Have you been diagnosed with Inflammatory Bowel Disease? Are your symptoms so severe that it is debilitating and prevents you from substantially performing your duties? If so, you may be entitled to social security disability benefits for inflammatory bowel disease.
What Is Inflammatory Bowel Disease?
Not to be confused with the non-inflammatory functional disorder of irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) involves the chronic inflammation of a part or all of the digestive tract. IBD primarily includes Crohn’s disease as well as ulcerative colitis; however, there are other diseases that may fit under the general title of “Inflammatory Bowel Disease.”
Crohn’s Disease
Crohn’s disease is an IBD that causes inflammation of the lining of the digestive tract. This inflammation can spread deep into the affected tissues and can involve different areas of the digestive tract. Crohn’s disease can involve any portion of the alimentary tract from mouth to anus. This inflammation can present in an asymmetrical and segmental fashion. Common manifestations of Crohn’s disease include obstruction, stenosis, perineal involvement, and fistulization. There can also be extra-intestinal manifestations. Rarely is Crohn’s disease curable. Surgical resection is a treatment option; however, recurrence of Crohn’s disease can be a lifelong battle.
Ulcerative Colitis
Unlike Crohn’s disease, which can affect the alimentary tract from mouth to anus, ulcerative colitis only affects the colon. The inflammation that comes with ulcerative colitis may be limited to the rectum. Alternatively, ulcerative colitis could extend proximally to include any contiguous segment. Finally, ulcerative colitis can, in some cases, involve the entire colon. A total colectomy may cure ulcerative colitis.
Symptoms of Inflammatory Bowel Disease
If you have been diagnosed with IBD, you may experience the following symptoms:
- Perineal disease;
- Diarrhea;
- Palpable abdominal mass (this is usually inflamed loops of bowel);
- Fecal incontinence;
- Abdominal tenderness;
- Rectal bleeding;
- Arthralgia (joint pain);
- Abdominal pain;
- Vomiting;
- Fatigue;
- Fever;
- Nausea
There can be other laboratory findings that may be indicative of IBD, including weight loss, malnutrition, edema, hypomagnesemia, anemia, hypocalcemia, hypoalbuminemia, or hypokalemia.
IBD can also manifest symptoms that are “extra-intestinal” – in other words, in other body systems. For example, there can be eye involvement, with uveitis, iritis, or episcleritis present. Gallstones and other hepatobiliary diseases may present themselves. Urologic diseases such as obstructive hydro nephrosis or kidney stones may manifest. There may be skin involvement, such as pyoderma gangrenosum or erythema nodosum – the most common cutaneous manifestations that occur with inflammatory bowel diseases. Vascular disease and thromboembolic disorders can manifest as part of IBD. Finally, non-destructive arthritis may manifest along with IBD.
How Is Irritable Bowel Disease Diagnosed?
Crohn’s Disease Diagnosis
Crohn’s disease has a broad range of symptoms. As such, there is no single test that can definitively diagnose Crohn’s disease. Diagnosis is done through a combination of evaluating symptoms and attempts to exclude other potential causes for the symptoms. Preliminary testing can include lab tests on stool and blood, and X-rays of both the lower and upper GI tracts. A colonoscopy or an upper endoscopy may be appropriate. Doctors also frequently desire a biopsy of the colon or other affected area, to determine the presence of Crohn’s disease. Finally, a doctor may wish to order small intestinal imaging to better visualize portions of the intestine not readily visualized by either an endoscopy or colonoscopy.
Ulcerative Colitis Diagnosis
Like Crohn’s disease, evaluating for ulcerative colitis will start with lab tests on blood and fecal matter. Specifically, the lab tests will assess stool specimens for the possibility of a parasitic, viral, or bacterial cause of diarrhea. Blood tests will evaluate for anemia and signs of infection. Endoscopy, either sigmoidoscopy or a total colonoscopy, may be employed. A biopsy may also be taken. Finally, as with Crohn’s disease, an evaluation of the lining of the small intestine may be ordered.
Criteria for Disability
There are a number of different types of symptoms which can lead to a diagnosis of IBD. As a starting point, IBD can be documented by a biopsy, endoscopy, or other appropriate medically acceptable imaging, or operative findings; along with either the following documented symptoms from Category A or B of the Social Security Administration’s (SSA) blue book listing 5.06 for disabilities.
Category A
Category A requires documentation of an obstruction (not an adhesion) of stenotic areas in the colon or the small intestine, with proximal dilatation. This must be confirmed by imaging or surgery, with hospitalization or surgery for intestinal decompression. This obstruction must have occurred, within a six month time frame, on at least two occasions that are at least 60 days apart.
Category B
Category B requires two of the following symptoms present, despite ongoing treatment, within a six month period:
- The need for supplemental daily parenteral nutrition through a central venous catheter or enteral nutrition through gastrostomy; or
- Anemia with hemoglobin test results of less than 10.0 g/dL, on two separate evaluations at least 60 days apart; or
- Involuntary weight loss of at least 10%. This weight loss can be calculated in kilograms, pounds, or by using the Body Mass Index. There must be documentation of two evaluations at least 60 days apart; or
- Serum albumin of 3.0 g/dL or less, on two separate occasions at least 60 days apart; or
- Perineal disease with a fistula or draining abscess, accompanies by pain that cannot be completely controlled by prescribed narcotic medication, on at least two evaluations 60 days or more apart; or
- A tender abdominal mass, clinically documented, that is palpable on physical examination with abdominal cramping or abdominal pain that cannot be completely controlled by prescribed narcotic medication, present on at least two separate evaluations that occur at least 60 days apart.
Other Considerations
In determining impairment, if your IBD impairment does not meet any of the criteria of SSA’s listing 5.06, the SSA will consider the effects of the extra-intestinal manifestations if they meet or are medically equal to another system. SSA will also consider the extra-intestinal manifestations when assessing residual functional capacity.