Digestive Disorders and Social Security Disability Claims

Digestive disorders - This column will take a look at how the Social Security Administration (SSA) determines if a person with esophagus problems meets the criteria to be awarded Disability Insurance Benefits. It will help to take a brief look at how the digestive system works and then examine how the SSA evaluates health problems related to the esophagus. In a nutshell, the esophagus is the tube used by the body to swallow food and pass it from the mouth to the stomach.

The digestive system begins with the mouth and ends with rectum. This system is called the gastrointestinal tract. The body is designed to process food into usable fuel and expel what is unusable. The food must be digested while it passes through the gastrointestinal tract and the nutrients changed into a form that can be used by the body. The body has digestive enzymes which are chemicals that cause the food to be broken down into usable components. Once the food is broken down into components then it must be absorbed into the blood through the small intestine.

The food goes from the mouth into the pharynx which is the throat. The pharynx leads to the esophagus which is a tube about 10 inches long that leads into the stomach. Food is pushed down the esophagus during swallowing by movement called peristalsis. The esophagus empties into the stomach. The stomach is divided in three regions; the upper section is called the fundus, the middle is called the body and the lower portion is called the antrum. The stomach has two muscular rings called sphincters that control food going in and out of the stomach. The cardiac sphincter controls the entry of food from the esophagus into the stomach and the pyloric sphincter controls the exit of food from the stomach into the small intestine.

The small intestine is about 20 feet long and absorbed nutrients from the food through very small bodies called villi. The nutrients absorbed through the villi pass into the blood stream. The small intestine connects to the large intestine which collects the unusable portions of the food and allows it to pass out of the body.

Unfortunately, the esophagus does not always work the way it was designed. This rest of this column will examine the SSA Listing for problems related to the esophagus. If a worker meets the requirements of a Listing for a particular disease, then his claim should be approved without the need for a hearing before an Administrative Law Judge. When a person has difficulty passing food through his esophagus, there is a specific Listing to evaluate "stricture, stenosis, or obstruction of the esophagus (demonstrated by X-ray or endoscopy) coupled with weight loss".

Stricture means an abnormal narrowing of an opening or passage way in the body. Stenosis is very similar in meaning and refers to a tightening of a passageway within the body. This narrowing of the esophagus must be proven clinically by either X-rays of the esophagus or a procedure called an endoscopy in which a flexible fiber optic tube is placed through the mouth to allow the doctor to see the inside of the esophagus.

Weight Loss Tests

In addition to having the clinical evidence showing the blockage in the esophagus, the worker must meet a weight loss test relating to a persisting gastrointestinal disorder. The weight loss must have lasted for at least three months and can be anticipated to last at least twelve months. There are two standards in the weight loss schedule.

One simply requires that the worker weigh a certain amount with no additional requirements. This first schedule is very difficult to meet as the weight requirement which must be met calls for the worker to be gaunt. The second schedule allows the worker to weigh slightly more than the first schedule but the worker must have additional health problems.

For example under the weight loss only test, a man who is 5 feet 10 inches tall would have to weigh only 115 pounds to meet the standard. A woman who is 5 feet 2 inches tall would have to weigh 86 pounds to meet the weight only standard. As you can see from this example the weight limitation only test is for very emaciated people.

The other weight schedule is only slightly less severe. The weight limits are increased but the worker must have additional health problems in addition to the blockage of his esophagus. Under the second weight schedule, the 5 feet 10 inch man could weigh as much as 122 pounds. The 5 feet 2 inches tall woman could weigh up to 92 pounds. These weight limitations are still very stringent.

In addition to the weight test the worker must have at least one of the following problems: 1. Serum albumin of 3.0 grams per deciliter or less; 2. Hematocrit of 30% or less (Hematocrit is a measure of red blood cells in a volume of blood); 3. Serum calcium of 8 mg. per deciliter or less; 4. Uncontrolled diabetes mellitus due to pancreatic dysfunction with repeated episodes of hyperglycemia (excessive sugar in the blood); hypoglycemia (inadequate sugar in the blood), or ketosis (an accumulation of acids in blood or tissues); 5. Fat or nitrogen in the stool above a certain measurable level; or 7. Persistent or recurrent ascites (an abnormal collection of fluid in the abdomen due to fluid leaking out of the blood stream into the abdominal cavity) or edema (swelling) not attributable to other causes.

Meeting the Listings in this particular area can be very difficult. However, workers can also be award Disability Insurance Benefits if they have a combination of health problems which while they do not meet the listing, in combination prevent them from being able to perform substantial gainful employment.

The Listings are designed to award Disability Benefits to workers who are clearly very ill. The Administrative Law Judge at a hearing can use his discretion to determine that a worker, while not meeting a specific disability listing has health problems severe enough to warrant the award of Disability Insurance benefits.

Notice: Since Social Security Disability is directed under Federal law, the information in this column will apply anywhere in the United States. However each Office of Hearings and Appeals and District Office have their own ways of doing things as does the various Federal District and Circuit Courts. I have kept this column primarily dealing the the mechanics of how the Social Security District Offices and Office of Hearings and Appeals evaluates disability claims.
- Pitt Dickey

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years. He practices with the firm of Smith, Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place and can be reached at 910-485-8020 or at pitt@smithdickey.com . Or at the firm web site of www.smithdickey.com .