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SSDI EvaluationDisability Personal Story

Hepatitis C and Social Security Disability Insurance

Hepatitis C SSDI GuidelinesHere is an explanation of Social Security's five-step process to determine if a Hepatitis C patient qualifies for SSDI:

  1. Determine if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $1,040 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.
  1. Conclude the Hepatitis C disability must be severe enough to significantly limit one's ability to perform basic work activities needed to do most jobs. For example:
  • Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
  • Seeing, hearing and speaking
  • Understanding/carrying out and remembering simple instructions
  • Responding appropriately to supervision, co-workers and usual work situations
  • Dealing with changes in a routine work setting
 
  1. Hepatitis C is listed under the category of impairments known as the Digestive System - Medical Listing 5.05 (chronic liver disease). The following criteria have been established indicative of the inability to engage in any substantial gainful activity, i.e., if one has a diagnosis of Hepatitis C and one of the following, a finding of disabled under the Social Security Act is warranted:
  • Chronic liver disease characterized by liver cell necrosis, inflammation, or scarring (fibrosis or cirrhosis), due to any cause that persists for more than six months. Chronic liver disease may result in portal hypertension, cholestasis (suppression of bile flow), extrahepatic manifestations or liver cancer. Significant loss of liver function may be manifested by hemorrhage from varices or portal hypertensive gastropathy, ascites (accumulation of fluid in the abdominal cavity), hydrothorax (ascitic fluid in the chest cavity) or encephalopathy.
  • Chronic liver disease including, but not limited to, chronic hepatitis, alcoholic liver disease, non-alcoholic steatohepatitis (NASH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis, hemochromatosis, drug-induced liver disease, Wilson's disease and serum alpha-1 antitrypsin deficiency.
  • Chronic viral hepatitis infections caused by hepatitis C virus (HCV), and to a lesser extent, hepatitis B virus (HBV). Chronic HBV infection is diagnosed by the detection of hepatitis B surface antigen (HBsAg) in the blood for at least six months. Chronic HCV infectionis diagnosed by the detection of hepatitis C viral RNA in the blood for at least six months. In addition to hepatic manifestations, both HBV and HCV may have significant extrahepatic manifestations.
  • Gastrointestinal hemorrhaging from esophageal, gastric, or ectopic varices or from portal hypertensive gastropathy, requiring a transfusion of at least two units of blood must be at least 30 days apart and occur at least three times during a consecutive six-month period. For hemorrhaging resulting in hemodynamic instability, and requiring hospitalization for transfusion of at least two units of blood.
  • Ascites or hydrothorax not attributable to other causes, despite continuing treatment as prescribed, present on at least two evaluations at least 60 days apart within a consecutive six-month period.
  • Spontaneous bacterial peritonitis infection with ascitic peritoneal fluid containing an absolute neutrophil count of at least 250 cells/mm3.
  • Hepatorenal syndrome, defined as functional renal failure associated with chronic liver disease in the absence of underlying kidney pathology, with any one of the following evaluations: elevation of serum creatinine, marked sodium retention and oliguria (reduced urine output).
  • Hepatopulmonary syndrome is defined as arterial deoxygenation (hypoxemia) associated with chronic liver disease and is evaluated with documentation of intrapulmonary arteriovenous shunting and vasodilatation in the absence of other causes of arterial deoxygenation.
  • Hepatic encephalopathy usually indicates severe loss of hepatocellular function and is defined as a recurrent or chronic neuropsychiatric disorder, characterized by abnormal behavior, cognitive dysfunction, changes in mental status, or altered state of consciousness, present on at least two evaluations at least 60 days apart within a six-month consecutive period.
  • End-stage liver disease is evaluated with SSA CLD scores of 22 or greater, calculated using a formula that includes three laboratory values: Serum total bilirubin (mg/dL), serum creatinine (mg/dL), and International Normalized Ratio (INR). All of the required laboratory values must have been obtained within 30 days of each other.
 
  1. Explore the ability of an individual to perform work they have done in the past despite their chronic liver disease. If the SSA finds that a person can do his or her past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.
  1. Review age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine chronic liver disease disability, the SSA enlists medical-vocational rules, which vary according to age.
 
For example, if a person is:

Under age 50 and, as a result of the symptoms of Hepatitis C, unable to perform what the SSA calls sedentary work, then the SSA will reach a determination of disabled. Sedentary work requires the ability to lift a maximum of 10 pounds at a time, sit six hours and occasionally walk and stand two hours per eight-hour day.

Age 50 or older and, due to the Hepatitis C disability, limited to performing sedentary work, but has no work-related skills that allow him to do so, the SSA will reach a determination of disabled.

Age 55 or older and, due to the disability, limited to performing light work, but has no work-related skills that allow him to do so, the SSA will reach a determination of disabled.

Over age 60 and, due to the Hepatitis C disability, unable to perform any of the jobs he performed in the last 15 years, the SSA will likely reach a determination of disabled.

Any age and, because of Hepatitis C, has a psychological impairment that prevents even simple, unskilled work, the SSA will reach a determination of disabled.

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