Social Security Disability for Diverticulitis

Diverticulitis does not always often last long enough to qualify for disability, unless you have serious complications.

By , J.D. · Albany Law School

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, and particularly in the sigmoid colon (the end of the 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, 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 the abdominal lining caused by rupture of a diverticulum)
  • blockages or stenosis (severe narrowing) of the colon or small intestine
  • perforations (holes 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 area.

Can Diverticulitis Qualify You for Disability Benefits?

The pain and discomfort of diverticulitis often improve in less than 12 months, which is the amount of time the Social Security Administration (SSA) requires you to be unable to work. This can make it difficult to get disability benefits. But if you have repeated bouts of diverticulitis with 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 medical 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 for SSDI or be financially eligible for SSI, and not be making over about $1,500 per month.

How Do You Meet or Equal a Disability Listing?

Social Security doesn't have a medical listing for diverticulitis, meaning there are no automatic approvals based on diverticulitis. But if your condition is similar to another disease that does have a listing, and it's as severe as the criteria in the listing, it's possible that the SSA will consider your medical problem to be equivalent in severity to that listing.

Inflammatory bowel disease (IBD) has many of the same symptoms that can accompany diverticulitis, and IBD does have a medical listing (listing 5.06).

What does the IBD listing require? In order to receive disability benefits under IBD, you must show that you have repeated complications from your bowel disorder, such as the following:

  • bowel obstructions or stenosis (severe narrowing that makes it difficult for nutrients to pass) that required hospitalization or surgery
  • abdominal mass that can be felt on physical examination with abdominal cramping or pain (suggesting inflammation)
  • perianal disease with a draining abscess or fistula
  • severe anemia (low hemoglobin) or low levels of serum albumin (a protein in your blood)
  • other frequent complications, such as intestinal perforations or infections.

(For the details of the listing, see our articles on disability for IBD and Crohn's disease).

What does it mean to equal a listing? It's possible that your condition can "equal" the criteria for IBD without suffering from IBD itself. If you can show that your symptoms are similar in severity and duration to the criteria in the IBD listing, the SSA can find that you equal the listing and will grant you disability benefits.

Like people with chronic diverticulitis, patients with IBD often have periods of symptoms and periods without symptoms, which can include constipation, rectal bleeding, abdominal pain, fatigue, fever, and nausea. Fistulas and abscesses are common complications of IBD, and surgery is often needed for these complications. Similar to IBD, diverticulitis can cause obstructions in the intestine due to scarring and intestinal stenosis due to infection and inflammation of the diverticula. In addition, rectal bleeding and difficulty getting enough nutrition can cause anemia, and peritonitis (infection) can occur with abscesses and perforations, requiring hospitalization or surgery.

Also, repeated episodes of diverticulitis can lead to bowel surgery, which sometimes leads to complications like 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.

What If I Can't Meet a Listing but I Can't Work Due to My Condition?

If the symptoms of your diverticulitis are serious but not as severe as those in a disability listing, you could still qualify for Social Security disability benefits if you can show that your limitations prevent you from fulfilling the physical or mental demands of a job.

Diverticulitis can cause various physical limitations that can make having a job difficult. For instance, standing, lifting, and carrying heavy items may not be possible due to abdominal pain. Weakness from fever, vomiting, and not eating can also make the physical demands of the job more difficult.

Or you may have frequent constipation or bowel issues that require lengthy trips to the bathroom and rectal pain that requires you to be able to change positions frequently. And you may need to miss a couple of days per month during flare-ups of diverticulitis.

Not many jobs can accommodate lengthy restroom breaks, needing to change positions at will, and two or more absences a month. If you have limitations like these, Social Security might agree that you can't do even the simplest sit-down jobs. Read more about which limitations can rule out all types of work in our article on getting disability when you can't do even sit-down jobs.

Be sure to tell your doctor about how your diverticulitis affects you on a day-to-day basis so that your limitations are incorporated into your treatment notes. 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 work 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.

What Medical Evidence Do I Need for My Disability Claim?

The most important part of your claim is your medical records, so you'll need to give Social Security permission to obtain them.

Your medical records should contain the following:

  • your doctor's treatment notes showing your symptoms and limitations
  • the results of physical exams and blood tests
  • imaging tests such as a CT scan or ultrasound, and
  • records from hospitalizations and surgical procedures, if applicable.

It's also key to ask your doctor (preferably a gastroenterologist) to fill out a medical source statement for you that lists your diagnosis, your symptoms, and your limitations, backed up by objective evidence like a CT scan, which is the gold standard for diagnosing diverticulitis and its complications.

Finally, make sure you add details when you complete the adult function report. It will give Social Security a good idea of how diverticulitis impacts your activities of daily living. Be sure to include details of how limited you are on your "bad days" when you suffer from diverticulitis flare-ups.

How Do I Apply for Disability Benefits for Diverticulitis?

There are four ways to file an application for Social Security disability benefits:

  • File online through Social Security's website.
  • Complete the application over the phone at 888-772-1213, between 8 a.m. and 7 p.m., Monday through Friday. (People who are deaf or hard of hearing can call the TTY number at 800-325-0778.)
  • Apply in person at your local Social Security office (call to make an appointment first).
  • Hire an attorney or representative to file your application for you.

If you're going to have a consultation with an attorney, take a list of your employers and any medical records you have with you. For more tips, check out our article on how to apply for Social Security disability benefits.

Updated October 5, 2023

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