Does Diverticulitis Qualify for Social Security Disability?

Diverticulitis (die-vur-tik-yoo-LIE-tus) is a disorder of the digestive system. Diverticulitis occurs when small pouches called diverticula form in the wall of the sigmoid colon (the lower part of the large intestines) and get infected or inflamed.

Even with treatment, diverticulitis can cause symptoms like intense, recurring abdominal pain and bloating. If your diverticulitis symptoms are severe enough to interfere significantly with your life, you might qualify for Social Security disability benefits.

Signs and Symptoms of Diverticulitis

Common signs and symptoms of diverticulitis include:

• abdominal pain, usually on the left side, but sometimes on the right side (this is more frequent for people of Asian descent)
• nausea and vomiting
• fever
• abdominal tenderness
• cramping and bloating, and
• constipation or diarrhea.

If you're experiencing these symptoms, let your doctor know as soon as possible so that you can get the proper diagnosis and start treatment (if you haven't already). If you're only being treated by your family physician or general practitioner, consider seeing a gastroenterologist. Gastroenterology is the branch of medicine that treats your intestines.

Diagnosis and Treatment for Diverticulitis

When you show up to your doctor's office or the emergency room with symptoms of diverticulitis, your doctor will want to conduct a physical examination in order to rule out other disorders with similar symptoms. The examination will include checking your abdomen for tenderness. For women, a pelvic exam is generally included as well.

Other common diagnostic tools for diverticulitis include:

• blood, urine, and stool tests
• medical imaging such as computed tomography (CT) scan, X-ray, or ultrasound, and
• colonoscopy.

Once you've been diagnosed with diverticulitis, your doctor will start you on a treatment regimen (or adjust your current plan). The type of treatment depends on how severe your symptoms are. People with mild symptoms can sometimes avoid future bouts of diverticulitis effectively by making adjustments to their diet such as eating more fiber-rich foods. But if your symptoms are more severe, you might need to be hospitalized to receive intravenous antibiotics or undergo surgery (to repair perforations, or remove blockages or unhealthy parts of your intestine).

Can I Get Social Security Disability for Diverticulitis?

In order to be eligible for Social Security disability benefits, you need to show that you have a medical impairment that has significantly interfered with your life and prevented you from working for at least 12 months. Because diverticulitis—along with most other digestive problems—generally improves quickly with treatment, Social Security doesn't often award disability benefits based on diverticulitis alone.

But if your diverticulitis causes complications like fistulas, abscesses, intestinal bleeding, or dangerous weight loss, you're more likely to qualify for disability. Alternatively, if your medical records show a long history of related digestive problems, you could get disability benefits if your digestive problems are severe and long-lasting enough.

Social Security's Listing of Impairments for Medically Disabling Digestive Conditions

The Social Security Administration (SSA) maintains a listing of impairments that can automatically qualify for disability, and people with diverticulitis might also suffer from some of these impairments. If your medical record shows that your digestive conditions match the requirements of any of the following listings, you could qualify for disability.

• Severe Weight Loss. You can be found disabled under this listing if, despite ongoing treatment, you've had a body mass index (BMI) of less than 17.5 for at least six months.
• Gastrointestinal Hemorrhaging. If you've had severe and recurrent bleeding from your gastrointestinal tract (esophagus, stomach, small intestine, or large intestine) that has required blood transfusions, you might meet this listing.
• Inflammatory Bowel Disease (IBD). IBD is an umbrella term that covers any chronic inflammatory intestinal disorder, including Crohn's disease and ulcerative colitis. Some types of IBD might be a secondary reaction to diverticulitis. If you have a diagnosis of IBD and clinical documentation of other specific criteria, you could meet this listing.
• Short Bowel Syndrome. You can be found disabled under the short bowel listing if you've had more than half of your small intestine surgically removed, and need to use a central catheter.

Getting Disability Benefits by Showing Your Symptoms Prevent You From Working

If you have diverticulitis but don't meet any of the impairment listings mentioned above (or any other Social Security impairment listing), the SSA will assess your residual functional capacity (RFC). Your RFC is what you are capable of doing despite the limitations caused by your medical conditions. Social Security will use your RFC to translate your medical limitations into terms an employer (or vocational expert) would understand, in order to determine if there are any jobs you can still do.

For instance, if you have severe gastrointestinal bleeding, you might be calling in sick so frequently that you couldn't perform any job full-time. Or, if you have chronic abdominal pain and cramping, you might be too distracted by the discomfort to focus enough on your work tasks. If you have persistent diarrhea and need immediate and frequent access to a bathroom, an employer might not hire you because you need extra breaks.

If the SSA determines there are no jobs you can do due to your symptoms and limitations, you will be awarded benefits under what is called a "medical-vocational allowance." But if the SSA finds that you're capable of performing any kind of work, the SSA can deny your claim.

What You Need to File a Disability Claim for Diverticulitis

Social Security will be looking at your medical records for evidence that you're getting treatment for your diverticulitis symptoms (as well as any other medical conditions that are contributing to your disability claim). Make sure that you give the SSA permission to obtain records of your medical treatment, and let them know the dates and locations of any doctor's visits or hospitalizations.

Your complete medical records should contain most, if not all, of the following:

• progress notes showing that you're regularly seeing a doctor, ideally a gastroenterologist
• what your doctor has observed from your physical examinations
• blood, urine, or stool tests
• objective medical imaging such as a CT scan, and
• surgical records, if any.

One way you can help your disability claim is to have a doctor (preferably a gastroenterologist) who you've seen consistently for a long time write a medical source statement about your diverticulitis. The SSA values the opinions of treating doctors who are familiar with your medical history and who specialize in the area of your condition.

Another way you can help your claim is to be very thorough in filling out the function report. The SSA will ask you to submit this important questionnaire about your activities of daily living to get a clear picture of how your diverticulitis interrupts your life. The more specific you can be, the harder it will be for the SSA to conclude that your diverticulitis isn't disabling.

_{Updated May 25, 2022}