Applying for Social Security Disability Benefits with Liver Disease
According to the American Liver Foundation, more than 30 million Americans have some form of liver disease. When chronic or advanced, including cases in which a liver transplant is necessary, medical qualification for disability is “automatic,” though you must still submit an application and back up your claim with medical evidence.
If your disease is less advanced but prevents you from working, you may still be able to get benefits.
Symptoms, required treatments, and complications can collectively disable you. In this case, you’ll need to show you’re unable to work in any job for which you otherwise hold the appropriate qualifications.
Disability programs through the SSA include Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Both programs pay monthly, and once you’re approved, you can count on disability as a source of consistent income for covering medical bills, everyday living costs, and other expenses.
The Costs of Liver Disease
Medical bills are a major part of living with any chronic illness, but the full financial and other costs of liver disease go well beyond just expenses.
As your disease progresses, absences from work may become more frequent and decreased earnings are the inevitable result. Daily health challenges, symptom flare-ups, and treatment side effects all likely take their toll on your personal life as well.
When it comes to medical costs, the type and stage of your liver disease determines your actual expenses.
With hepatitis, for example, you’ll have maintenance medications you take all of the time and other drugs that are only prescribed when needed.
With chronic liver disease, like cirrhosis, or end stage liver disease, hospitalization costs, diagnostic tests, and frequent lab work, become major expenses.
The average three-day, in-patient stay in a U.S. hospital, according to Healthcare.gov, is around $30,000. There will often be emergency room charges prior to being admitted, and the Washington Post reports ER costs average $1,233 per visit.
End-stage or advanced, chronic liver disease patients in Detroit face monthly medical expenses of about $5,000, per research conducted by the Henry Ford Institute. Costs can vary by location of course, but average expenses are high throughout the nation.
If liver disease progresses to liver failure and you require a transplant, then the costs become astronomical, with The National Foundation for Transplants reporting a liver transplant surgery and the first year of follow up treatment averaging $575,000.
Whether you have Hep-C, cirrhosis, or another form of liver disease, you will face ongoing medical expenses and other costs.
Social Security disability benefits can provide consistent income to help you contend with these financial challenges. Medicare and/or Medicaid eligibility is often available to disability recipients, which means you’ll have fewer concerns over doctor bills, prescription costs, and other healthcare charges as well.
Medically Qualifying for Benefits with Liver Disease
Most liver disease applicants who get approved for benefits meet a listing in the SSA’s Blue Book.
This manual, which is used by physicians and claims examiners alike, contains listings for common disabling conditions. Also outlined in the manual are the medical evidence requirements necessary for proving the severity of your condition, though these details can be difficult to understand without a doctor’s help.
Your doctor can help you determine if you’ll qualify through the Blue Book. You’ll need your doctor to coordinate with the SSA regarding medical records and other requests for information throughout the disability review process too, so it’s best to get him or her on board even before submitting an application for benefits.
Dependent upon the type of liver disease you have, the SSA and your doctor may review any of the liver-related listings in Section 5.00:
- Hepatitis, cirrhosis, and other chronic liver conditions are covered by listing 5.05.
- If you have had a liver transplant, you can qualify for benefits under listing 5.09.
- If your liver disease causes severe weight loss, but does not qualify under another listing, you may meet or match listing 5.08.
In some cases, liver disease is secondary, like when kidney problems lead to complications with other body systems. When you have other medical issues, the SSA will consider your overall health and will consult multiple listings in the Blue Book to determine how or if you can qualify under a listed condition.
Your doctor can do the same and can access the full Blue Book online.
Qualifying for Disability without Meeting a Listing in the Blue Book
Liver disease must be advanced to qualify under a disability listing. This unfortunately means you may need to go through additional reviews.
You’ll be required to show that your disease, your necessary treatments, and/or the complications you experience are severe enough that they stop you from working completely.
This process is known as “residual functional capacity”or RFC analysis.
The SSA will issue additional questionnaires for you to complete. They will ask your doctor and potentially others, like a friend or family member, to fill out similar questionnaires or “functional reports.”
If you suspect, based on input from your doctor or a Social Security advocate or attorney, that you can’t meet a disability listing, then you can begin preparing for the RFC in advance. You’ll need details about how your liver disease limits your daily activities and the specific limitations you experience.
A thorough report from your doctor is extremely helpful in this type of disability review. In the report, your doctor should detail the diagnosis, progression, and prognosis for your condition.
He or she should also describe your specific symptoms, how frequently you experience them, and the manner in which they affect your everyday life, including your ability to work.
For example, your liver disease may cause frequent nausea that is not controlled by medications. Your doctor can report:
- The treatments that have been attempted and failed,
- the severity of your nausea,
- how often it affects you,
- and how long the typical bout lasts.
These kinds of details help the disability claims examiner understand the impact of your illness on your employability. Because your education, work training, and job skills also affect the type of work for which you’re qualified, the SSA looks at these as part of the RFC too.
They additionally take into consideration your age and the likelihood of being able to acquire new skills and change career paths.
If through an RFC the SSA determines you can’t work in a job for which you are otherwise qualified, then you’ll be found medically eligible for benefits.
How to Apply for Disability Benefits with Liver Disease
A disability application must be thorough and complete. There should be no blanks on any of your forms and you will ideally have lengthy medical records to support your claim. The SSA may review records going back several years, though current medical information also plays an important role in approval.
The most severe symptoms or complications you experience with your liver disease affect the specific records the SSA needs from you. However, with any liver disease application, medical evidence must generally include:
- Liver value lab results
- Imaging results, like MRIs with contrast
- ER and hospitalization records
- Surgical notes and biopsy results
You can complete and submit your SSDI application online or at the local SSA office. For SSI benefits though, you’ll need to call the SSA at 1-800-772-1213 or visit your local branch. SSI requires a personal interview during which your application is filled out for you by a representative.