Disability Benefits for Liver Disease and Cirrhosis

Liver disease is one of the more common conditions identified in applications for disability benefits, reflecting its prevalence in the country as a whole. According to the Centers for Disease Control, about 1.8% of American adults have a diagnosed liver disorder, while the American Liver Foundation estimates that between 80-100 million adults in the U.S. have an excess of fat in their liver ("fatty liver disease").

Because fatty liver disease is often asymptomatic, many people may not know they have it. But the disease can worsen, causing inflammation of the liver, and in some cases may result in cirrhosis. Cirrhosis is a condition where scarring in your liver interferes with its ability to function properly.

While cirrhosis is commonly associated with alcoholism, non-alcoholic cirrhosis can be diagnosed even in those who abstain from alcohol. A diagnosis of alcoholic cirrhosis doesn't necessarily preclude you from getting disability benefits, however.

Can I Get Disability for Liver Disease?

You may qualify for disability benefits if symptoms or complications from your liver disease keep you from working full-time for at least one year. The Social Security Administration (SSA) doesn't award benefits based just on a diagnosis of liver disease—you'll need to provide medical records showing that the disease is either severe enough to meet a listed impairment or to rule out all jobs based on a reduced residual functional capacity.

Before Social Security looks at your medical records, however, the agency needs to see that you meet the financial eligibility requirements for at least one of the two disability benefits—Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Eligibility for SSDI is determined by your work history, while SSI is based on your income and asset levels. If you're not legally allowed to receive benefits under either program, you won't be able to get disability no matter how severe your liver disease may be.

Qualifying for Disability Benefits for Fatty Liver Disease

Once the SSA determines that you meet the preliminary eligibility criteria, the agency will then begin analyzing your disability claim using the five-step sequential evaluation process. First, you'll need to show that you haven't been working at or above the level of substantial gainful activity—around $1,550 per month—for at least one year. Then, you'll need to show that your liver disease is a "severe impairment," meaning that it has "more than a minimal impact" on your daily activities. It's unlikely that people with asymptomatic fatty liver disease will meet this requirement, for example.

Steps 3, 4, and 5 in the sequential evaluation process are where most disability determinations are made. At step 3, the SSA determines whether your liver disease is severe enough to meet or equal a "listed impairment." Listed impairments are disorders that Social Security considers especially severe. If you have certain medical evidence in your records that satisfies the specific criteria of a "listing," you can get disability automatically.

Getting Disability for Cirrhosis Meeting the SSA Listing for Chronic Liver Disease

Advanced complications from fatty liver disease, such as cirrhosis, may be severe enough to meet the requirements of Listing 5.05, Chronic liver disease. Social Security defines chronic liver disease as "loss of liver function with cell death, inflammation, or scarring of the liver that persists for more than six months," and identifies alcoholic cirrhosis as a common cause of the disorder.

In order to qualify for disability automatically under listing 5.05, your medical records must contain evidence of at least one of the following:

• gastrointestinal hemorrhaging resulting in hemodynamic instability (irregular blood flow), and requiring a blood transfusion
• ascites or hydrothorax (fluid buildup in the cavities between gastrointestinal organs) present on at least two separate evaluations within one year
• spontaneous bacterial peritonitis (an infection of the fluid covering abdominal organs)
• hepatorenal syndrome (kidney failure)
• hepatopulmonary syndrome (dilation of blood vessels in the lungs causing reduced oxygen flow)
• hepatic encephalopathy (brain dysfunction), or
• a "chronic liver disease" score of at least 20 on at least two separate evaluations within one year.

Listing 5.05 has some of the most technical criteria out of all the listings. For example, in order to meet the listing due to peritonitis, you must have evidence of "peritoneal fluid containing a neutrophil count of 250 cells/mm3 or higher." The agency looks at documentation such as blood tests, electroencephalograms (EEG), and liver biopsies for these technical findings, but it can also help to get your treating physician's opinion on whether you meet the criteria of listing 5.05.

