What Is Alcoholic Cirrhosis?
Alcoholic cirrhosis is a liver disease caused by the chronic consumption of excess alcohol. Alcohol abuse causes the liver to become inflamed, and the chronic inflammation eventually leads to scarring of the liver, and then cirrhosis. Cirrhosis is poor liver function caused by the scarring.
Symptoms caused by alcoholic cirrhosis often appear gradually. Symptoms can include swelling of the hands and abdomen, impotence, difficulty thinking, pale stools, abdominal pain, weight loss, and yellowing of the skin and eyes. A liver biopsy is usually required to diagnose cirrhosis.
Treatment depends on the severity of your cirrhosis and can include medication, dietary changes, and shunts. If your alcoholic cirrhosis progresses to end-stage liver disease, you will likely require a liver transplant. (A liver transplant will automatically qualify for one year of disability benefits.)
Can I Get Approved for Disability Because of My Alcoholic Cirrhosis?
The Social Security Administration (SSA) goes through some preliminary steps with each application before evaluating whether your specific medical condition is disabling. You may be eligible for disability benefits because of your alcoholic cirrhosis if you aren't working, or aren't working above the substantial gainful activity (SGA) level (for 2015 the monthly amount is $1,090). That means if you are earning at least $1,090 or more a month, the SSA will automatically deny your claim for disability. Your alcoholic cirrhosis must be expected to last at least 12 months (or result in death). This requirement should be simple to satisfy because of the chronic nature of cirrhosis. Your alcoholic cirrhosis must also be a “severe” impairment, meaning that it has more than a minimal impact on your ability to do work-related activities.
The SSA will then see if your alcoholic cirrhosis meets or equals the criteria of one of the conditions described in its official Listing of Impairments. If your alcoholic cirrhosis satisfies the criteria of an illness outlined in the listing, you will be automatically approved for disability.
Automatic Approval Under the Chronic Liver Disease Listing
If you have been diagnosed with alcoholic cirrhosis, you might be approved automatically for disability under Listing 5.05, Chronic Liver Disease. Listing 5.05 addresses chronic liver diseases, hepatitis, primiary biliary cirrhosis, and alcoholic cirrhosis. In order to meet the listing requirements for this illness, your cirrhosis must be severe. You must have experienced one of the following problems, with complications as specified in the impairment listings:
- gastrointestinal hemorrhage requiring a blood tranfusion
- ascites (excess fluid in the peritoneal cavity) or hydrothorax (fluid in the pleural cavity)
- spontaneous bacterial peritonitis
- hepatorenal syndrome
- hepatopulmonary syndrome
- hepatic encephalopathy, or
- end-stage liver disease.
The severity criteria for Listing 5.05 are complex. For example, to meet the listing under peritonitis, your peritoneal fluid must contain a neutrophil count of 250 cells/mm3 or higher. It will be helpful to consult your treating physician to determine whether you have suffered any of the above complications to the level required to meet the SSA's impairment listing. The complete criteria for Listing 5.05 can be found at http://www.ssa.gov/disability/professionals/bluebook/5.00-Digestive-Adult.htm#5_05.
What if My Alcoholic Cirrhosis Doesn’t Meet the Liver Disease Listing Requirements?
If your alcoholic cirrhosis does not meet or equal the listing requirements of Listing 5.05, you will not be automatically approved for disability. However, you still have a good chance at being approved for disability if you can show that your alcoholic cirrhosis limits you so much that it prevents you from working. At this stage, the SSA will assess your "residual functional capacity" (RFC) level based on your ability to perform basic work tasks. To give you an RFC, the SSA will look through your medical records for your doctor's opinion on:
- how well you can understand and follow instructions
- how long you can walk, stand, and sit, and
- how much you can lift or carry.
The SSA will give you an RFC level, such as medium work, light work, or sedentary work. For example, if your doctor says can lift no more than 10 pounds at a time and can walk or sit only four hours per day, you would get a sedentary RFC. The SSA will then evaluate whether you are able to perform your past work with your RFC. If you had a position that involved heavy physical labor or very skilled work, it will be easier for you to prove that you can no longer perform this type of work.
The SSA will then look at its medical-vocational guidelines to see if at your age, with your education, you can be expected to learn a new job that fits your RFC level. Learn more about how the SSA uses your RFC and medical-vocational guidelines to decide if you can work.
Getting the Right RFC
It is important at this stage to provide the SSA with a statement from your treating physician regarding his or her opinion of your physical RFC. The RFC should state whether you require unscheduled breaks during the day or if you need to lie down. It is important that your doctor provides the SSA with objective medical evidence to support the RFC.
If you are receiving treatment for mental health issues such as depression and anxiety, you should also request a mental RFC from your treating doctor or psychologist. A mental RFC should include specific limitations on your ability to concentrate, follow directions, get along with others, perform tasks in a normal amount of time and whether or not you are currently using drugs or alcohol, and how long you have abstained from drugs and alcohol.
And because medications for alcoholic cirrhosis can have serious side effects, it is important to document all the medications you take and how they affect you. The can affect what RFC the SSA give you, and thus their decision whether you are disabled or not.
If you are still drinking, the SSA adds an additional step to its evaluation process, called a drug addiction/alcoholism (DAA) determination. The idea is that if you are still drinking and it's contributing to your impairments, you won't get SSDI or SSI benefits even if you're disabled. To evaluate whether your alcohol abuse contributes to your disability, the SSA asks if you would be able to work if you stopped drinking. For more information, read Nolo's article on DAA determinations.