Social Security Disability for Diverticulitis
If you suffer from diverticulitis that has not responded well to treatment and made working impossible for you, you may be eligible for disability benefits. Diverticulitis is a digestive disease that is most often in the large intestine, but I can also be in the stomach, small intestine, or even the esophagus. It develops from diverticulosis, which causes external pouches to form on the colon.
There are three conditions resulting from diverticular disease, including diverticulosis, diverticular bleeding, and diverticulitis. Diverticulosis, which leads to diverticulitis, is a common disorder that occurs in about 10% of people older than 40 and more than half of those older than 60.
While many people experience a mild case that is effectively resolved by medication, you can be among the 25% of those people with acute diverticulitis that experience complications such as a blockage in the small intestine or colon, an abnormal passageway between the bladder and bowel, an abscess, or peritonitis, which is an emergency requiring immediate care resulting from a swollen or infected pouch rupturing and spilling its contents into your abdomen.
The Financial Impact of Treating Diverticulitis
Cost Helper explains that diverticulitis can be an expensive medical condition to treat. According to the U.S. Agency for Healthcare Research and Quality, it is not uncommon to spend up to five days hospitalized because of the condition. The average five-day hospitalization costs about $8,300. Less than 20% of the cases of diverticulitis diagnosed require surgery, but if surgery is required it does cost anywhere from $30,000 to $50,000.
It can cost around $500 for antibiotics and homecare. Some of the most used antibiotics for the condition are expensive, including Flagyl and Cipro. Cost Helper indicates that the average bout with diverticulitis can cost anywhere from $500 to more than $50,000 if you don’t have health insurance. If you are insured, it will cost any copays plus coinsurance costs, which range from 5% to 50% of the total bills.
Medically Qualifying for Disability Benefits with Diverticulitis
The Social Security Administration (SSA) has a medical guide called the Blue Book that it uses to determine if an individual meets the criteria of being disabled. Your condition must have already lasted, or be expected to last, as least one entire year. Because it can usually be treated, it can be a more challenging condition to gain benefits approval with. In order to be approved for benefits with diverticulitis, you have to be able to prove that
- Your symptoms are as severe or worse than the symptoms necessary to qualify for disability benefits for a listed condition OR
- Your symptoms are so severe that you can’t be expected to perform any work that you are qualified to perform or any work duties that you could be trained to perform.
Because diverticulitis is common and generally responds well to treatment, it does not have a listing in the Blue Book. The closest condition to diverticulitis that is listed in the Blue Book is Inflammatory Bowel Disease (IBD). The symptoms of your diverticulitis can be compared to IBD to gain approval. The guidelines laid out for qualifying based in IBD is in Blue Book Section 5.06. The conditions that Disability Determination Services will look for basing a disability on IBD include:
- Chronic anemia with a hemoglobin of 10 g/dL or lower that has been tested two times within a two-month timeframe.
- Serious abdominal pain that is not controlled with narcotic pain relievers. This must be tested two months apart on at least two separate occasions.
- Documentation by medical imaging, such as a CT scan, that shows your condition.
- A draining abscess or fistula.
- Involuntary loss of weight that is significant or extreme.
- Requirement of a catheter to meet nutritional needs.
- Bowel obstructions requiring hospitalization at least two times in a six-month period. These hospitalizations must be at least two months apart.
Since diverticulitis doesn’t have its own listing, you have to be able to convince Disability Determination Services with evidence that you are unable to continue working because of the severity of your condition.
Gaining Approval Through a Residual Functioning Capacity
If you aren’t able to meet the requirements to be approved for benefits because of your condition by using the Blue Book and the medical qualification process, you can still get approved by using a residual functional capacity (RFC) and the medical-vocational allowance. Using this approach, you prove that you cannot return to your past work, but that you cannot transition to a new position at work either. You can have your treating physician complete the RFC, as your treating physician knows more about your condition as well as your limitations and restrictions.
If your diverticulitis causes frequent blood loss, you may experience fatigue and weakness. Your physician would indicate that on the RFC. You may be unable to frequently bend, lift or carry items, including items that weigh five pounds or less, so that must be indicated. If your condition has caused weight loss that makes you have trouble standing or walking, that should also be noted. You may have to frequently reposition because of abdominal pain, and that can impact your ability to work as well.
The medical-vocational allowance will also consider your work experience, transferrable skills, educational level, and age to see if your condition would allow you to do sedentary work, which means you would sit at a desk. If your diverticulitis has impacted your energy levels, causes severe pain, and results in frequent bathroom visits, you wouldn’t be able to perform those kinds of duties either and that needs to be clearly indicated on the RFC.
Applying for Disability Benefits
The key to a successful disability claim is providing plenty of evidence by supplying complete medical records, documents, physician notes, and test results. Provide details about how your ability to perform specific tasks and activities have been impacted by your condition.
On average, it takes five months for a disability case to gain approval. If your claim is denied, you can appeal that ruling twice before appearing before an administrative law judge to make a ruling on your claim.
With diverticulitis, you need to have blood tests, scans such as MRIs and CT scans, and detailed examination reports that provide strong proof of your condition and its severity. Because it is a complicated process, a disability attorney can help you with your claim and increase your odds of gaining approval. You can start the disability claims process online at www.SSA.gov or by calling 1-800-772-1213.