Crohn’s disease is a long-term condition. It flares up and remits, often unpredictably, which can make it difficult and expensive to manage. Plus, because of its long-term nature and debilitating complications, holding a job is challenging for Crohn’s patients.
Getting disability benefits can be a godsend for these patients. But does the Social Security Administration consider Crohn’s a disability? Let’s find out!
Does the Social Security Administration (SSA) consider Crohn’s a disability?
Yes, the SSA considers Crohn’s a disability. Crohn’s is evaluated under the Inflammatory Bowel Disease listing, which is listing 5.06.
However, the criteria for getting approved as disabled due to Crohn’s disease is strict. This is why around only 26% of disability applicants with the primary complaint of Crohn’s disease get accepted at the initial stage.
The good news is that most people appeal their denial, and when they do, around 76% of them are able to convince Social Security judges of their disability due to Crohn’s.
What is the SSA’s disability criteria for Crohn’s disease?
The SSA evaluates Crohn’s disease under rigid criteria. Generally, you’ll be eligible to receive disability benefits if your condition has progressed to severe stages and:
- Your monthly income is less than $800
- Your prognosis is poor
- Your disease is directly causing mental or physical impairment
- Crohn’s has affected your job for at least 12 months
- Your condition has advanced to a stage where you can expect work-related activities to be disrupted for 12 months (for e.g. if you need frequent surgeries).
However, this is not all that you need. Sometimes, you’ll be evaluated against even stricter criteria. You must have a formal diagnosis of Crohn’s disease (from a registered medical professional, preferably a Crohn’s specialist) along with:
- Obstructed bowels — this can be either in the small or the large intestine. It must require two instances of hospitalization or surgery within six months.
OR two of the following:
- Hemoglobin levels of less than 10 g/dL demonstrated by two blood tests 60 days apart
- Serum albumin levels of less than 3 g/dL demonstrated by two tests 60 days apart
- Weight loss of 10% or greater (involuntary) demonstrated twice, 60 days apart
- Need for a feeding tube (via nose, mouth, gut) or feeding via an IV catheter
- Abdominal pain uncontrolled with prescription pain medication, documented twice, 60 days apart or extremely tender abdomen
- An abscess or fistula in the perianal region with uncontrolled pain, documented twice, 60 days apart
Where can I obtain the medical evidence for Crohn’s?
The SSA requires you to submit objective proof of Crohn’s disease to get considered. The higher the objectiveness of your proof, the more likely you are to get accepted.
You must provide copies of all the tests that have been performed so far in working up your condition. This can include blood counts, fecal occult blood test, colonoscopy, biopsy results, and MRI or CT scans.
In addition to that, you need to provide any notes your doctor took during your appointments as well as any documents from a previous hospitalization or surgery.
Make sure these notes are from the doctor who treats your Crohn’s. And it’s a good idea to consult a gastroenterologist before you apply for social security benefits. Because while the SSA will consider notes and recommendations from a registered general practitioner (and your family doctor), a Crohn’s specialist has more weight.
Finally, if you fail to provide sufficient medical evidence for your condition, the SSA may send you for a consultative examination, where the SSA asks a registered medical professional to examine you to clear up any confusion.
The SSA can ask your current doctor to perform a consultative examination if he has the necessary skills, training, and equipment. But many doctors refuse to comply, in which case the SSA appoints another doctor for you.
I don’t qualify for SSA’s disability criteria for Crohn’s. Now what?
Sometimes, your condition may be subjectively too debilitating for you to hold a job but you will not meet the objective SSA disability criteria for Crohn’s. And apart from appealing the denial, you have two options.
The first is to apply under a weight loss listing (listing 5.08) because Crohn’s disease can cause significant weight loss due to malnutrition.
The three criteria for listing 5.08 include:
- You have a BMI of less than 17.50
- You’ve continued to lose weight despite following the prescribed treatment
- Your doctor has documented your weight on two occasions, 60 days apart and within 6 months
You must meet all three criteria to be considered under the weight loss listing.
The other option is to have the SSA evaluate your residual functional capacity (RFC), which determines if you can hold your past job looking at your functional status. If it turns out you can’t, the SSA will consider your ability to learn new skills and take up a different job looking at your educational background and age.
You’re more likely to be granted disability benefits if you’re old with a limited educational background at this point.
Note that many Crohn’s patients are also under the treatment of a psychiatrist/psychologist. Crohn’s is a source of anxiety for many people. In turn, anxiety can trigger flare ups, creating a vicious circle.
If you’re under psychiatric treatment, you can have the SSA figure out your mental RFC, which determines the jobs you can do keeping in view your mental status. If it’s compromised, the number of jobs you can do gets reduced and you have a higher chance of getting disability benefits.
I’ve been rejected for disability by the SSA. What can I do now?
Getting rejected by the SSA means you’ll probably have to maintain your job. But under the The Americans with Disabilities Act, you can request “reasonable adjustment” from your employer. Reasonable adjustment refers to workplace adjustment that doesn’t cause unnecessary difficulty to the employer.
In the context of Crohn’s, you can try asking your employer to move your desk closer to the restroom, allow you to work from home (only if your role qualifies for remote working), and grant you paid medical leaves for doctor's appointments or Crohn’s surgery.
Medically Reviewed by Onikepe Adegbola, MD PhD