Advanced Liver Disease and Social Security Disability

  The information below comes from Section 5.05 of the Social Security Disability Book. These are the medical criteria that get you approved for SSD.   A lot of hocus pocus, but we sure learn a lot when we or a loved one has ESLD!  We can figure this out. You must also have recent work quarters…don’t get too sick before applying.   If   you have missed too many quarters of work before you apply, you will be denied.   Mike missed his opportunity and has struggled…but now, with Medicaid, he is doing okay. Lawyers can help if you have been denied but they take a cut, generally a not to exceed flat fee. And don't let time go by when you are denied...the ability to appeal expires! http://www.ssa.gov/disability/professionals/bluebook/5.00-Digestive-Adult.htm#5_05   5.05  Chronic liver disease, with: A. Hemorrhaging from esophageal, gastric, or ectopic varices or from portal hypertensive gastropathy, demonstrated by endoscopy, x-ray, or other appropriate medically acceptable imaging, resulting in hemodynamic instability as defined in 5.00D5, and requiring hospitalization for transfusion of at least 2 units of blood. Consider under disability for 1 year following the last documented transfusion; thereafter, evaluate the residual impairment(s). OR B. Ascites or hydrothorax not attributable to other causes, despite continuing treatment as prescribed, present on at least 2 evaluations at least 60 days apart within a consecutive 6-month period. Each evaluation must be documented by: 1. Paracentesis or thoracentesis; or 2. Appropriate medically acceptable imaging or physical examination and one of the following: a. Serum albumin of 3.0 g/dL or less; or b. International Normalized Ratio (INR) of at least 1.5. Back to Top OR C. Spontaneous bacterial peritonitis with peritoneal fluid containing an absolute neutrophil count of at least 250 cells/mm3. OR D. Hepatorenal syndrome as described in 5.00D8, with on of the following: 1. Serum creatinine elevation of at least 2 mg/dL; or 2. Oliguria with 24-hour urine output less than 500 mL; or 3. Sodium retention with urine sodium less than 10 mEq per liter. OR E. Hepatopulmonary syndrome as described in 5.00D9, with: 1. Arterial oxygenation (PaO2) on room air of: a. 60 mm Hg or less, at test sites less than 3000 feet above sea level, or b. 55 mm Hg or less, at test sites from 3000 to 6000 feet, or c. 50 mm Hg or less, at test sites above 6000 feet; or 2. Documentation of intrapulmonary arteriovenous shunting by contrast-enhanced echocardiography or macroaggregated albumin lung perfusion scan. Back to Top OR F. Hepatic encephalopathy as described in 5.00D10, with 1 and either 2 or 3: 1. Documentation of abnormal behavior, cognitive dysfunction, changes in mental status, or altered state of consciousness (for example, confusion, delirium, stupor, or coma), present on at least two evaluations at least 60 days apart within a consecutive 6-month period; and 2. History of transjugular intrahepatic portosystemic shunt (TIPS) or any surgical portosystemic shunt; or 3. One of the following occurring on at least two evaluations at least 60 days apart within the same consecutive 6-month period as in F1: a. Asterixis or other fluctuating physical neurological abnormalities; or b. Electroencephalogram (EEG) demonstrating triphasic slow wave activity; or c. Serum albumin of 3.0 g/dL or less; or d. International Normalized Ratio (INR) of 1.5 or greater. OR G. End stage liver disease with SSA CLD scores of 22 or greater calculated as described in 5.00D11. Consider under a disability from at least the date of the first score.  

Something of interest I recently stumbled upon myself while I'm waiting for my disability hearing . I was made aware that the Social Security Admin. contracts out the re-evaluation work to non governmental service groups , They are in charge of handling the re-evaluation process .

SS awaits the determination of this group of ( professionals ??) to determine if your case should still be claimed . Considering I have had TIPS and still taking medications for encephalopathy doesn't seem to have swayed then from pursuing cancellation of my claim . My Hepatologist and GP have both written letters stating that I am not currently able to work and that has had no effect either . I have decided to get a attorney which by most estimates will set me back $ 3000.00 .

I am still receiving benefits until the hearing but scraping money together is gonna be a pain in itself to pay a attorney , In the event I lose at the hearing and claim is denied I will have the joy of paying them back every cent they paid me from the time of the initial determination letter .

