Patients with Hepatitis C (HCV) that are no longer able to maintain gainful employment can qualify for Social Security Disability benefits by meeting the Social Security Administration’s (SSA’s) disability listing for Chronic Liver Disease. Progression of HCV varies and patients may qualify for benefits under several distinct circumstances, all of which meet the SSA’s severity level requirements for disability approval.
The Chronic Liver Disease Listing
This listing appears in Section 5.00 – Digestive System of the SSA’s Blue Book, along with evaluation criteria and documentation requirements. Several subsections of the Chronic Liver Disease listing refer readers to “medically acceptable” criteria, appearing elsewhere in this Blue Book section.
A patient medically qualifies for benefits by meeting any one of the following chronic liver disease manifestations:
- Hemodynamic instability requiring hospitalization and blood transfusion due to gastric, esophageal, or ectopic hemorrhage or portal hypertensive gastrophy.
- Presentation with hydrothorax or ascites, documented on two separate occasions and at least 60 days apart, but within a consecutive six months.
- Spontaneous bacterial peritonitis (SBP)
- Hepatorenal syndrome
- Hepatopulmonary syndrome
- Hepatic encephalopathy
- End stage liver disease
- Requiring a liver transplant (considered disabled for 12 months after procedure)
Required evidence varies based on disease manifestation; however, the SSA may need to see the following with a HCV application:
- HCV RNA labs over a 6-month period
- Quantitative and qualitative treatment reports
- Liver enzyme values
- Blood clotting and platelet counts
- Liver biopsies
- Imaging scans, including CAT scan, MRI, ultrasound, or x-ray
- Neutrophil counts
- Serum creatinine and other kidney values
- Blood oxygenation test results
- EEG and other neurological evaluations
Approval for Disability Under Medical Vocational Allowance
While less frequently approved for benefits, HCV patients that do not meet the SSA’s disability listing for chronic liver disease may qualify for benefits if they have pronounced functional limitations that preclude gainful employment. Provided the applicant’s medical condition and work qualifications support an inability to find and maintain a job, then the applicant can qualify for benefits under a medical vocational allowance.
The SSA’s standard process in reviewing claims is to first attempt to match an applicant’s medical records to a listed disability. When an applicant does not meet a listing and is not a severity level match to any listed condition, a residual functional capacity (RFC) is triggered.
RFC Reviews and the Physician’s Role
In an RFC review, the SSA looks at what activities an applicant can preform every day, from the perspective of the applicant, as well as functional limitations documented by the applicant’s treating physician. Other sources may also be consulted as part of the RFC, including family members or caregivers.
In advocating for a patient with advanced HCV, it is essential to document functional limitations in ongoing medical records. Medical records still serve as backup documentation for summarized statements presented via functional report forms issued by the SSA during the disability review process.
It is crucial to note that the SSA must additionally see specific clinic findings, even if a patient does not precisely meet or closely match any of the disease paths outlined in the Blue Book. Any gaps in medical records or missing diagnostic evidence may result in disability review delays at best and in a denial of benefits at worst. Refer to introductory information in Blue Book Section 5.00 for more information on medically acceptable evidence and required clinical findings.