As a disability lawyer in Indiana, I speak to clients daily about the documentation they need to prove their Social Security disability claims. Once you have applied for benefits, the
Social Security Administration (SSA) will, with your permission, request medical
records from the physicians and other medical providers who have treated or evaluated you
for your impairments. As you proceed through the appeals process, the SSA will request updated information from your providers, and if you reach a hearing, the Administrative Law Judge (ALJ) will make sure that all of your medical records have been added to your Social Security file. For some impairments, including cirrhosis of the liver, it is very important that your medical records include complete documentation of your symptoms and objective evidence of your condition.
Cirrhosis of the liver is evaluated by the SSA as a digestive system impairment. If you have cirrhosis of the liver, the SSA's Listing of Impairments Section 5.05 for chronic liver disease requires documentation of at least one of the following:
- Hemorrhaging due to esophageal, gastric, or ectopic varices or portal hypertensive gastropathy, resulting in hemodynamic instability and requiring hospitalization for transfusion. Acceptable documentation includes:
- Ascites or hydrothorax, in spite of continuing treatment, on at least two evaluations at least sixty days apart. Acceptable documentation includes:
- Laboratory tests showing serum albumin of 3.0 g/dL or less
- Coagulation studies showing increased International Normalized Ratio (INR)
- Spontaneous bacterial peritonitis. Acceptable documentation includes:
- Laboratory tests showing an absolute neutrophil count of at least 250 cells/mm3.
- Hepatorenal syndrome. Acceptable documentation includes:
- Documentation of low arterial oxygenation
- Echocardiography (ECG) or lung perfusion scan showing intrapulmonary arteriovenous shunting
- Hepatic encephalopathy. Acceptable documentation includes:
- Documentation of abnormal mental state or cognitive dysfunction
- Documentation of surgical portosystemic shunt placement
- Documentation of neurological abnormalities such as asterixis
- Electroencephalogram (EEG)
- Serum albumin laboratory tests
- Coagulation studies showing increased INR
- End stage liver disease. Acceptable documentation includes:
- Liver function testing showing excess serum total bilirubin, serum creatinine, and INR
Other tests used to diagnose cirrhosis and evaluate its severity include:
- Magnetic resonance elastography
- Magnetic resonance imaging (MRI)
- Computed tomography (CT) scan
In addition to reviewing your medical records for documentation of liver disease, the SSA will also consider the side effects of your medication and treatment, whether you are complying with your doctor's instructions, and whether your medical treatment is helping. Further, the SSA must consider how pain, fatigue, weakness, and other symptoms affect your ability to perform work activities.
If you have cirrhosis of the liver due to alcohol abuse, the most important thing you can do is to stop consuming alcohol. Stopping drinking will not only be good for your health, but it will also help you to show that you are following your doctor's orders to discontinue all use of alcohol. If you are presently using alcohol or failing to otherwise follow your treatment instructions, Social Security may conclude that your symptoms would not prevent you from being able to work if you were compliant with treatment. You will be able to present your best case to the SSA if you are receiving regular treatment from specialists, are taking your medications as prescribed, and are following your doctor's instructions regarding your diet and behaviors.
I have found that people living with cirrhosis of the liver have many physical and mental symptoms that affect their ability to work. Toxins in the blood can cause mental confusion
and difficulty concentrating. Other symptoms
such as high blood pressure, swelling in the legs and abdomen, loss of
appetite, feeling tired or weak, and difficulty fighting infections can affect your ability to work a full time job day in and day out. What do you do if you
are incapable of working due to cirrhosis of the liver, and you expect to be unable to work for more than twelve months? The
first thing to do is to apply for benefits. After you apply, it is important to comply with all of the SSA's requests to help them get a complete picture of your impairment. Many initial applications are denied, though, and the next step is to start the appeals process right away.