According to the National Institutes of Health (NIH), about 20 percent of Americans are affected by gastroesophageal reflux disease (GERD). Occasional reflux is normal, but when symptoms occur more than twice a week, it is considered GERD, a more serious, chronic health condition.
For some people, GERD symptoms can be effectively controlled through diet and lifestyle adjustments and prescription medications. For others however, GERD is a troubling and potentially disabling disease that can lead to serious, even life-threatening complications.
If your GERD is not effectively controlled through available treatments or has led to pronounced complications, then you may be able to qualify for disability benefits from the Social Security Administration (SSA). Benefits through Social Security Disability (SSDI) and/or Supplemental Security Income (SSI) can cover your everyday living expenses.
The Costs of GERD
GERD often takes a toll on your earnings long before its symptoms and complications advance to the point that you’re unable to continue working. In fact, the International Foundation for Functional Gastrointestinal Disorders (IFFGD) reported in 2008 that GERD cost the United States an average of $2 billion per week from decreased productivity and work absences.
Prescriptions, frequent doctor visits, and tests to monitor the condition of your esophagus, stomach, and lungs may all be among the medical expenses you face. The exact costs depend largely on the kinds of complications you experience, but no matter the specifics, your medical costs can add up quickly.
If you have esophagitis, esophageal strictures, or Barrett’s esophagus, which are all common complications, your doctors will need to keep a close eye on these conditions. Frequent endoscopies may be necessary, and the average cost per procedure is more than $800, according to CBS News. Prescription medications are bound to be a primary medical expense for you. Healthline statistics report that doctors in the U.S. write nearly 65 million GERD-related prescriptions annually, and many patients must take multiple drugs to control or lessen the disease’s affects.
If your GERD causes respiratory complications, then you’ll face additional costs, like asthma medications or a CPAP machine. You may experience more frequent infections or aspiration problems too, and these lead to greater prescription costs, frequent emergency room visits, and often in-patient, hospital charges as well.
Medically Qualifying for Benefits with GERD
GERD alone, particularly if it response well to treatment, doesn’t meet the SSA’s medical eligibility requirements. When long-term, chronic GERD causes serious complications though, it is a disabling condition that can meet or match a listing in the Blue Book. This is the manual physicians and claims examiners follow when determining eligibility for disability benefits.
Though there’s no listing for GERD, but there are several others under which you may be able to get approved for benefits, like 5.02 if you have esophageal bleeding, 3.03 with asthma, or 3.08, if you suffer chronic respiratory infections.
The appropriate listing depends on the types of complications you experience, and the SSA may consult several listings when reviewing your claim.
You will want to ask your doctor to consult the Blue Book, so he or she can ensure your medical records can meet SSA requirements. Your doctor is one of your primary advocates and can order additional tests to round out your medical documentation for disability benefits, if necessary.
Qualifying for Disability without Meeting a Listing in the Blue Book
Unfortunately, many people that apply for disability with GERD can’t get approved through a standard, first review. They must instead go through a Residual Functional Capacity or RFC evaluation to determine if their symptoms and complications are so severe that they prevent employment completely.
If you are able to show pronounced limitations in your activities of daily living (ALDs), then you can potentially qualify through and RFC and receive a medical vocational allowance from the SSA. This allows you to get benefits, even if you cannot meet a disability listing.
The RFC process looks at all your medical information as well as your education, age, work experience, and overall employability. If the SSA finds your GERD stops you from working in any job for which you would otherwise be qualified, then you’ll be found medically eligible for disability.
The disability examiner assigned to your claim will send “functional report” forms or questionnaires to you, your doctor, and possibly to friends, family members, or others that you list on your application as people who know the daily challenges your GERD causes. These questionnaires are time sensitive, and must be completed and returned, typically within just 10 days.
If you know you’re likely to have to go through an RFC, then you can prepare in advance for getting your functional reports back in on time. Your physician’s input can make or break your claim. Make sure your doctor is on board and will finalize and submit his or her forms quickly.
How to Apply for Disability Benefits with GERD
Your disability application must be backed up with sufficient medical evidence. Certain records play a key role in approval, but the manner in which you may qualify for benefits determines which records are most crucial.
If you are able to qualify under a disability listing, then your doctor, social security advocate, or attorney can help you determine what records are most important. If you must qualify through an RFC evaluation instead, then the SSA will need to see a variety of medical documents that show the severity of your GERD symptoms and complications and the affects that they have on your life.
These records may include:
- Endoscopy results
- ER and hospitalization records
- Sleep studies
- Respiration evaluations
- Surgical or biopsy records
- Prescription drugs you’ve taken and their results
- Other treatments attempted
Long-term reflux disease, with symptoms that do not respond well to treatment, usually leads to disability. In cases like this, the SSA needs to understand how the damage has progressed over time, decreasing your daily abilities, including your ability to maintain a job and earn a living. A detailed statement from your doctor, explaining the progression of your GERD complications, can be beneficial.
If you’re applying for SSDI, you can do so at the local office or submit your application online, via the SSA’s website. For SSI however, an interview is required, and usually takes place at the local SSA branch.
Work closely with your doctor before and during your disability application. You may also want to consider seeking help from a Social Security advocate or attorney, especially if you know you cannot qualify under a disability listing.
