
You do not need a Disability Lawyer to be approved for benefits, but having someone who knows the system always helps.
If you are looking for a Disability Lawyer in Raleigh, NC or anywhere else in North Carolina, The Bishop Law Firm represents Social Security Disability clients in Raleigh, Durham, Fayetteville, Cary, Rocky Mount, Wilson, Smithfield, Louisburg, Chapel Hill, Roanoke Rapids , Winston Salem, Garner, Greensboro, Greenville and more areas in North Carolina. Call us today for a free case review, (919) 615-3095 or start online now.