Claimants with very severe complications may also qualify for disability automatically under listing 5.07, Intestinal failure, or listing 5.09, Liver transplantation. If you've received a liver transplant, the SSA will consider you disabled for one year following the date of the surgery, and then re-evaluate how you're doing after the year is over.

Getting Disability for Liver Disease or Cirrhosis With a Reduced Residual Functional Capacity

Because listing criteria are often difficult to meet, most people who receive disability are awarded after steps 4 and 5—being unable to perform your past relevant work or any other work, respectively. Social Security determines what kinds of jobs, if any, you can do by assessing your residual functional capacity (RFC). Your RFC is a set of limitations that reflect what you can and can't do, physically and mentally, in a work environment. It describes how well you can perform basic tasks such as walking, sitting, standing, lifting and carrying objects, and following instructions.

Social Security reviews your medical records, self-reported daily activities, and doctors' opinions when assessing your RFC. For example, if you're unable to lift more than ten pounds at a time due to fatigue and you can't walk or stand for more than two hours in an eight-hour workday, the agency will find that you have an RFC for "sedentary" (sit-down) work. The agency then compares your current RFC with the demands of your past jobs to see whether you can still do them. If not, then Social Security needs to determine whether any other jobs exist that you can perform despite the limitations in your RFC.

Disability applicants 50 years of age and older can have an easier time showing that they can't do other work thanks to a special set of rules known as the medical-vocational grid. The grid takes into consideration factors such as your age, education, and any transferable skills you may have acquired from your old jobs. Applicants younger than 50, however, generally need to show that they can't do even the simplest sit-down jobs in order to be found disabled.

Is Alcoholic Cirrhosis a Disability?

It's a common misconception that you can't get Social Security disability benefits if you have a disorder that was caused by substance abuse, such as alcoholic cirrhosis. But that policy would unfairly penalize people with long periods of sobriety under their belts. The agency even specifically states in the listings that digestive disorders like cirrhosis "...are often chronic in nature and will not necessarily improve with cessation in drug or alcohol use."

Social Security typically treats alcoholic cirrhosis the same way that it treats non-alcoholic cirrhosis or other chronic liver disease. You can meet listing 5.05 with alcoholic cirrhosis or show that your RFC rules out all work. However, if your medical record suggests that drug or alcohol use is "material" to a finding of disability, your application for benefits can be denied. "Material" means that the agency isn't sure that you'd still be disabled if you stopped using substances.

Social Security Ruling (SSR) 13-2p addresses how to make a materiality determination in claims where drug or alcohol use is a factor. While the specifics are discussed in detail in our article on SSR 13-2p and substance abuse, the important takeaway is that the agency won't automatically deny your application because your cirrhosis was caused by excessive alcohol consumption.

Applicants who've maintained sobriety for a long time will likely not face any significant inquiries into their past habits. If you're still drinking, however, Social Security may need to evaluate to what extent alcohol use is an ongoing contributor to your disability. In many instances, alcoholic cirrhosis has affected the liver to the point where the damage isn't reversible even when drinking completely stops, but the SSA won't just assume that's the case.

It's a good idea to get your doctor's opinion, if possible, about how ongoing alcohol use affects your cirrhosis symptoms and prognosis. It's even better if you can establish a period of sobriety so that the SSA can see whether your symptoms persist without the influence of alcohol.

Legal Assistance Can Help With Your Disability Claim

While you aren't required to have a lawyer at any stage of the disability determination process, it's often a good idea. For example, an experienced disability attorney can help you get benefits by:

• gathering medical evidence showing that you have symptoms like abdominal pain which keep you from working a sit-down job on a regular basis
• writing a brief to an administrative law judge arguing that side effects from your cirrhosis medication keep you from thinking clearly enough to complete basic tasks, or
• cross-examining a medical expert to elicit testimony that you meet or equal listing 5.05.

Most disability lawyers offer free consultations, so it doesn't hurt to ask around to find one who is a good fit for you.