Celiac disease, also known as gluten-sensitive enteropathy (GSE), is an autoimmune condition. People with this disorder are unable to digest gluten properly. When they eat foods with gluten, they can experience debilitating symptoms. The body attacks the villi of the small intestine. This can prevent the body from absorbing valuable nutrients. While it is possible to qualify for disability benefits with celiac disease, it isn’t easy. A skilled Social Security disability lawyer can vastly improve your chances of success.
How Celiac Disease Impacts Your Ability to Work
Gluten is found in food products containing wheat, spelt, rye, and barley. Common examples include most breads and pasta. When people with celiac disease eat these foods, they can experience such symptoms as:
- Abdominal pain
- Bloating
- Weight loss
- Vitamin deficiencies
- Anemia
- Osteoporosis
- Joint pain
- Chronic headaches
- Diarrhea
- Fatigue
- Canker sores
- Depression
Celiac disease can affect a person’s ability to engage in substantial gainful activity (SGA). To qualify for Social Security Disability Insurance (SSDI), applicants must not exceed the SGA threshold for income. With severe cases of celiac disease, a person may need to take frequent breaks from work. They may also need to take too many sick days to maintain steady employment.
Doctors will usually diagnose celiac disease with a blood test. They may also collect a sample of the small intestine. Treatment consists of a gluten-free diet. Since most symptoms disappear when someone stops eating gluten, it can be difficult to qualify for disability benefits with celiac disease alone. A Social Security disability attorney can help package the strongest case possible to improve the chances of approval.
Gaining Approval for Social Security Disability Benefits
The government offers two programs to assist people unable to work due to a disability or illness. These are Social Security Disability Insurance (SSDI) and Supplementary Security Income (SSI). In both cases, applicants must prove their disability prevents them from keeping steady employment. Applicants must miss at least one year of work because of their condition.
While a gluten-free diet should resolve symptoms, someone can go years with undiagnosed celiac disease. They may experience all the symptoms without an official diagnosis. Even when their celiac disease is identified, it can take time to develop a proper diet. It can take time for the symptoms to subside. If this takes at least one year, they may qualify for Social Security disability benefits for that period of time. Benefit payments stop when they return to work and exceed SGA income thresholds.
Medical and Financial Eligibility Requirements
The Social Security Administration (SSA) Blue Book lists qualifying conditions for disability benefits. Celiac disease is not on this list. But, people with celiac disease may still qualify for benefits by proving equivalency. Celiac symptoms may be equivalent in severity to a listed disability. People can also list more than one condition on their application.
One example is inflammatory bowel disease (listing 5.06). Your physician must provide a written opinion that your celiac symptoms are equivalent to the IBD listing. You must meet two of these criteria in a six-month period while on medication:
- Anemia with a hemoglobin result of under 10.0 g/dL
- Tender abdominal mass with pain or cramping
- Weight loss of at least 10 percent from normal
- Need for supplementary daily nutrition through a gastrostomy or IV
Another example is weight loss due to any digestive disorder (listing 5.08). The Blue Book states this involves having a body mass index (BMI) of less than 17.5 for at least two months. This is despite following all suggested treatments from your doctor.
The SSDI and SSI programs differ in their financial requirements. With SSDI, you must have accrued a minimum number of work credits through gainful employment. Your current income is not a factor. By contrast, SSI is a needs-based program. Only people with limited financial resources are eligible. The SSDI and SSI programs have similarities in their other non-medical requirements too. A Social Security disability attorney can walk you through these criteria and how they apply to your case.
Residual Functional Capacity
If the symptoms of celiac disease are not equivalent to another Blue Book listing, applicants may still be able to qualify for benefits. The other path is through a residual functional capacity (RFC) assessment. The RFC describes the level of work you are able to do on a regular basis. This includes sedentary, light, medium, or heavy work.
Sedentary work is described as sitting for six hours and standing or walking for two hours in one day. If you are unable to do this because of your condition, you may be eligible for benefits. What it takes to be found disabled can also vary based on age and education. The claim must be backed by evidence, like medical documentation from your doctor. They may state that you miss work often or you are unable to focus on work because of severe pain or headaches.
Why You Need the Help of a Skilled Lawyer
Especially since celiac disease is not listed in the SSA Blue Book, it is vital to seek the help of an experienced Social Security disability lawyer. They can help you navigate the complex application process. Gathering medical evidence and completing paperwork accurately can help improve the chances your application will be approved. A skilled attorney will know the ins and outs of the system, presenting the strongest case possible for receiving SSDI benefits.
The reality is that most disability applications are initially denied. If this happens to you, an experienced lawyer can help you avoid common mistakes in appealing an SSDI decision. They can represent you throughout the appeals process and attend court with you. Consider retaining an attorney as early in your application process as possible.
