Social Security Disability for Diverticulitis

Diverticulitis occurs when small sacs or pouches that form in the inner lining of your intestines (diverticula) become inflamed or infected. This most often occurs in the large intestine, or colon.

Symptoms, Complications, and Treatment of Diverticulitis

Diverticulitis symptoms include pain in the belly that can get worse when you move, fever and chills, bloating and gas, diarrhea, constipation, nausea, vomiting, loss of appetite, and decreased eating. The symptoms can last anywhere from a few hours to weeks.

If diverticulitis is not treated quickly enough, there are several different complications that can occur:

• rectal bleeding
• peritonitis (infection of abdominal lining caused by rupture of a diverticulum)
• blockages in the colon or small intestine
• perforations (hole in the diverticula or colon)
• abscesses (pus collecting in diverticula), and
• fistulas (abnormal passageways that develop between the intestines and other areas).

These complications can lead to serious illness, and with some of the complications, including peritonitis and perforations, hospitalization and surgery are often necessary.

The treatment for diverticulitis depends upon the severity of the inflammation or infection. Oftentimes, bed rest, bowel rest (no solid food), changes in diet, and antibiotics are enough to treat diverticulitis. Surgery is rarely suggested for an initial diverticulitis episode, but if an individual has recurrent episodes of diverticulitis, treatment may require the surgical removal of the affected colon area.

Can Diverticulitis Qualify You for Disability Benefits?

The pain and discomfort of diverticulitis often improves in less than 12 months, which is the amount of time Social Security requires you to be unable to work. This can make it difficult to get disability benefits, but if you have complications such as bowel obstructions, abdominal infections, abscesses, or fistulas, you have a better chance of getting benefits.

In order to receive disability benefits from Social Security, you must match the requirements of one of Social Security's disability listings or prove that the limitations caused by diverticulitis prevent you from being able to work a full-time job. In addition, you must be insured by SSDI or be eligible for SSI, and not be making over about $1,500 per month.

Meeting or Equaling a Disability Listing

Social Security does not have a disability listing for diverticulitis, meaning there are no automatic approvals based on diverticulitis. However, if your condition is similar to another disease that does have a listing, and it is as severe as the criteria in the listing, it's possible for your medical problem to "equal" (be considered equivalent) to that listing.

Inflammatory bowel disease (IBD) has many of the same symptoms that can accompany diverticulitis, and it does have a disability listing (see our articles on disability for ulcerative colitis and Crohn's disease). For those with IBD, there are periods of symptoms and periods without symptoms, which may include diarrhea, rectal bleeding, abdominal pain, fatigue, fever, nausea, vomiting, and peritonitis. Obstructions, fistulas, and peritonitis are common complications of IBD, and surgery is often needed for these complications.

In order to receive disability benefits under IBD, you must show one of the following:

• Two bowel obstructions in the past six months that have required hospitalization or surgery OR
• Two of the following in the past six months:
  • peritonitis with an abscess or fistula, with pain that cannot be controlled with medication, occurring twice in the past six months
  • abdominal mass that can be felt on physical examination, with pain that cannot be controlled with medication, occurring twice in the past six month
  • severe anemia
  • low serum albumin
  • need for nutrition via tubes or catheter, or
  • weight loss of more than 10% of your body weight.

For those with diverticulitis, it is possible that your condition can equal the criteria for IBD without suffering from IBD itself. Diverticulitis can cause obstructions in the intestine due to scarring. In addition, rectal bleeding and improper nutrition can cause anemia, peritonitis can occur with abscesses or fistulas, and lack of a desire to eat can cause significant weight loss.

Repeated episodes of diverticulitis can lead to bowel surgery, which can sometimes cause short bowel syndrome, another disability listing.

It's important to keep in mind that if your diverticulitis is a symptom of a larger problem, such as cancer of the large intestine, you may qualify for other listings for the larger problem.

Limitations Prevent You From Working

If the symptoms of your diverticulitis are severe but do not equal those of a disability listing, you may still qualify for Social Security disability benefits if you can show that your limitations prevent you from being able to fulfill the physical or mental demands of a job.

Diverticulitis can cause various physical limitations that can make having a job very difficult. The physical demands of a job, such as standing, lifting, and carrying items may not be possible for those with diverticulitis due to pain. Weakness from fever, diarrhea, vomiting, and not eating can also make physical demands of the job more difficult.

Non-physical demands of the job, including being able to complete tasks asked of you and getting along with co-workers, can also be difficult due to pain and fatigue caused by diverticulitis. Social Security should consider this when determining if you can work.

Social Security will review your medical records for limitations and incorporate them into an RFC (residual functional capacity) assessment. The agency will then use your RFC, your age, and your background to determine whether your limitations make it impossible for you to work any kind of job. For more information, see our article on Social Security's assessment of whether you can work.