Social Security Disability for a Hiatal Hernia

Hiatal hernias occur when the upper part of the stomach pushes through a weakened area in the diaphragm and moves into the chest cavity. Doctors don't yet know what exactly causes a hiatal hernia, but it's a common condition that typically develops slowly as you age.

Hiatal hernias can cause daily symptoms ranging from uncomfortable to severe. If symptoms from a hiatal hernia have left you unable to work for at least 12 months, you might be eligible for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

Symptoms, Complications, and Treatment of Hiatal Hernias

There are two main types of hiatal hernias—sliding hiatal hernias (the most common kind) and paraesophageal hiatal hernias, which are less common and more likely to require surgery.

Symptoms of Hiatal Hernias

Many people with hiatal hernias don't have any symptoms, but for those who do, the most common symptoms are:

• acid reflux
• heartburn
• chest or stomach pain
• difficulty swallowing
• nausea and vomiting, and
• shortness of breath.

Both sliding and paraesophageal hernias will produce the above symptoms, but unlike sliding hernias, paraesophageal hernias can also cause back pain.

Hiatal Hernia Complications

The most frequent symptom associated with hiatal hernias is acid reflux. Over time, uncontrolled acid reflux can damage the esophagus (throat). The chronic presence of acid in the throat can lead to esophagitis, causing difficulties in swallowing, ulcers, and bleeding. It can also cause scar tissue to form that narrows the throat, known as esophageal stricture.

Serious complications of a hiatal hernia, though rare, can include:

• gastritis, which occurs when trapped acid in the herniated part of the stomach causes inflammation, ulcers, and bleeding
• gastrointestinal blockage, which happens when something blocking your intestine prevents food or liquid from passing through, and
• ischemia, a painful condition where the blood supply to the herniated part of the stomach is cut off.

Hiatal Hernia Treatment

Treatment for hiatal hernias varies based on how severe the symptoms are. For milder symptoms, making lifestyle adjustments to your diet (such as eating smaller, more frequent meals), avoiding alcohol, and smoking cessation can help. Medications like antacids, acid-reducing H-2-receptor blockers, and proton pump inhibitors are often prescribed to manage chronic reflux associated with hernias.

In more severe cases, surgery may be necessary. Surgery is typically recommended when conservative treatment doesn't work or the patient has a serious complication.

Can I Receive Disability Benefits for a Hiatal Hernia?

When determining if you're eligible for disability payments, the Social Security Administration assesses your condition in two ways. First, the agency will determine if your condition is in the Listing of Impairments (also known as the Blue Book). The Blue Book contains medical criteria that Social Security uses to evaluate disabling conditions in adults. If you meet the criteria of a listing, you'll automatically qualify for benefits—as long as you also satisfy the non-medical requirements for SSDI or SSI.

If your condition isn't listed in the Blue Book, or if your symptoms don't meet the criteria of a listed impairment, then Social Security will evaluate whether your condition is severe enough to prevent you from engaging in any kind of full-time work.

Getting Disability for a Hiatal Hernia by Meeting a Listed Impairment

Hiatal hernias don't have their own listing in the Blue Book, but there are related impairments under the section for digestive disorders that are sometimes associated with hiatal hernias. Depending on what evidence your medical record contains, you might be approved for disability benefits under one of the following listed impairments.

Listing 5.02, Gastrointestinal Hemorrhaging

Some people with hiatal hernias experience gastrointestinal hemorrhaging (bleeding) which is a listed impairment under listing 5.02. If you experience bleeding from your hernia, you may be able to qualify for disability under this listing if you have medical documentation for all of the following criteria:

• at least three blood transfusions
• each transfusion is of at least two units of blood
• the transfusions occurred within one consecutive year, and
• there were at least 30 days between each transfusion.

If you've had blood transfusions but aren't sure whether you meet (or "equal") the criteria for listing 5.02, ask your doctor to review the listing with you. Your doctor may agree to write a medical source statement saying that you qualify for disability under the listing.

Listing 5.08, Weight Loss Due to Any Digestive Disorder

If your hiatal hernia or associated symptoms have caused you to lose a significant amount of weight, you might qualify under listing 5.08 for digestive disorder weight loss. Your medical records will need to show that you have a body mass index (BMI) of less than 17.5 on two occasions at least 60 days apart within a consecutive twelve-month period.

Getting Disability for Hernia Work Restrictions

You can still qualify for disability even if you don't meet a listing if your symptoms are so severe that you haven't been able to work for 12 months or more. (In Social Security lingo, this is called the durational requirement.) For many patients with hiatal hernias, this can be difficult, because surgery usually resolves the symptoms. And the SSA is likely to assume you'll need much less than a year to recover from hernia surgery. But if you've had complications during or after the surgery, you may take longer to fully recuperate.

How Does Social Security Decide Your Work Restrictions?

Social Security will decide whether you can work despite your health conditions by doing a residual functional capacity (RFC) assessment. The agency will determine your RFC by looking at your medical records and activities of daily living to decide what you can and can't do in a work environment. Any limitations you have, physical or mental, that are supported by evidence in your disability application will be included in your RFC.

For example, if you have chronic abdominal pain and acid reflux, your RFC might restrict you from doing labor-intensive jobs that require frequent bending, stooping, or crawling. And if your hernia causes shortness of breath, your RFC may state you need to be allowed to take unscheduled breaks throughout your workday.

How Does Social Security Use Your RFC to Determine Whether You Can Work?

Social Security will compare your current RFC with your work history to see if you can return to any of the jobs you've done in the past. If you're able to perform your past work—for example, your RFC limits you to sedentary work and all your past jobs were desk jobs—your application will be denied.

If you can't return to your past jobs, Social Security will need to decide whether you can do any other work despite the limitations in your RFC. The agency will consider factors such as your age, education, and any transferable skills you've acquired to see if other jobs exist that you can do.

For applicants 50 years of age and older, Social Security uses a special set of rules called the medical-vocational grid to help determine whether they should be found disabled. Applicants younger than 50 generally must show that they can't do even the easiest, sit-down jobs before the agency can award them disability benefits.

VA Disability Benefits for Veterans With Hiatal Hernias

Veterans might be able to receive VA disability benefits for hiatal hernias. The VA recognizes a hiatal hernia as a disability under diagnostic code 7346 within the digestive system section of the Schedule of Ratings. (38 CFR § 4.114.)

You can get a hiatal hernia VA rating of 10%, 30% or 60%. Your VA disability rating is assigned based on the severity of your symptoms and how much they interfere with your ability to work. For more information on the VA disability rating system, see our article on how disability ratings work for VA benefits.

To receive a 30% disability rating, your medical record must show evidence of chronic stomach discomfort with difficulty swallowing, heartburn, or indigestion. For the highest disability rating of 60%, your hernia must cause you to experience severe symptoms such as intense pain, significant weight loss, vomiting blood, or passing bloody stool, along with moderate anemia or other combinations of symptoms that would cause a significant decline in your overall health.

Keep in mind that the VA and Social Security have different rules about awarding disability benefits. While having a high disability rating from the VA may help your application for SSDI or SSI, even a 100% VA rating isn't enough on its own (in other words, just the rating letter without supporting medical records) to establish disability for SSDI or SSI purposes.

You can learn more about how to apply for VA disability in our article on filing for VA disability benefits.

Filing for Disability Due to a Hiatal Hernia

There are four ways you can file your application for Social Security benefits:

• File for disability 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.
• Hire an attorney or representative to file your application for you.

For more tips, check out our article on how to apply for Social Security disability benefits.