Can You Get Social Security Disability for Crohn's Disease?

Crohn's disease is a type of inflammatory bowel disease (IBD), a chronic inflammatory condition of the intestines. Crohn's disease primarily causes breaks (ulcerations) in the lining of the small and large intestines, but it can affect the digestive system at any point in the gastrointestinal (GI) tract, as well as the kidneys, skin, and eyes. In severe cases, bowel obstructions and perforations can occur.

Symptoms of Crohn's Disease

Crohn's disease usually causes inflammation in the lower part of the small intestine and the beginning of the large intestine. The inflammation extends deep into the intestinal lining and can cause pain and make the intestines empty frequently.

Disabling symptoms of Crohn's include:

• abdominal pain and cramping
• chronic diarrhea
• urgent need to move bowels
• rectal bleeding
• fever
• fatigue
• loss of appetite and unintentional weight loss
• fistulas and fissures (anal tears), and
• constipation and bowel obstruction.

These symptoms tend to fluctuate between periods of inactivity (remission) and activity (relapse or exacerbations). Crohn's disease can be difficult to diagnose because its symptoms are similar to other intestinal disorders, such as irritable bowel syndrome (IBS), and to another type of IBD known as ulcerative colitis.

Perianal disease (for example, fissure, fistulas, abscesses, or anal canal stenosis),

Types of Crohn's Disease

Iloecolotis is the most common form of Crohn's disease, but there are five main types of the disease, defined by the location of the inflammation in your GI tract:

• gastroduodenal Crohn's inflames the stomach and the start of the small intestine (duodenum)
• jejunoileitis inflames the middle part of the small intestine (jejunum)
• ileitis inflames the end of the small intestine (ileum)
• ileocolitis inflames the ileum and the beginning of the large intestine (colon), and
• granulomatous colitis inflames only the colon.

Diverticulitis is a sometimes-related form of inflammation in your large intestine, usually at the end of your colon (the sigmoid colon). Like Crohn's, diverticulitis symptoms aren't usually constant but can flare up and then recede.

Is Crohn's Disease a Disability?

Yes, the Social Security Administration (SSA) considers severe Crohn's disease to be a significant impairment that can prevent an individual from performing substantial work.

The limitations caused by the symptoms listed above can be disabling, and the ongoing treatment for Crohn's can also make it difficult to work. Doctors treat acute flare-ups of Crohn's disease aggressively to achieve remission. Once remission is achieved, treatment usually continues, including antibiotics for infections and anti-inflammatory drugs to control inflammation. Severe Crohn's cases may require multiple surgeries to control or maintain remission of the disease.

Even after surgery, Crohn's can continue to be a lifelong problem that makes it impossible to hold down a full-time job.

Can You Get Disability Benefits for Crohn's Disease?

Yes, you can get disability benefits if your Crohn's disease causes severe symptoms that make it extremely difficult for you to do physical activities and focus on work. Social Security will approve you for benefits if you either show that there are no jobs you can do with your limitations or you show that your medical evidence meets the criteria in a medical listing.

In the listing of impairments published by the SSA, Social Security evaluates Crohn's disease under the medical listing for inflammatory bowel disease (IBD).

Meeting the Listing for Inflammatory Bowel Disease

Social Security includes inflammatory bowel disease in its list of impairments called the Blue Book. To qualify under the IBD listing (listing 5.06), your IBD or Crohn's disease must be documented by endoscopy, biopsy, surgery, or imaging (like a CT scan or x-ray), and you need to have a certain number of serious complications. How many complications you need and how often they have to occur depends on the type of complication.

Here are the three sets of complications in listing 5.06—to get disability, you must fit the criteria of ONE of them:

1) Obstruction or stenosis. You must have had a bowel obstruction, or a severe narrowing in the small intestine or colon that made it difficult for nutrients to pass, that required two instances of hospitalization:

• for intestinal decompression or surgery
• within a 12-month period, and
• at least 60 days apart.

OR

2) Two of the complications listed below. You must have had any two of the following symptoms that occurred at least 60 days apart within a 12-month period (you can have two instances of the same symptom):

• severe anemia (hemoglobin less than 10 g/dL)
• low levels of serum albumin (3.0 g/dL or less)
• a tender abdominal mass with abdominal cramping or pain (indicating inflamed loops of bowel)
• perianal disease with a draining abscess or fistula, or
• the need for daily supplemental nutrition either by a feeding tube or central venous catheter.

OR

3) Repeated complications of IBD with other limitations. You must have experienced serious complications or flare-ups three times within a 12-month period, with each lasting at least two weeks. Here are examples of what Social Security considers serious complications:

• an intestinal perforation (a hole that develops in the intestines)
• an abscess (a pocket of pus that developed after an infection)
• infectious colitis (an intestinal infection)
• pyoderma gangrenosum (an inflammatory skin condition)
• a ureteral obstruction (a blockage of the tubes that carry urine to the bladder)
• primary sclerosing cholangitis (scarring in the bile ducts), or
• hypercoagulable state (a risk of developing blood clots).

In addition, to fulfill the third set of criteria, you must be able to prove have "marked" (severe) limitations in one of the following:

• activities of daily living
• social functioning, or
• completing tasks in a timely manner.

