IBD & Social Security Disability

January 22, 2013 at 9:51 pm 1 comment

We all know IBD can be disabling- the chronic pain, fatigue, surgery and complications.

But did you know that IBD could qualify you for Social Security Disability benefits?

Who Can Qualify?
According to the Social Security Administration, you can receive benefits if you are unable to work (total disability).  You may be considered disabled if:

  • You cannot do work that you did before;
  • SSA decides that you cannot adjust to other work because of your medical condition(s); and
  • Your disability has lasted or is expected to last for at least one year or to result in death.

In addition to fitting into the definition of “disabled,” you must have worked long and recently enough to qualify for disability benefits. You also must have worked in jobs covered by Social Security.

To become eligible for disability, you need a certain amount of work credits. A work credit is based on your total yearly wages or self-employment income. You can earn up to four “work credits” each year. Credits equate to a certain amount of wages earned and it changes each year. For 2013, you earn one credit for each $1,160 of wages. So when you’ve earned $4,640, you’ve earned your four credits for the year.

The number of work credits you need to quality for disability benefits depends on how old you are when you become disabled. For the most part, you need 40 credits, 20 earned in the last 10 years ending with the year when you became disabled. However, the rules are different for younger workers:

  • Before age 24–You may qualify if you have 6 credits earned in the 3-year period ending when your disability starts.
  • Age 24 to 31–You may qualify if you have credit for working half the time between age 21 and the time you become disabled. For example, if you become disabled at age 27, you would need credit for 3 years of work (12 credits) out of the past 6 years (between ages 21 and 27).

So, say you are 24. You need to have worked 1.5 years during the three years before you became disabled. As long as you earned six credits ($6,960), you may be eligible for Social Security Disability Benefits.

How is IBD Covered?

According to the Blue Book (Disability Evaluation Under Social Security) – September 2008, inflammatory bowel disease falls under Section 5.06.

If you are applying for benefits because of IBD, you will need to be able to provide documentation by endoscopy, biopsy, appropriate medically acceptable imaging, or operative findings with:

  • Obstruction (not adhesions) in the small intestine or colon confirmed by imaging or in surgery, requiring hospitalization for intestinal decompression or for surgery and occurring on at least two occasions at least 60 days apart within a consecutive six-month period

or

  • Two of the following despite continuing treatment and occurring within the same consecutive six-month period:

    • Anemia with hemoglobin of less than 10.0 g/dL, present on at least two evaluations at least 60 days apart; or

    • Serum albumin of 3.0 g/dL or less, present on at least two evaluations at least 60 days apart; or

    • Clinically documented tender abdominal mass palpable on physical examination with abdominal pain or cramping that is not completely controlled by prescribed narcotic medication, present on at least two evaluations at least 60 days apart; or

    • Perineal disease with a draining abscess or fistula, with pain that is not completely controlled by prescribed narcotic medication, present on at least two evaluations at least 60 days apart; or

    • Involuntary weight loss of at least 10 percent from baseline, as computed in pounds, kilograms, or BMI, present on at least two evaluations at least 60 days apart; or

    • Need for supplemental daily enteral nutrition via a gastrostomy or daily parenteral nutrition via a central venous catheter.

Think You Might Qualify?

If you think you might qualify, the next step is to apply online. Here is some of the information that SSA will need from you:

  • Your Social Security number and proof of your age;

  • Names, addresses and phone numbers of doctors, caseworkers, hospitals, and clinics that took care of you and the dates of your visits;

  • Names and dosages of all the medications you are taking;

  • Medical records from your doctors, therapists, hospitals, clinics and caseworkers, that you already have in your possession;

  • Laboratory and test results;

  • A summary of where you worked and the kind of work you did; and

  • Your most recent W-2 form or, if you were self-employed, a copy of your federal tax return.

Being as detailed as possible is extremely helpful in this process- if you are vague or leave out details, you put yourself at risk of being denied benefits.

The online application can be found here. Additionally, you’ll have to fill out the Adult Disability Report form.

So I applied. What Now?

Social Security Disability applications are notoriously backlogged, so you won’t hear back for four to six months regarding your application. If you are trying to expedite an application, you can contact your local Senator or Congressman and ask them to intervene on your behalf to help speed up the process. However, if you do, there is no promise that it will actually speed the process up. But it can’t hurt to try.

The Disability Determination Services in your home state make the initial disability determination. They will secure all the medical evidence needed and arrange for exams if there isn’t enough evidence to render a decision. After putting all of the information together, they will arrive at a disability determination. It’s extremely important to note that only about 35 percent of initial applications are approved.

If you are denied at first, don’t fret!

You are in the majority of people who are denied the first time around. You can appeal the decision. If you choose to, make sure you provide all the additional documentation necessary to make your case undeniable. CCFA has a great sample appeal letter available on their website.

Got approved for benefits? Awesome!

You will continue to receive benefits for as long as you are disabled. However, your eligibility  may change if your health improves and you become no longer disabled or if you would like to go back to work instead of depend on your disability benefits. You are responsible for letting SSA know of any changes to your eligibility.

From time to time, SSA will review your case to verify that you are still disabled. They will notify you when its time to review your case and will keep you informed about your benefit status.

Well that’s Social Security Disability in a very brief nutshell. Please note that I am in no way an expert on Social Security– this was just my attempt to summarize information on benefits available to IBD patients.

For more information, check out SSA’s Disability Benefits Planner. There are also tons of attorneys around the country who specialize in disability law and can help you through the process.

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Entry filed under: Finances, General Disease. Tags: , , , , , , , , , , , , .

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1 Comment Add your own

  • 1. ss  |  August 6, 2014 at 9:35 am

    Can you tell us more about this? I’d like to find out some
    additional information.

    Reply

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