Disability Determination for Liver Disease
An overview of what you need to qualify for disability benefits based on liver disease or liver damage.
Liver damage is primarily caused by chronic liver disease, which can result from alcohol and drug abuse, genetic disorders, exposure to environmental toxins, viruses and autoimmune disorders. Symptoms include an enlarged liver, jaundice, abdominal swelling, chronic fatigue, and mental impairments.
Can I Get Disability Benefits for Liver Disease?
There are several prerequisites you must meet before the Social Security Administration (SSA) can determine if you are eligible for disability based on your liver disease. First, the SSA will look to see if you are working and engaged in "substantial gainful activity" (SGA). For 2016, if you earn $1,130 or more a month, the SSA will find that you are engaged in SGA and automatically deny your claim. Your liver disease must also be expected to last 12 consecutive months.
Once the SSA has determined that you meet these basic requirements, the SSA will then look to see if your liver damage meets or equals one of the qualifying conditions in its Listing of Impairments (also called the "blue book"). If your liver damage meets or equals an impairment listing, you will be automatically approved for disability.
Digestive and Liver Disease Listings
If you are able to establish that your liver damage is caused by chronic liver disease, you could be approved under Listing 5.00. To demonstrate that your liver disease is chronic, the medical evidence must show that the disease has lasted at least six months.
Primary Biliary Cirrhosis (PBC)
One common cause of liver damage is primary biliary cirrhosis (PBC). PBC is a chronic liver disease characterized by ongoing inflammation of the liver. This inflammation causes scarring of the liver (cirrhosis) and leads to a buildup of toxins in the body. If you meet all the criteria for PBC, you will be approved for disability.
Hepatitis is another chronic liver disease that can result in liver damage. For disability purposes, the effects of hepatitis on your liver are more important than the type of hepatitis you are infected with.
Chronic Alcoholic Liver Disease
You also may be eligible for disability under Listing 5.00 if you suffer from chronic alcoholic liver disease. However, it is important to note that you usually must abstain from alcohol to get disability benefits if a doctor says that your liver disease could improve. If, on the other hand, abstinence from alcohol would not reverse your alcoholic liver disease, you could be automatically approved for disability if you meet the listing criteria.
What If My Liver Damage Doesn’t Meet the Listing Requirements?
Even if your liver damage doesn’t meet the listing for liver disease, you could still win your claim for disability. The SSA will determine if you are able to perform your past work despite your illness even if you don't meet the requirements of the listings above.
An RFC Assessment
To win a claim at this point, you must provide a Residual Functional Capacity (RFC) assessment prepared by your treating physician. An RFC explains and documents any work-related limitations you have that are caused by your liver disease. For example, if you experience significant fatigue that requires frequent unscheduled breaks or periods of rest, your RFC should state this. Liver disease can also cause significant mental limitations like memory loss, agitation, difficulty with concentration, impaired judgment, and confusion. If you suffer from any of these symptoms, your doctor should discuss them in detail in your RFC assessment and explain how they affect your ability to perform basic work activities like following directions, interacting with co-workers, focusing on your work, and completing tasks on time. If the SSA agrees that you have a 20% reduction in your productivity level because of these limitations, the SSA would find you disabled.
For more on this important concept, please see Your Residual Functional Capacity (RFC).
How Pain Figures Into RFC
Liver damage can also cause significant pain that can make it difficult to perform your daily activities. Your doctor should state his or her objective medical opinion for any limitations placed on your physical activities due to your pain related to your liver disease. However, because pain is subjective, it can be difficult to prove your level of pain to the SSA. If you require help to perform activities like bathing, preparing meals, or cleaning your home, you should provide this information to the SSA. If your pain prevents you from physical activity such as walking, lifting, carrying, pushing or pulling, your doctor must state this on your RFC and state the specific limitations. If your pain prevents you from lifting ten pounds or limits your ability to sit and stand to less than six hours per day, you may be successful in your claim for disability.
Include Medical Documentation to Support Your Doctor's Opinion
When your doctor prepares your RFC assessment, you must ensure that he or she includes medical documentation to support your doctor's opinion. This includes lab results, biopsies, scans, medication lists, x-rays, hospitalizations, and notes from your visits. A doctor's RFC assessment is only as good as the objective medical evidence provided to support it.
How an RFC Affects the Disability Determination
If the SSA finds you should still be able to do your most recent work despite the limitations in your RFC, you will be denied disability benefits. However, if the SSA decides you are unable to do your past work, the SSA will establish whether there is any other work you are able to do. To make this determination, the SSA will consider the combined effects of your age, education, past work history, and any documented symptoms related to your liver disease. It is easier for older applicants with little education and with a history of heavy or medium work jobs to win approval at this stage.