Pancreatitis and Qualifying for Disability Benefits

Pancreatitis is not listed as an impairment by the SSA, however, an individual who has pancreatitis and experienced severe weight loss or cannot work at a full-time job on a “regular and sustained” basis may qualify. Qualifying can be difficult and an experienced attorney can improve your chances for approval.

Approximately 220,000 people are affected by acute pancreatitis and 80,000 people are affected by chronic pancreatitis each year. Pancreatitis is a painful and sometimes debilitating disease that can severely limit an individual’s ability to work and may qualify for disability. Pancreatitis ranges from mild to life threatening and can seriously damage the heart, lungs and kidneys.

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The pancreas is a long, flat gland located behind the stomach that produces pancreatic juices called enzymes.

During digestion, enzymes break down sugars, fats, and starches. The pancreas also makes hormones that aid in regulating blood sugar level and appetite, stimulate stomach acids and tell the stomach when to empty. Pancreatic enzymes include lipase, protease, and amylase; hormones produced by the pancreas include insulin, glucagon, amylin and gastrin.

Pancreatitis is an inflammation of the pancreas that occurs when digestive enzymes attack the pancreas, causing severe pain, diarrhea, weight loss, and malnutrition.

There are two types of pancreatitis: acute and chronic. Both are serious, but acute pancreatitis occurs very suddenly and usually lasts only a few days while chronic pancreatitis gets worse over time and leads to permanent damage which may meet the requirements for SSDI.

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from Pancreatitis. If you have been denied disability don’t give up!

Symptoms of acute pancreatitis include:

•   Fever
•    Upper abdominal pain
•   Rapid pulse
•   Nausea and vomiting
•   Abdominal pain that radiates to the back
•   Abdominal pain that becomes worse after eating
•   Tender abdomen

Chronic pancreatitis may follow acute pancreatitis and includes the following symptoms:

•    Constant upper abdominal pain that radiates to the back
•   Diarrhea and weight loss caused by the pancreas not releasing enough enzymes
•   Upset stomach and vomiting

Both acute and chronic pancreatitis are often caused by gallstones and heavy alcohol use.

The main cause of acute pancreatitis is usually gallstones that cause inflammation of the pancreas and block a pancreatic or bile duct.

Other contributing factors and conditions of acute pancreatitis include:

•    Infections such as viruses or parasites
•   Autoimmune diseases
•   Medications
•   Metabolic disorders
•   Surgery
•   Injury to the abdomen
•   Undergoing an ERCP, (endoscopic retrograde cholangiopancreatography) a procedure to study the bile ducts, pancreatic duct and gallbladder

The most common causes of chronic pancreatitis are long time alcohol use and genetic disorders of the pancreas. Other causes include:

•    Cystic fibrosis
•   High levels of calcium or fat in the blood
•   Autoimmune disease
•   Medications
•   Obesity
•   Injury to the abdomen
•   Undergoing an ERCP, (Endoscopic retrograde cholangiopancreatography) a procedure to study the bile ducts, pancreatic duct and gallbladder

To diagnose pancreatitis, a doctor will conduct blood tests to measure digestive enzyme levels in the blood; high levels of amylase and lipase indicate acute pancreatitis. Other tests also normally used in diagnosis include:

•   Pancreatic function tests to find out if the pancreas is making enough enzymes;
•    Imaging tests such as CT scans, MRIs and ultrasounds;
•   Biopsy of pancreatic tissue; and
•   Endoscopic ultrasound to look for inflammation and blockages in the pancreatic or bile ducts.

Initial treatment of pancreatitis focuses on controlling pain, diet, nutritional support and removal of underlying causes.

Some patients may require surgery, antibiotics, and intravenous fluids while other cases may be treated with insulin and pancreatic enzymes.

Individuals with pancreatitis suffer with pain, diarrhea and weight loss, often making it difficult to hold full-time employment.

Unfortunately, pancreatitis is not listed as an impairment in Social Security’s Blue Book, so an applicant would not qualify for Social Security Disability benefits under that diagnosis. However, an individual who has pancreatitis and experienced severe weight loss may be eligible for disability benefits if they can meet the criteria of Section 5.08, Weight loss due to any digestive disorder.

In addition to the impairments specifically mentioned in these listings, other digestive disorders, such as esophageal stricture, pancreatic insufficiency, and malabsorption, may result in significant weight loss.

We evaluate weight loss due to any digestive disorder under 5.08 by using the Body Mass Index (BMI).

To meet the criteria of this listing, you must have experienced severe weight loss despite following prescribed treatment and have a BMI of less than 17.50 on at least two tests taken at least 60 days apart within a consecutive 6-month period.

If you haven’t experienced extreme weight loss, you may still be able to qualify for benefits if you can prove that pancreatitis makes it impossible for you to work at a full-time job on a “regular and sustained” basis.

“Regular and sustained” means you are able to perform a sit-down job for 40 hours per week without any special accommodations like frequent breaks or needing to lie down. In some cases, the severity of an applicant’s medical condition fluctuates and causes the claimant to miss work frequently. These applicants are often denied because some days they are able to do their work, while other days they are out sick or even hospitalized.

If you can prove that your pancreatitis would make you miss too much work, Social Security may approve your claim.

You will need to provide documentation and medical evidence to support your claim that you’re unable to work. You should include doctors’ notes and opinions detailing how your pancreatitis limits your activities and impacts your employment; for example, how long you are able to walk or stand and whether you are able to do sedentary, light, medium or heavy work. Social Security will also consider the effects of any medications you take and how often you need breaks for rest or bathroom breaks. It’s important to note that if you have chronic pancreatitis due to alcohol abuse and you are still drinking, the SSA may deny you benefits.

Additionally, you may be eligible for Social Security Disability benefits if you have another impairment; for example, high blood pressure or diabetes.

Applicants often have more than one illness or injury that prevents them from working full time. By itself one disorder may not meet the requirements of an impairment as stated in Social Security’s Blue Book. However, if an applicant has multiple medical conditions, Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. Social Security will also evaluate how your limitations affect your ability to work (called a medical-vocational assessment), taking into account whether or not you are able to drive, your age, and your level of education.

Applying for Social Security Disability benefits is especially challenging with a diagnosis like pancreatitis that does not match a specific Blue Book impairment listing.

Consulting a qualified disability attorney who can review your case can help you avoid needless delays and improve your chances for approval.

Lonnie Roach, a partner in the Austin law firm Bemis, Roach & Reed, has successfully assisted hundreds of clients who have been denied long term disability benefits.

A client from Round Rock was diagnosed with pancreatitis.

By 2009, he was on eight medications, including Hydrocodone and Fentanyl. He could not operate a motor vehicle in the course and scope of employment, as required by his occupation, while under the influence of the narcotics he needed to take. He was awarded SSDI benefits, however, Reliance Standard denied his claim. Under appeal, we were able to his benefits reinstated.