Just recently, one of our clients was granted at hearing on the basis of debilitating colitis. Social Security had previously denied her claim after finding her capable of performing light work with ready access to a bathroom. After speaking with her and reading her medical records, it was clear that Social Security had not fully considered the nature of her illness or the severity of her symptoms.
What is colitis?
Colitis refers to inflammation of the colon and causes several symptoms including: chronic diarrhea; abdominal pain; cramping; bloating; and dehydration. Associated symptoms of dehydration include: lightheadedness; weakness; and fatigue.
What medical documentation is needed to establish the diagnosis and prove disability?
At step 2 of the sequential evaluation, the judge must find that you have a severe impairment or combination of impairments that have or are expected to last at least 12 continuous months or be expected to result in death.
There are many causes for inflammation and some are highly treatable and non-severe according to Social Security standards. Therefore, it is very important to talk with your doctor, and have him or her document your symptoms so that the proper tests to exclude other conditions with similar symptoms (i.e. diverticulitis, irritable bowel syndrome) can be performed and a proper treatment plan started.
Common and highly treatable causes of colitis can include: infections (E. Coli, Salmonella); antibiotics (recently taken after an infection elsewhere in the body); and co-existing conditions affecting the vascular system (diabetes, high or low blood pressure, high cholesterol).
More rare, severe, and often debilitating causes of colitis fall under the category of inflammatory bowel disease or “IBD” (ie. Crohn’s, ulcerative and microscopic colitis).
Preliminary tests include: a complete blood count or “CBC” to check for commonly associated conditions such as anemia; and blood chemistry panels (i.e. sodium, potassium, BUN, creatinine) to check for dehydration. Biopsy taken during colonoscopy generally provides the definitive diagnosis. Imaging studies, such as an x-ray or CT scan, may be ordered. Genetic testing can also be used to exclude other similar conditions, such as Celiac disease.
Treatment in chronic cases often involves prescribed medications including: anti-inflammatories; immunosuppressants; and narcotics. In the most serious cases, surgery may be required.
For chronic conditions, your primary care provider will usually refer you to a gastroenterologist, who will ensure the proper tests are performed.
How do I demonstrate that colitis prevents me from working?
While colitis, in general, may not limit your ability to lift, sit or stand long enough to work, it most likely prevents you from making it through a full work day or work week, without significant interruption (i.e. at-will breaks to accommodate your bathroom needs).
Social Security Ruling 96-8p states that an RFC is an individual’s maximum remaining ability to do sustained work activities in an ordinary work setting on a regular and continuing basis, defined as 8 hours a day, for 5 days a week, or an equivalent work schedule.
If the judge finds that your condition would require you to be frequently absent from work or need unscheduled breaks, a finding of disability usually follows at step 5 of the sequential evaluation.
Our client did a great job communicating her symptoms to her doctors, who also did a great job detailing the frequency of her bathroom needs in her medical records.
Three lessons for claimants:
- First, don’t give up. The regulations and rulings are often not appropriately applied at the initial and reconsideration levels. As with our client, it was not until the hearing that our client was able to explain her symptoms and persuade the judge that her condition caused her essentially to be housebound, as she experienced daily bathroom emergencies, requiring more than simple ready access to a bathroom.
- Second, make sure your doctors document the frequency and/or duration of your symptoms. Our client’s medical records reflected that she would urgently need to use the bathroom up to 8 times a day and experienced “accidents” while out in public.
- Third, speak to an attorney early in your case. By talking and meeting with our clients well ahead of the hearing, we are able to determine not only what medical records are needed, but also request a medical source statement from your doctor to develop a winning theory.
For much more on the disability process, please refer to our new ebook, 10 steps to preparing for your Social Security disability hearing.
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