Can I Receive Social Security Disability Benefits for Diverticulitis?

Diverticulitis is a fairly common digestive disease.  The severity and the longevity of the disease can vary greatly, though.  For some patients, a treatment of conservative therapy with bowel rest may be sufficient; others may require more aggressive antibiotics or even surgery.

The exact cause of diverticulitis is unknown.  It was previously thought that a high fiber diet may help alleviate the pressure in the colon, thereby lowering the chances of diverticulitis forming.  However, in a study designed to test this theory exactly, it was shown that patients with a high fiber diet actually had an increased frequency of developing diverticulitis.

Most cases of diverticulitis are diagnosed by use of a CT scan.  CT scans are cited to be very accurate (98% effective) in diagnosing diverticulitis.  Symptoms of diverticulitis may include one or more of the following:

• abdominal pain
• nausea
• vomiting
• fever
• cramping
• constipation

While the Social Security Administration (SSA) does not have a listing that directly addresses diverticulitis in its Listing of Impairments, your diverticulitis may be disabling enough that you meet Social Security’s definition of disability in a different way.  In order to receive Social Security disability benefits for diverticulitis, you must prove one of two things:

• the symptoms you experience are at least equal in severity to the symptoms of  another condition in Social Security’s Listings, or
• the symptoms you experience prevent you from performing all of the demands of a full-time job on a regular and continuing basis.

One possible way a claimant might qualify for Social Security disability benefits for diverticulitis is to equal the listing for inflammatory bowel disease (IBD).  IBD is listed under Section 5.06 of the SSA’s Listing of Impairments, and it has many of the same symptoms as diverticulitis.  To meet the listing for IBD you must show one of the following:

• two hospitalizations in the last six months, which are at least 60 days apart, from obstructions of stenotic areas in the small intestine or colon
• two of the following despite treatment as prescribed and occurring in a six month period, at least 60 days apart:
  • anemia with hemoglobin of less than 10.0 g/dL
  • serum albumin of 3.0 g/dL or less
  • clinically documented tender abdominal mass papable on a physical examination with pain, or cramping that is not completely controlled by medication
  • perineal disease with draining abscess or fistula, with pain that is not completely controlled by medication
  • involuntary weight loss of at least 10 percent, as computed in pounds, kilograms, or BMI
  • need for supplemental daily enteral nutrition via a gastrostomy or daily parenteral nurtition via a central venous catheter

If your symptoms of diverticulitis meet these requirements, Social Security may find that your condition “equals” Listing 5.06, and therefore find that you are entitled to disability benefits under their rules.

Even if you do not meet the requirements of the Listing, you may be found disabled if your diverticulitis symptoms keep you from working.  Often, my clients who suffer from diverticulitis have difficulty maintaining full-time work because they are unable to perform their jobs for eight hours a day, five days a week.  They may require frequent trips to the bathroom due to nausea or diarrhea, or they are unable to get to work every day due to their illness.  In my experience, if Social Security finds that you need extra, unscheduled breaks or days off, they will find that, under their rules, you are unable to work.

It is not enough to simply describe your symptoms to Social Security; the SSA must find that you have a documented medical condition that is reasonably expected to cause those symptoms.  Therefore, medical records are a very important part of the process for claimants with diverticulitis.  Medical records from a specialized physician like a gastroenterologist will likely be more helpful than records from a primary care physician.  Additionally, records showing clinical findings, test results, and consistent treatment will provide evidence to support the severity of your condition.  

Many Social Security disability claimants find it helpful to hire an attorney or a qualified representative to help them through what can be a very long application and appeals process.  The SSA can ask some difficult and confusing questions, and sometimes claimants aren’t sure what they need to make sure Social Security knows about their daily activities or their prior work experience.  It may also be beneficial to a claimant to have an attorney or representative’s office help with the collection of necessary medical records and other evidence for the hearing.  Most attorneys and representatives offer a free consultation to prospective claimants to answer questions or evaluate their case.