Social Security Liver Disease

Preface: 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

This column will examine how the Social Security Administration evaluates liver disease in connection with awarding Disability Insurance Benefits.

The medical root word for liver is “hepat”. The liver has a number of vital functions in a healthy body. The liver produces a secretion of fluid called bile. Bile is made up of cholesterol, bile pigments and bile acids. When red blood cells enter the liver the hemoglobin in the blood cells that is destroyed is chemically changed to a substance called bilirubin which is the waste product from this change.

The liver mixes the bilirubin with the bile produced in the liver and both are expelled into the duodenum. The duodenum is the part of the small intestine that attaches to the bottom of the stomach and receives both digested food from the stomach and bile from the liver.

The bile that the liver produces goes into a tube called hepatic duct and enters a tube called the cystic duct.

The bile goes from the cystic duct into the gallbladder that stores the bile until it is needed. After a person eats and food enters his stomach and duodenum the gallbladder secretes bile into the common bile duct into the stomach and duodenum to help with the digestion of food. The pancreas also secretes bile into the common bile duct as well.

The main purpose of the bile is to break up large chunks of fats in food so that the secretions from the pancreas can digest the fats. This breaking up of the fat is called emulsification. Some of the other important functions of the liver is to regulate the amount of sugar in the blood.

This blood sugar is called glucose. The liver takes out unneeded sugar from the blood stream and stores it in the liver as glycogen. The liver regulates the amount of sugar in the blood by either releasing or removing glucose into the blood stream. The liver also serves to filter the blood by cleaning it of waste materials. The liver makes some types of proteins including the protein that helps the blood to clot.

The Social Security Administration has a criterion it uses to evaluate liver problems to determine if the worker is entitled to disability insurance benefits. The rest of this column will look at the tests applied to determine disability in the context of liver problems.

A person meets the listing for Chronic Liver Disease if he has one of the following liver conditions: portal cirrhosis, post necrotic cirrhosis, or biliary cirrhosis (cirrhosis is a disease of the liver in which the liver cells become diseased. Frequently cirrhosis can develop from alcohol abuse which impairs the ability to the liver to function); or chronic active hepatitis. Hepatitis is a liver disease in the liver becomes inflamed.

There are three types of viral hepatitis; type A hepatitis which is spread by a virus that can be transmitted by water and food. Type B hepatitis is spread by blood and is sometimes called serum hepatitis and can be spread through transfusions, unclean surgical tools and dirty hypodermic needles. It can also be spread by body fluids as well.

Type C hepatitis is also spread by blood contact or body fluids. Recently there has been a substantial amount of Type C hepatitis reported in the news media and it continues to be a growing health problem.

In addition to having one of the diseases described above the worker must have one of the following conditions:

A. Esophageal varices. These are swollen and misshapen veins in the esophagus caused by high blood pressure resulting from liver disease. The claimant must also have had an episode of massive bleeding from his esophagus. The claimant will be considered to be disabled for three years after his last massive bleeding episode and then will be re-evaluated.

B. Performance of a shunt operation for esophageal varices. The shunt operation is to reroute the blood through the veins to avoid the damaged area. The claimant is considered to be disabled for three years after such surgery.

C. Serum bilirubin of 2.5 mg per deciliter or greater persisting on repeated examinations for at least 5 months

D. Ascites not attributable to other causes. Ascites is a condition in which fluid leaks out of the blood and collects in the abdomen of the patient leading to a large swelling in the stomach area. The ascites must recur or be persistent for at least 5 months.

E. Hepatic encephalopathy. This is a disease of the brain caused by liver disease.

F. Chronic liver disease confirmed by liver biopsy and one of the following:

1. Ascites not attributable to other causes, lasting at least three months, or;

2. Serum bilirubin of 2.5 mg per deciliter lasting for at least three months, or;

3. Hepatic necrosis (death of liver cells) or inflamation of the liver lasting at least three months documented by repeated abnormalities of prothrobin time (time that it takes blood to clot) and enzymes showing liver dysfunction.

It should be remembered that the Listing for Liver disease is designed to determine at the earliest stage in the application process if a claimant meets the standards for disability insurance benefits.

If the claimant does not meet the bare technical standard an Administrative Law Judge can still award him disability insurance benefits if the Judge finds that the claimant’s health problems in combination meet the equivalent of a listing for disability.

Disability claimants should not become discouraged if they are denied twice before reaching the hearing level before an Administrative Law Judge.

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 . Or at the firm web site of www.smithdickey.com .