Crohn’s Disease & Social Security Disability Benefits

MAW PPP Banner Jan 18 2013

This Blog Post is written by Guest Blogger, Molly Clarke

Please welcome Molly Clarke to the Professional Patient Perspective.  Molly writes for the Social Security Disability Help Blog and works to both promote disability awareness and assist people throughout the Social Security Disability application process. Their website offers a host of informational resources including an interactive disability forum, how-to’s, a Social Security Disability glossary and answers to frequently asked questions.  Please feel free to contact Molly Clarke at mac@ssd-help.org with any questions about applying for disability benefits.

Crohn’s Disease and Social Security Disability Benefits

Crohn’s Disease is an incurable, autoimmune medical condition that generally causes damage and inflammation to the large and small intestines.  Those who suffer from this condition can experience significant abdominal pain and may have difficulty controlling bowel movements.  People with Severe Crohn’s Disease may also suffer from an ongoing variety of serious medical effects of a compromised immune system.  The cumulative physical effects of Crohn’s Disease can also result in severe mental health problems.  If you have Crohn’s Disease and suffer from severe and frequent symptoms, you may find it impossible to maintain steady employment. The resulting loss of income and lack of medical insurance can be financially devastating.

If you find yourself facing these circumstances, you may qualify for Social Security Disability (SSD) benefits. The following will provide you with the information you need to begin the SSD application process.

Social Security Disability Benefit Programs

SSD benefits are governed and distributed by the Social Security Administration (SSA).  The SSA operates two separate programs that provide financial assistance to sick or disabled individuals. Each of these programs has their own set of eligibility requirements.

  •  SSDI – Social Security Disability Insurance (SSDI) is a program that offers benefits to disabled workers.  SSDI is funded by taxes that workers throughout the country pay into the program. Therefore, eligibility for SSDI is determined by applicants’ work history. To qualify, you will need to have earned income and contributed to the program in the past. Click here to read more about SSDI
  • SSI – Supplemental Security Income (SSI) is a needs-based program that provides benefits to disabled or elderly individuals who have very little income. To qualify for SSI, individuals must meet very strict financial limitations. Click here to read more about SSI.

In some cases, applicants can qualify for both SSI and SSDI.

Is Crohn’s Disease a Disability?

In addition to meeting the technical requirements that have been listed above, individuals must also meet the SSA’s definition of disability. Generally, the SSA considers a disability to be a condition that is expected to last at least one year and keep an individual from working.

To judge the severity of a specific condition, the SSA consults an official guidebook of potentially disabling conditions, known as the “Blue Book.” To qualify for SSD benefits with Crohn’s Disease, applicants must meet the criteria of Blue Book listing “5.06- Inflammatory Bowel Disease.”   Criteria for this listing include:

  •  Having a diagnosed IBD***

 -AND-

  • Having an obstruction of the small intestine or colon that requires at least two hospitalizations 60 days apart in a 6 month period.***

 -OR-

  • Two or more complications related to your Crohn’s disease that include untreatable anemia, a bowel obstruction, significant weight loss, a painful abdominal mass, an abscess or fistula.***

Here is this Blue Book listing on the SSA’s website.

***The SSA will consider the combined effects of all conditions that you may suffer from. For this reason, it is important you include information about any other ailments your Crohn’s Disease may have caused. This will give the SSA a better understanding of your limitations and consequential inability to work.

Medical Vocational Allowance

Individuals who have Crohn’s Disease may find that while they don’t meet the specific Blue Book requirements, they are nevertheless disabled by their condition. In that regard, if your symptoms keep you from maintaining employment but don’t match the Blue Book criteria, you may still be able to qualify for SSD benefits under a “Medical Vocational Allowance.”  

For example, if an applicant has not been hospitalized two times in the last six months, but cannot keep their job due to daily ongoing unpredictable bouts with paralyzing severe bouts of cramping pain or because they must spend extensive amounts of time each day in the bathroom—the SSA may take this into account and award this person benefits under a “Medical Vocational Allowance.”

To determine whether or not you qualify for a Medical Vocational Allowance, the SSA will look for evidence that your condition limits your ability to sit or stand for significant periods of time, lift or carry items, or follow instructions. The SSA will also consider your age, past work experience, and your ability to re-train and enter a different occupational field. Typically, and this may be of significant importance to many people, the SSA considers applicants 50 years or older to be unable to be re-trained to adapt to a different type of work.

 Preparing to Apply for Social Security Disability Benefits

Although the applications and instructions necessary to apply for SSD benefits are readily available on the SSA’s website, it is important not to rush into this process because many applications are initially denied because applicants made simple mistakes, are disorganized or do not supply the correct medical documentation.  In such instances, applicants must go through an appeals process which could take YEARS.  Therefore, before applying, make certain that you have financial records, physician’s statements, treatment histories, and any relevant medical exam results to support your disability claim.  As a result, by simply understanding what is expected during this process and being thorough in your preparation, you can significantly increase your chances of quickly receiving the financial assistance you need.

The Application Process & Attorney Fees

Once you are ready to begin the application process, you can do so online or in person at your local Social Security office. If at any point you are feeling overwhelmed or confused by application procedures, it may be in your best interest to retain the services of an attorney or patient advocate. A legal professional can assist you at any stage of the process and will ensure that your application thoroughly documents your condition and symptoms.  Moreover, the attorney who represents you applying for disability benefits is only paid if you are awarded benefits. If your claim is denied, your attorney will not receive any sort of compensation.  Additionally, the SSA has certain limits in place regarding attorneys’ fees such that they can only receive 25% of the applicant’s first payment (i.e., his or her “retroactive benefits”) or $6,000—whichever amount is less. This money is deducted from the successful applicant’s first payment and sent directly to the attorney by the SSA. 

After Receiving a Decision

A   As previously mentioned, many initial applications for SSD benefits are denied. This happens for many different reasons. Most often, applicants are denied for the following reasons:

  • His or her claim lacks hard medical evidence.
  • The applicant is filing a new claim rather than appealing an old claim.
  • The applicant’s income exceeds the “substantial gainful activity” allowance (i.e., $1,040 per month).
  • The applicant fails to follow treatment as prescribed by a doctor.
  • The applicant fails to attend appointments or respond to requests for more information from the SSA.

If your initial claim is denied, do not panic. You should appeal this decision within 60 days.

After Being Awarded Disability Benefits

If you are awarded benefits, the SSA will conduct “continuing disability reviews” approximately every three years. In some cases, when the applicant is expected to recover, the SSA will conduct reviews sooner. In cases where the applicant is not expected to recover, the SSA may wait longer to conduct a review. When conducting a continuing disability review, the SSA will request information similar to the information required as part of the initial application. For this reason, it is important that you continue to seek medical treatment and keep copies of all medical records.

The SSA will discontinue a person’s benefits if they are no longer disabled or earning “substantial gainful activity.”

 ***************************************************************************

For more information about applying for SSD benefits with Crohn’s Disease, please visit this page, Crohn’s Disease and Social Security Disability.

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