Getting Disability Benefits for Crohn’s Disease

Crohn's disease causes inflammation deep in the layers of the intestinal wall and throughout the gastrointestinal tract. Sufferers may experience chronic diarrhea, rectal bleeding, fevers, weight loss, fecal incontinence, and abdominal pain. Many Crohn's patients also experience problems in areas outside the intestinal tract, including arthritis, kidney disease, and eye and skin problems. Social Security will consider all of your Crohn's-related symptoms when determining your eligibility for disability.

Can I Get Disability for Crohn's Disease?

You might be eligible for Social Security disability benefits based on Crohn's disease depending on the severity of your disease.

The Social Security Administration (SSA) has a multi-step evaluation process to decide whether you're disabled.

First, Social Security will determine whether you're working at or over the substantial gainful activity (SGA) level. If you're earning $1,470 or more per month (in 2023), the SSA will deny your claim, because the agency sees that as evidence that you're not disabled.

The SSA must also determine whether your Crohn's disease is expected to last at least a year; because Crohn's is a life-long disease, this requirement is easily satisfied, as long as you can't work for that long.

At the next step, Social Security will look to see if your Crohn's disease meets or equals one of the conditions set forth in its Listing of Impairments. Crohn's disease is included as a qualifying condition under listing 5.06, for inflammatory bowel disease. If Social Security finds evidence in your medical records that demonstrates you meet the criteria of listing 5.06, you'll automatically be approved for disability benefits.

How Can I Qualify Under the Inflammatory Bowel Disease Listing?

You might meet listing 5.06 if you have had at least two of the following complications in the same year (at least 60 days apart), despite treatment:

• anemia (low hemoglobin)
• low serum albumin (a blood protein)
• a tender abdominal mass that your doctor can feel on physical examination, along with cramping or abdominal pain
• a draining abscess or fistula in the perianal area
• the need for supplemental daily nutrition through either a gastrostomy, duodenostomy, or jejunostomy (medical procedures that place a tube in your stomach or intestines) or a central venous catheter.

If you haven't had two or more of the above complications, you can still meet the listing criteria if you've had a bowel obstruction or narrowing of your intestines, accompanied by inflammation and confirmed by imaging, that required decompression or surgery (two times in the last year, at least 60 days apart).

Finally, you can also meet the listing if you have repeated, severe complications of Crohn's disease such as perforations, abscesses, or infections. Your complications must:

• last two weeks or more
• occur on average three times a year on average, and
• cause severe limitations in your daily activities, social functioning, or ability to concentrate.

If your Crohn's disease doesn't meet listing 5.06 because you haven't had severe complications or hospitalizations, but you have had significant weight loss, you might be found disabled under listing 5.08, weight loss due to digestive disorder.

What Are the Requirements of the Weight Loss Listing?

If you've lost an excessive amount of weight because of your Crohn's disease, you can be found disabled under listing 5.08. To qualify under listing 5.08 you must show all of the following.

• You've lost weight despite continuing treatment as prescribed by your doctor.
• The weight loss resulted in a body mass index (BMI) of less than 17.50.
• Your doctor has measured your weight on at least two occasions at least 60 days apart, within one year.

What If I Don't Meet a Listing?

Sometimes people with Crohn's are too sick to work but don't meet the specific listing criteria for IBD or weight loss. In this case, you can still be approved for disability, but it may be more difficult.

Your Physical RFC Assessment

Social Security will look at your documented symptoms to determine what type of work you can do: heavy work, medium work, light work, or sedentary work. The agency will create a residual functional capacity (RFC) assessment for you, describing what you can and can't do, and will then compare your RFC to your past work. If Social Security believes you can do your past work, your claim will be denied.

If the SSA agrees that you can't do your past work, the agency will next consider whether you can learn to do another job, given your RFC and your age, education, and work background. Older, less educated people are more likely to be approved at this stage.

To help the SSA assess your RFC correctly, it's helpful to provide the agency with an analysis from your treating doctor(s) about how Crohn's affects your ability to work (but remember, your doctor's opinion must be supported by objective medical evidence like a CT scan).

Your doctor can fill out an RFC form to describe your limitations:

• how long you're able to sit, stand, walk, lift, carry, push, and pull
• whether you're required to rest throughout the day, and
• if you need frequent and unscheduled breaks to use the restroom.

The more restrictions your RFC reflects, the more likely you are to be approved. In particular, if you have limitations that require you to have unlimited access to a restroom at all times, this can prevent you from keeping any type of job.

Getting a Mental RFC Assessment

Chronic illnesses like Crohn's can also cause anxiety and depression. It's important to let the SSA know if you're under a doctor's care for any emotional problems or mental illnesses.

If you're seeing a psychiatrist or psychologist, the SSA should create a mental RFC assessment for you as well. Your mental RFC will reflect your cognitive and emotional limitations, such as your ability to focus, follow directions, get along with others, and complete tasks in an acceptable amount of time. If your mental RFC limits you to unskilled work with simple instructions, that will greatly limit the types of jobs you can be expected to do.

What Medical Evidence Do I Need?

The more objective medical evidence you provide, the more likely the SSA is to find you disabled. You should provide copies of all tests performed that relate to your Crohn's disease, such as:

• blood and fecal occult tests
• colonoscopy and endoscopy reports
• MRIs, and
• CT scans.

You should also provide copies of the notes your doctor takes during your appointments, called treatment notes or progress notes, and any reports from surgeries or hospitalizations.

Social Security will only consider medical evidence from acceptable medical sources. This includes licensed physicians (including osteopaths), nurse practitioners, and psychologists, among others, but Social Security will likely give more weight to opinions and diagnoses that come from doctors who specialize in Crohn's, such as gastroenterologists.

If you don't provide enough medical evidence for the SSA to make a decision, the agency may send you for a consultative examination (CE). Sometimes the CE is performed by the doctor who ordinarily treats you, but a CE can also be performed by another qualified physician.

How Can I Apply for Disability Benefits?

The SSA has several ways you can start your application for disability benefits.

• Apply online at ssa.gov. Filing online gives you the option to save your application and return to it later. You'll receive a confirmation number where you can track your application.
• Apply over the phone by calling Social Security at 800-772-1213. If you're deaf or hard of hearing, you can use the TTY number at 800-325-0778.
• Apply in person at your local Social Security field office.

If you need help with your application, you can try contacting a disability advocate or attorney for a consultation. If they think you have a reasonable chance of getting approved for benefits, they should be able to help with filling out your application, gathering your medical records, and filing an appeal if you get denied.

_{Updated October 9, 2023}