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A Summary of Social Security Disability Benefits for Viral Hepatitis

Nicole Cutler L.Ac. February 16, 2011

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If chronic Hepatitis B or C has rendered you incapable of performing any work, Social Security disability benefits may provide a safety net. Understanding the guidelines for disability will help those truly in need to better work their way through an intensive application process.

While many with chronic Hepatitis B or C are able to prevent their liver disease from progressing to a severe condition, some are not as fortunate. When the symptoms of liver disease are severe enough to prevent Americans from working, they may be eligible for Social Security Disability Insurance (SSDI) from the U.S. government.

At the end of 2010, over eight million Americans were receiving compensation from Social Security for their inability to earn an income. If the idea of getting a monthly check from the Social Security Administration sounds like a reprieve from your monetary pressures, make certain of your eligibility before applying. Nearly each year for the past 10 years, the percentage of people being approved for SSDI has diminished. In 2010 alone, only 35 percent of the nearly 2.2 million applications for this reward were approved. Just like any other nationally sponsored program involving funds, being approved for Social Security benefits requires a lot of effort, paperwork and proof of your problem.

SSDI benefits are paid to totally disabled individuals who have worked and paid into the Social Security system for at least five of the previous 10 years. If approved for SSDI, the Social Security Administration issues a monthly check based upon how much was earned and paid into their system. Benefits are also paid to dependent children who are under 16 years old, or who are under 18 years old and still in high school.

Before proceeding with a claim for SSDI, or even before reading this article in its entirety – understand that all of the negative parts of your illness must emerge and take center stage. It can be challenging to remain positive about your outlook for the future when undertaking the task of highlighting the severity of your disease. With that said, the basics of Social Security disability eligibility for someone with chronic hepatitis are outlined below.

By SSDI’s definition, a person is considered disabled if the following two conditions are proven:

  1. Due to a medical condition, the individual is unable to perform the tasks of a job for which he or she is suited.
  2. That medical condition either has or will last for at least 12 months or is expected to result in death.

Although these conditions appear to be straightforward, the key to being approved for benefits is supplying irrefutable evidence of your disability. By learning how to best assemble your case for disability, your chances of being approved increase.

Known as the Blue Book, Social Security publishes a list of impairments that qualify for disability benefits. In section 5.00 – Digestive Diseases of the Blue Book, paragraph D, number 4 broaches chronic viral hepatitis infections. Although Hepatitis B and C are mentioned here, these illnesses alone are not sufficient to qualify for disability. Because the presentation of viral hepatitis can vary greatly, Social Security has specific guidelines on how severe the condition must be.

Further along in section 5.00.D.4, it is stated that all types of chronic viral hepatitis infections are evaluated under section 5.05 or any listing in an affected body system(s). Moreover, if the person’s health issues are not specifically described in 5.05, Social Security will consider the effects of hepatitis upon their assessment of “residual functional capacity.” Below are some details in section 5.05 that describe how severe the disabling condition must be:

  • Esophageal Varices – This must be demonstrated by medical imaging with documentation of a massive hemorrhage attributable to these varices or implementation of an esophageal varices shunt.
  • Bilirubin – This value must be 2.5 mg per deciliter or greater persisting repeatedly for at least five months.
  • Ascites – Due to liver disease, ascites must recur or persist for at least five months as proven by abdominal paracentesis or persistent hypoalbuminemia of 3.0 gm per deciliter or less.
  • Hepatic Encephalopathy – Physician documentation of how this problem prohibits daily functioning is necessary.

If none of these liver disease complications are applicable, there are some additional SSDI qualifications that may accurately describe your condition. Along with a liver biopsy confirming chronic liver disease (obtained independent of social security disability evaluation), one of these three must be met for SSDI consideration:

  1. Ascites – Proven by abdominal paracentesis or persistent hypoalbuminemia of 3.0 gm per deciliter or less, recurrent or persisting for at least three months and not attributable to other causes.
  2. Bilirubin – This value must be 2.5 mg per deciliter or greater persisting repeatedly for at least three months.
  3. Liver Cell Necrosis or Inflammation – As documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction, this must persist for at least three months.

Recognizing that you may qualify for SSDI is only the first step in an intensive process to receive compensation. Experts who evaluate these claims agree that regardless of the guidelines or illness being appraised, the most important component of any accepted application is medical proof documenting an inability to earn income. This could include documents such as a disability diary, doctor’s notes, records from an alternative healthcare practitioner, medical procedure results, physician letters explaining why you are unable to work and declining performance reviews from your former employer.

Since the Social Security disability program is designed to pay benefits to those suffering from medical problems so severe that they cannot function at any type of work, claimants who are not completely disabled are denied. Thus, the process of applying for and receiving benefits can be harsh and lengthy. However, if you are in the unfortunate position of being completely unable to earn an income due to symptoms from chronic hepatitis, SSDI may be able to offer you some much needed monetary relief.

Editor’s Note:

For more information on disability, visit the Social Security Administration’s website at www.ssa.gov. Or, to read about an explanation of Social Security’s five-step process to determine if a Hepatitis C patient qualifies for SSDI, visit: http://www.allsup.com/about-ssdi/ssdi-guidelines-by-disability/hepatitis-c.aspx.

References:

http://www.cpmc.org/advanced/liver/patients/topics/ssbenefits.html, Obtaining Social Security Benefits for Patients with Liver Disease, Jeffrey A. Rabin, Esq., Retrieved July 11, 2008, California Pacific Medical Center, 2008.

http://www.hcvadvocate.org/hepatitis/hepc/gettingdb.html, Getting Disability Benefits Under Social Security with HCV, Jacques Chambers, CLU, Retrieved July 11, 2008, Hepatitis C Support Project, 2008.

http://www.socialsecurity.gov/disability/professionals/bluebook/5.00-Digestive-Adult.htm#5_05, Medical/Professional Relations, Retrieved July 12, 2008, Social Security Administration, 2008.

http://www.ssa.gov/OACT/STATS/dibStat.html, Selected Data from Social Security’s Disability Program, Retrieved February 24, 2011, Social Security Administration, 2011.

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