A Free Guide To Social Security and Supplemental Security Income Disability Benefits

Regional Enteritis/Crohn’s Disease and Disability Benefits

By R. M. Bottger

            If you have Regional Enteritis/Crohn’s Disease (demonstrated by operative findings, barium studies, biopsy, or endoscopy), here is how SSA will evaluate your disability case.  In all cases, you must either have met these criteria for 12 months in a row or be expected to meet at these criteria at least 12 months in a row.  If you are temporarily this severe during an acute exacerbation and are responding to treatment, SSA will deny your case on the grounds that your condition is not expected to last at least 12 months in a row.  (See the article How Long Must Your Impairment Last to Qualify for Disability  Benefits?)  If you are not following prescribed therapy, your case will be denied on the grounds that with prescribed therapy your condition is not expected to persist at this level of severity at least 12 months in a row. 

People of Any Age

            A person of any age will be found disabled if he or she meets the criteria described in this section.

A person with Regional Enteritis/Crohn’s Disease will be found to be disabled if he or she has persistent or recurrent intestinal obstruction evidenced by abdominal pain, distention, nausea, and vomiting and accompanied by stenotic areas of small bowel with proximal intestinal dilation.

A person with Regional Enteritis/Crohn’s Disease will be found disabled if he or she has persistent or recurrent systemic manifestations such as arthritis, iritis, fever, or liver dysfunction, not attributable to other causes.

A person with Regional Enteritis/Crohn’s disease will be found disabled if he or she has intermittent obstruction due to intractable abscess or fistula formation.

            A person with Regional Enteritis/Crohn’s Disease will be found disabled if he or she weighs less than the values specified in Chart A for men and Chart B for women.  The weights must have persisted for at least 3 months and be expected to persist at least 12 month with prescribed therapy.

Chart A-Men

Chart B-Women

A person with Regional Enteritis/Crohn’s Disease will be found disabled if he or she meets one of the following criteria and weighs less than the values specified in Chart C for men and Chart D for women.  The weights must have persisted for at least 3 months and be expected to persist at least 12 month with prescribed therapy.

·        Serum albumin of 3.0 gm. per deciliter (100 ml.) or less

·        Hematocrit of 30 percent or less

·        Serum calcium of 8.0 mg. per deciliter (100 ml.) (4.0 mEq./L) or less

·        Uncontrolled diabetes mellitus due to pancreatic dysfunction with repeated hyperglycemia, hypoglycemia, or ketosis

·        Fat in stool of 7 gm. or greater per 24-hour stool specimen

·        Nitrogen in stool of 3 gm. or greater per 24-hour specimen

·        Persistent or recurrent ascites or edema not attributable to other causes

  Chart C-Men

Chart D-Women

Children Under the Age of 18

            A child under the age of 18 with Regional Enteritis/Crohn’s disease will be found to be disabled if he or she has intestinal manifestations or complications, such as obstruction, abscess, or fistula formation which has lasted or is expected to last 12 months.

A child who has Regional Enteritis/Crohn’s disease will be found disabled if the disease has caused either a fall of 15 percentiles of weight which persists or the persistence of weight which is less than the third percentile (on standard growth charts) and one of the following:

·        Stool fat excretion per 24 hours:

o       More than 15 percent in infants less than 6 months.

o       More than 10 percent in infants 6-18 months.

o       More than 6 percent in children more than 18 months

·        Persistent hematocrit of 30 percent or less despite prescribed therapy

·        Serum carotene of 40 mg./100 ml. or less

·        Serum albumin of 3.0 gm./100 ml. or less

Children under the age of 18 will be found disabled if they have a fall of greater than 25 percentiles in height which is sustained.  

Children under the age of 18 will be found disabled if a bone age of two standard deviations below the mean for chronological age.

People Age 50 and Older

            Once a person reaches age 50, it becomes easier to meet the medical requirements for disability benefits.  When a person reaches age 55, it becomes even easier to meet the medical requirements for disability benefits.  People who have done physically demanding work benefit most from the more lenient rules as they age.  This is because SSA believes that older workers are less able to adapt to other, less demanding types of work.  People over the age of 50 may qualify for disability benefits with less severe disease than is described in this article.

Conclusion

            Not very many people are found to be disabled solely on the basis of Regional Enteritis/Crohn’s Disease.  In the 9 years that I was a Disability Determination Specialist, I only remember seeing 3 allowances based on Regional Enteritis/ Crohn’s Disease.  One fellow had severe anemia requiring monthly blood transfusions due to intractable bleeding due to Crohn’s Disease.  The second fellow had severe, intractable fistula formation despite extraordinary medical care.  The third man had severe weight loss and repeated surgeries.  However, it is possible that I saw other cases that I have forgotten since I adjudicated about 800 cases per year during the 9 years.  Only the severest cases of Regional Enteritis/Crohn’s Disease qualify as disabling.

Copyright 2002 by R. M. Bottger