Getting Disability Benefits for PBC (Primary Biliary Cirrhosis or Cholangitis)

Primary biliary cirrhosis (PBC), now known as primary biliary cholangitis, is a chronic disease that leads to permanent liver scarring and poor liver function. Advanced biliary cirrhosis can lead to internal bleeding, swelling from fluid build- up, and life-threatening infections. The cause of primary biliary cholangitis is not known, but it is considered to be an autoimmune disease, and alcohol is not thought to be a factor.

Does PBC Qualify for Disability Benefits?

A simple diagnosis of primary biliary cholangitis will not make you eligible for disability benefits, but Social Security does have a disability listing for chronic liver disease. The listing lays out the severe symptoms that are required to qualify for disability for PBC and other liver disease. Specifically, your medical records must show that you have experienced at least one of the following complications of PBC:

• peritonitis with a neutrophil count over 250 cells per cubic millimeter
• hepatorenal syndrome with a certain level of creatine or sodium
• ascites (fluid in the peritoneal cavity)
• hydrothorax (fluid in the pleural cavity)
• end-stage liver disease with a CLD score of at least 22
• hepatopulmonary syndrome with poor arterial oxygenation or intrapulmonary arteriovenous shunting
• hepatic encephalopathy with cognitive dysfunction or other neurological abnormalities, or
• gastrointestinal hemorrhage.

This is a complicated list of symptoms that you'll likely need to discuss with your doctor to find out whether you have any of these severe conditions. In addition, a liver transplant will automatically qualify you for benefits.

PBC Without the Above Complications

If your primary biliary cholangitis has not advanced so much that you don't have any of the above complications, you won't meet the level of severity required by the disability listing for chronic liver disease. But Social Security will look at how your disease is limiting your activities and will decide whether someone in your condition can be expected to do full-time work.

To evaluate your abilities, Social Security will develop a residual functional capacity (RFC) for you, based largely on information provided by your doctor on any physical limitations or restrictions you have. For instance, your doctor may submit a medical source statement that says whether you can lift more than 20 pounds, walk or stand more than 4 hours per day, or need to take frequent rest breaks due to fatigue. Armed with this information, Social Security will assign you a level of work that you should be able to do: sedentary work, light work, or medium work.

If your past work is heavier than the level you are assigned, and Social Security agrees you can't do the work, the agency will look to see if there are other, less demanding jobs you can do.

But if you are older than 50, there are circumstances in which Social Security can't say you have to adjust to a new line of work. Social Security has to look at your educational level and job skills to see if you should be expected to learn to do another type of work (using what are called the grid rules). If you don't have transferable job skills, depending on your age, the grid rules may excuse you from learning another type of work. If the grid rules do not rule out having to adjust to a new type of work, Social Security will evaluate, whether given your RFC level, there are other types of jobs you can do. For more information on this evaluation, see our article on RFCs and medical-vocational allowances.