Because Social Security considers the complications in the third set of criteria as less severe than in the first two sets of criteria, the agency also wants to see proof that you're having severe limitations in your day-to-day functioning.

If you have complications of Crohn's that aren't mentioned in the listing, Social Security might find that they "equal" the IBD listing requirements.

Getting Disability for Crohn's Without Meeting a Listing

If you don't have the complications above that are required for meeting the medical listing, you might be able to qualify for benefits "vocationally" rather than medically. You'll need to show that your symptoms make it impossible to work your prior job, and that, with your job skills and education, there are no other types of jobs you could learn to do (that you would be capable of doing).

First, Social Security will look at your documented symptoms to determine your residual functional capacity (RFC): what activities you can still do despite your medical condition. To help the SSA assess your RFC, it's helpful for your doctor to know enough about your limitations to be able to describe them fully in your treatment notes:

• how long you're able to sit, stand, walk, and lift
• how much weight you can carry and how often, and
• whether you can operate heavy equipment or drive.

Your doctor should also document how often you have flare-ups and should detail whether you need to frequently reposition yourself or take frequent and unscheduled breaks or trips to the restroom. These last limitations, often caused by chronic diarrhea, can affect your ability to keep any type of job, and are often the reason that Social Security judges will grant benefits for Crohn's disease.

Other patients with Crohn's have symptoms so severe that they need to take off several days a month from work, which also rules out most jobs.

For more information, see how the SSA judges your ability to work despite your symptoms.

When Crohn's or IBD Causes Mental or Cognitive Deficits

Crohn's can also cause mental and cognitive impairments. Cognitive and emotional symptoms can include:

• difficulty focusing and staying on task
• difficulty learning and applying new information
• inability to keep up with fast-paced work
• memory problems
• stress, and
• depression.

If you experience any of these mental symptoms, Social Security will consider how they affect your ability to work. The SSA has to consider your combined impairments when determining whether you can work, so let your doctor know about these health concerns so that they're included in your doctor's treatment notes when they get sent to the agency.

My Crohn's Disease Meets the Criteria for Disability. What's Next?

If you've been unable to work for a year—or you're not working now and are sure you won't be able to work for at least a year—and you think you can qualify under the above disability criteria, here are your next steps.

Gather the Medical Evidence Social Security Needs to Decide Your Claim

What types of medical evidence do you need to meet the listing for Crohn's disease? Your doctors' treatment notes should be extensive and include a record, over time, of the frequency and severity of all of your physical and mental symptoms.

To get approved for disability under the listing for IBD specifically, your medical records should also include the following:

• clinical examination notes with information about abdominal symptoms
• CT scan or MRI imaging results
• the results of recent blood tests measuring your hemoglobin and albumin
• a summary of the hospitalization(s) you've had, and
• if you've had an intestinal resection, a copy of the surgical report.

If your medical records are thin, Social Security might also send you for an independent exam by one of their doctors or ask your doctor to complete a questionnaire about your limitations.

To learn more, read about how to gather the medical evidence you'll need to prove you qualify for Social Security disability because of your inflammatory bowel disorder.

Qualify for SSDI and SSI: Meet the Non-Medical Requirements

Even if your Crohn's or IBD qualifies as a disability under Social Security's medical rules, you must meet certain non-medical requirements to be eligible for disability. The specific requirements depend on which benefit(s) you're applying for—SSDI, SSI, or both.

For SSDI eligibility, you must have worked and paid Social Security taxes—FICA or self-employment tax. And you must have worked long enough to have earned the required amount of work credits.

Since SSI disability is for low-income applicants who haven't worked much or haven't worked recently, the non-medical requirements are based on your income and assets. (Although your citizenship or immigration status is also a factor.) Learn more about the specific income and asset limits you must meet to qualify for SSI.

When you apply, Social Security can help you decide whether to apply for SSDI or SSI, or the agency can decide for you.

Apply for Disability for Crohn's or Inflammatory Bowel Disease

You can apply for Social Security disability online or by phone at 800-772-1213 (TTY 800-325-0778). You can also contact your local SSA office to get help completing your application in person.

In addition to your name, Social Security number, and work history, the SSA will need records of your medical evidence, including:

• clinical and laboratory findings
• your doctor's notes (including specific statements about how your IBD limits your ability to work), and
• medications and treatments you've tried (plus how well they work and whether they cause any serious side effects).

After You Apply for Benefits for Crohn's Disease

After you submit your application, your state's disability determination services (DDS) agency will assign your claim to a disability examiner for review. The process can take several months, but the more evidence and medical documentation you're able to provide, the better your chances of being able to get your claim approved.

Unfortunately, getting disability benefits for IBD or Crohn's disease isn't easy. According to the most recent statistics available from Social Security, only 26% of disability applicants whose primary complaint was Crohn's disease were approved at the initial application stage. But at the hearing stage, Social Security judges granted benefits to 76% of those who appealed the denial. So, even though it can take a year or more to get a hearing date, for most people, it makes sense to appeal. (But keep in mind that you generally can't work while you're waiting for a disability decision.)

If you receive a denial letter and feel your case is strong enough to win an appeal, consider contacting a disability lawyer to help you file the appeal paperwork before the deadline (60 days after the denial). Here's what to do if you get denied.