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Digestive System Disorders

Social Security Announces Changes in the Digestive System Listings Criteria

While making disability determinations, one of the steps Social Security goes through is to ask whether or not the claimant's condition “meets or equals a listing.” The Listings are a list of impairments that are considered severe enough to prevent a person from doing any gainful activity. Most of the listed impairments are permanent, very serious, or expected to result in death. The impairments are grouped together by the major body systems that they affect. So far, there are 14 categories of impairments, and within each category there are several sub-categories of illnesses. If the claimant has the listed impairment, with medical records to support it, then the case automatically wins at this step in the determination process.

One of the categories within the Listings is the “Digestive System,”and within it there are several sub-categories such as chronic ulcerative colitis, liver transplant, gastro-intestinal hemorrhage and peptic ulcer disease. In order to win a case under one of these Listings, the claimant must show that they have undergone an endoscopy or other comprehensive medical test. Further, the claimant must have medical documentation that states surgery is not an option, or that despite surgery they continue to have symptoms such as severe weight loss, massive hemorrhages, ascites or other severe complications.

As medical technology has improved over the years, certain conditions that were considered disabling in the past no longer pose the type of limitations they once did. Therefore, the Social Security Administration regularly updates the Listings to keep in step with modern medicine. Alternatively, over the years illnesses that were once unknown have now been adequately researched. The medical community has a better understanding of new diseases, and therefore the Listings are frequently updated to include newer disabling conditions as well.

Recently, several changes have been made to the Digestive System Listing. Social Security Commissioner Michael J. Astrue stated that the old “digestive listings…do not accurately reflect advances in the diagnosis and treatment of digestive disorders.” Therefore, among the changes is a new “disability calculator tool,” which is supposed to help make quicker decisions for cases involving chronic liver disease.

Another change is to eliminate the “peptic ulcer disease” sub-category because with new treatment methods, the Administration has stated “this condition is rarely disabling.”

Though these changes have been set forth to make disability determinations quicker and more accurate, it is obvious the changes will cause some people with real, disabling conditions to be denied.

For example, though peptic ulcer disease is not always disabling, it can be when it causes recurrent ulceration after surgery, severe weight loss, or inoperable fistula formation. However, if this listing is taken out without providing a substitute category to include people with advanced peptic disease, this will lead to incorrect denials.

In order to ensure that your case is handled appropriately in the wake of the Administration’s Listings changes, obtain representation early. It is vital to enlist the assistance of an attorney well versed in Social Security regulations, updates and changes. Taking a proactive approach right from the start may prevent having to wait later on due to mistakes and incorrect denials.

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