Medical Criteria Needed to Qualify with Cirrhosis of the Liver

The liver performs many critical functions in the body, and even a slight imbalance can wreak havoc on your health. Being diagnosed with cirrhosis of the liver is a health crisis that is likely to impact your personal and professional life.

Fortunately, the Social Security Disability Insurance Program (SSDI) was developed to provide disability benefits to individuals suffering from debilitating conditions, such as yourself.

Just because you have been diagnosed with cirrhosis of the liver does not mean that the Social Security Administration (SSA) will automatically provide you with disability benefits.

You will need to provide sufficient medical documentation to illustrate that your condition is severe enough to warrant financial assistance.

Ensuring that you have all of the pertinent medical information and documentation when applying for SSDI will significantly enhance your application, making it much more likely that you will be approved for disability benefits.

The Importance of the “Blue Book”

In order to evaluate your application, disability examiners will utilize a medical guide known as the Blue Book. The Blue Book lists specific criteria and symptoms related to cirrhosis of the liver to determine if your condition is severe enough to warrant disability payments.

Cirrhosis of the liver is covered in the chronic liver disease section, 5.05, of the Blue Book. However, as the liver is so closely tied to many other body systems, you may meet an additional listing in the Blue Book.

For example, if you have lost significant weight due to your cirrhosis, you may meet criteria in section 5.08, weight loss for any digestive disorder.

To assist you with the information gathering process, here is the most relevant medical evidence that you will need to provide to give you the best chance of being approved for SSDI.

It is of vital importance to work with your health care providers to ensure that you have completed all of the medical tests required by the SSA and that all of your medical evidence is in order.

Evidence Needed Related to Your Cirrhosis Diagnosis

The first type of medical evidence that the Blue Book directly requests is a complete medical history of your liver disease. You should be able to provide the following evidence.

Records from your physician should include your presenting symptoms, the progression of your liver disease, as well as the results of a full physical examination. Your physician should be certain to address any of the following symptoms you might experience:

  • Itching (pruritus)
  • Extreme fatigue
  • Nausea, loss of appetite, or unintended weight loss
  • Sleep disturbances
  • Be certain that your physician addresses the following signs in your record
  • Evidence of fluid retention such as fluid in your abdomen or swelling in your arms or legs
  • Yellowing of the skin or eyes (jaundice)
  • Enlargement of the liver or spleen
  • Altered mental status

According to the Blue Book, to be approved for disability benefits, those with cirrhosis of the liver should have the following blood lab results:

  • Full Liver (hepatic) panel: This blood test shows how well the liver is working. It measures blood levels of total protein, albumin, bilirubin, and liver enzymes such as AST, ALT, and ALP
  • Coagulation studies: Coagulation studies, such as INR and platelets, show how well the blood is able to clot, which is controlled by the liver
  • Imaging tests that may show evidence of cirrhosis, such as the scarring or increased size of the liver, such as X-ray, CAT scan, MRI, or ultrasound
  • Liver biopsy results, if performed
  • If you have required hospitalization for a blood transfusion and received at least 2 units of blood as a result of instability due to internal bleeding, be certain that these records are included in your application. The SSA normally approves those who have been in this situation for at least one-year of benefits.
  • If you have experienced a bacterial infection in the lining of your stomach (peritonitis) with a neutrophil count of at least 250 cells/mm3, be certain that this is included in your records.
  • If you have experienced retained fluid in your abdomen or lungs, be certain that your physician has documented that in your record.
  • You may have required a paracentesis or thoracentesis, which is a draining of the fluid. If so, this should be included in your records

While any physician can order these tests or exams, the SSA gives more weight to the opinion of medical specialists. Therefore, it is important that you work with your gastroenterologist or hepatologist to gather this medical information.

Evidence Needed Related to Affected Body Systems

In some cases, your chronic liver disease may impact other organs. If this is the case, be certain that the following is documented:

  • Renal failure:
  • Elevated serum creatinine (above 2mg/dL)
  • Marked sodium retention (less than 10 mEq per liter)
  • Reduced urine output (less than 500 mL in 24 hours)
  • Lung problems:
  • Decreased arterial oxygenation (paO2) on room air
  • Neurological problems:
  • Changes in mental status
  • Altered state of consciousness, such as confusion, delirium, or coma

Evidence Needed Related to Your Cirrhosis Treatments

The treatment for cirrhosis of the liver will depend on the cause and the extent of liver damage present. While there is no cure, treatment can sometimes halt the progression of the disease.

The SSA will need to know what treatments you have received, your response to those treatments, and most importantly if your health status has worsened despite those treatments.

Be certain that your doctor has documented the following:

  • Medications that you are receiving
  • Treatments that you have attempted, but perhaps failed
  • Blood transfusions that you may have needed
  • Any procedures related to your liver disease, such as paracentesis
  • Any surgeries or procedures, such as ERCP or liver biopsies that you may have had, including operative notes or pathology reports, if applicable
  • Any lifestyle changes that you are required to follow by your physician
  • Any related medical complications, such as weakness, neurological complications, heart problems, or intellectual difficulties

The Blue Book notes that not every patient will meet a particular qualifying condition’s listing, but you may be unable to work regardless. If this is the case, you might still qualify for disability benefits utilizing a residual functional capacity (RFC).

Evidence Needed Related Your Quality of Life and Ability to Care for Yourself

Many people with cirrhosis do not qualify for SSDI benefits through the Blue Book digestive listing. However, you still may be too ill to work. If this is the case, your gastroenterologist should provide physician notes documenting his or her opinion regarding your limitations and inability to function without unscheduled breaks or days off.

The more specific that your doctor is about your limitations, such as your ability to walk without severe breathlessness or your ability to take a shower without assistance, the better your chances are of being approved for disability benefits.

Steps You Can Take to Win Your Disability Claim

Understanding the Social Security disability process is essential in winning your claim. Sufficient medical evidence is the key to success in earning the disability benefits that you deserve. In addition to gathering all of your documentation, it is imperative that you have a good working relationship with your physician.

The entire Blue Book is available online, and the section on the digestive system is quite detailed, so you may want to review section 5.05 with your physician to determine what medical records you have on hand, and what may need to be supplemented to be approved.

While you don’t need to provide medical documentation to the SSA yourself, it is helpful to be as organized as possible. When you visit your doctor, it is a good idea to present a written list of symptoms and side-effects that you are experiencing.

There are several ways your gastroenterologist or primary care physician can help including:

  • Ensuring that your full medical history related to your cirrhosis is up to date
  • Listing your past treatments and responses, as well as the plan for the future
  • Documenting all of your medications and experienced side effects
  • Performing any additional blood tests or procedures that you are missing

Some individuals have had success in filing and winning claims on their own. However, the majority of successful cases have been navigated by an experienced Social Security disability attorney or advocate.

While you may be concerned about your financial ability to pay for these services, a disability lawyer is not paid until you win your cirrhosis of the liver claim.

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