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Crohn's Disease and Social Security Disability

Applying for Social Security Disability Benefits with Crohn’s Disease

According to the Centers for Disease Control (CDC), about 1.6 million Americans have inflammatory bowel disorders (IBD). Crohn’s disease is one form of IBD, but the exact number of adults in the U.S. with this type of IBD is uncertain. The Crohn’s and Colitis Foundation of America (CCFA) estimates about 700,000 Americans have Crohn’s disease, and that most Crohn’s patients are diagnosed before the age of 35.

Some people find their symptoms can be controlled effectively with available treatments. Others however continue to have bouts of pronounced symptoms even when following prescribed therapies. Symptoms can include pain, inflammation, fatigue, fever, chronic diarrhea, bowel obstructions, and weight loss, among others, all of which can significantly disrupt your ability to work.

If you are among those for whom Crohn’s is a debilitating condition that is uncontrolled by available therapies, then you can qualify for disability benefits from the Social Security Administration (SSA). Disability programs include Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Whether you qualify for one or for both programs, you’ll receive monthly payments that can help you cover your everyday bills and living expenses as well as the costs of ongoing medical care.

The Costs of Crohn’s Disease

In its early stages, Crohn’s may not prevent employment, and some people are able to manage their illness through treatments. For others however, the disease progresses, requiring multiple surgeries, frequent hospital stays, and more and more time away from the job. A loss of earnings is therefore a huge cost associated with Crohn’s. Ongoing medical expenses weigh heavily on many patients as well.

The more frequently Crohn’s symptoms flare up, the higher the medical bills patients face, but even managing the disease can be expensive. Routine colonoscopies are recommended for Crohn’s, and at an average cost of $2,500 to $5,000 for each procedure, just keeping a watchful eye on your illness is a major expense.

Routine treatment for Crohn’s additionally includes frequent doctor visits, blood work, and prescription and over-the-counter medications. Biological drugs, like Remicade, are promising new treatments, but often fall outside the budget range of many patients. The CCFA reports copayments of between $2,000 and $4,000 per month for biological medications.

The CCFA reported the estimated direct costs for people with IDB were $1.84 billion in 2013. Your individual expenses may vary with your symptoms and based on what your insurance covers, but the CCFA puts the average annual expense per IBD patient at about $19,000.

Affording to manage your illness is a huge challenge with Crohn’s, and since stress level can play a major part in disease flare-ups, keeping your financial concerns to a minimum is essential. Social Security Disability benefits can be part of the solution, providing ongoing monthly income that helps offset your expenses and your worries.

Medically Qualifying for Benefits for Crohn’s

People suffering from Crohn's can qualify for benefits by meeting or closely matching the SSA’s Blue Book disability listing for IBD. This listing requires your symptoms are quite advanced, causing bowel tissue degeneration, obstructive scarring in your bowels, and other severe complications. The IBD listing also includes details of how you can qualify for benefits with liver and kidney complications, severe weight loss, and other symptoms.

Understanding the SSA’s requirements can be challenging without your doctor’s help though, because the Blue Book is written primarily for medical professionals. Work closely with your doctor to see if your Crohn’s symptoms and other medical records can satisfy eligibility requirements.

If you’re not able to qualify under the IBD listing, then you may still meet or closely match one of these other listings for digestive system-related disabilities:

  • Section 5.02, for bleeding in your bowels that requires a blood transfusion
  • Section 5.05, for chronic liver complications
  • Section 5.08, for severe weight loss

Qualifying for Benefits without Meeting a Disability Listing

If your symptoms aren’t able to satisfy any disability listing that appears in the Blue Book, you will have a more challenging time qualifying for benefits. This however doesn’t mean that you cannot get approved. It just means the SSA must take a closer look at your overall limitations by examining your “activities of daily living” or ADLs. This is done through a “residual functional capacity” or RFC analysis.

Crohn’s may, for example, cause frequent diarrhea, which means you must be close to a bathroom at all times. This can make it impossible to leave your home to shop for groceries or run errands, let alone go to work. Fatigue and muscle weakness are common with Crohn’s as well and can prevent you from cleaning your house, doing laundry, or any number of other everyday activities. These types of limitations are what the SSA looks for when completing an RFC evaluation.

The SSA also looks at your age, medical records, work history, education level, job experience, and work skills or training. They additionally gather information from you, your doctor, and others about how your symptoms limit your everyday life or ADLs.

Given your limitations discovered through an RFC, the SSA may find you cannot reasonably hold any job. When this is true, you can qualify for disability, even without meeting the requirements of a Blue Book-listed condition.

How to Apply for Disability Benefits with Crohn’s Disease

No matter how you may qualify for benefits, whether through an RFC or a standard, Blue Book listing, your application needs backup documentation or support. This requires giving the SSA access to your medical records, so you’ll need the names and contact information for all your healthcare providers, including your primary doctor but also your IBD specialists and any hospitals or other treatment facilities at which you’ve received attention. Although the specific tests, treatment records, and other documentation the SSA requires will vary based on your symptoms and your unique situation, a Crohn’s disability application must typically have the following records present in order to be approved:

  • Colonoscopy results, documenting the presence of inflammation, adhesions, or other physical abnormalities or changes in your bowels
  • Blood work and other lab results, showing kidney, liver, and blood count values
  • Treatment records, including medications, surgical procedures, and other symptom management techniques used and their affects
  • Operative notes from any surgical procedures you’ve undergone
  • Physical exam notes from your doctor, documenting symptom type, frequency, and duration

When applying for benefits with Crohn’s, your medical records must also usually include some historical data that shows how your condition has progressed or remained severe over several months. The doctor that coordinates your care for Crohn’s is instrumental in providing this report for the SSA, so be sure to work closely with him or her in applying for benefits.