Hmmmm , Looks like that dream of living out my last days on the beach in South America might just be happening after all . There is still some tropical forest down there where a hog like myself can wallow out a decent home . Just gotta watch the natives !!!! Anyhow , I'm just glad to be alive today and tomorrow is another day . Not gonna get my drawls in a bunch over this mess .


A. Ziffle

Our attorney wanted the 25% but cappped that out at some #, I can't remember...maybe $5K...but NOTHING until the pay out.

I think I have read that they give you the SSD in one year increments. And multiple diagnoses HELP. Connie's hips likely really really helped.

"The pro-Bono services by attorneys is only for those who are not receiving benefits . If you get the benefits you have to pay up front."

I wasn't aware of that, Ziffle. Thanks for the info.

Carol, at the time I applied for SSD, it was mainly my hip issues that got it for me. As a medical transcriptionist, I had to sit for long periods of time. That caused me too much pain and also affected my income, as an MT working from home gets paid by the line. Every time I would get up, I'd be losing money. Right at the time I was approved and got Medicare, the first HCC was diagnosed. So if I hadn't already gotten approved, I would have been with that diagnosis. They also sent me to their own doctor (a joke...his first words were "Why can't you work?" I informed him that I was still working P/T, but that it was very difficult.)

SS usually does a review at some point to make sure that the recipient can't work. However, if you reach full retirement age while on SSD, they change the status to Retirement benefits. No extra money, but you know they won't be bugging you.

Hugs,
Connie

OMG! The shrink cried? How long ago did his wife die? If it happened 20 yrs. ago, that would be even stranger. Reminds me of the attorney I first retained to help me with SSD. I had wanted a different one in the firm, but he was tied up with a murder case (this firm had all sorts of clients, not just those seeking disability benefits.) This attorney assigned to me had a desk that was a mess with paperwork all over it. While he was talking to me, his eyes were rolling back in his head. I didn't know if he wasn't paying attention, having a seizure, or grabbing a quick nap. In the end, he was fired and I got the attorney I originally wanted and the claim was approved quickly. I had sent medical records to the old one and he hadn't forwarded them to SS...they were still in the file cabinet.

Hugs,
Connie

Carol, what do you mean by SSD being paid in one-year increments? I get a check direct deposited to my checking account every month.

Hugs,
Connie

Connie, his wife had passed away a couple of years before.

Ziff...

I am trying to keep a civil tone myself. Mike is getting the royal run around from his insurance...though not SSD, that's a lost cause. Now he just wants to keep the Medicaid in place.

Can you believe they told him that he gets $1500 for out patient services for a YEAR. The year starts July 1, 2012. By August, his account is empty. And our Governor wants to cut the program more???

The man worked at major military contractor as an assembler of jet engines for years, then went to college a couple of years nights and became an IT guy and worked year after year after year when he couldn't do the heavy work any more (Hep slowed him down years ago). And then he couldn't work at all. His so called "private insurance" premiums went to $19,000 a year (with NO income) PLUS it covered $1000 in meds, no out patient doctors appointments and had a $10,000 deductible per hospitalization. It paid no ER visits unless you were admitted. So, he went through every dime he had before he gave up on the insurance route. Now, is now.

And after all that, after he is bone dry...f... him. I asked the lady at Medicaid did the Governor just intend for him to die without his after care and meds??? She said she hoped not...but I don't know.

I think we have an appeal working through the system now to get mike an exception because he has more than one thing wrong with him...hoping. But still frustrated...why the fight. Why the rooms full of clerks with their finger on the "drop dead" button...we didn't fill the form out right???

We are not talking about an illegal here, we are talking about a lower middle class guy who worked his whole life...starting as a kid in a grocery store after school, helping roof houses in the summer time, working doubles at the engine factory to make enough for the kid to go to Catholic school, then working at an insurance company doing PC stuff.

I think Ziffle's tone is perfectly calm.

I think I better go to bed early...

ML

Don't have any.  Good thought though.  C

 

Are you practicing latin ? You coming with me ? Really good fishin down there I hear , Heck maybe we can find a couple those Jennifer Lopez look alike chicks to share our humble shanty's with .



A. Ziffle

Carol, I don't think you were acting like a diva at all...merely stating how awful the state of affairs is with Medicaid and how it's likely to get worse. I don't think Medicare is quite as bad, though I keep hearing that severe cuts are going to be made.

God help us all.

Hugs,
Connie

Like Mike and Ziffle, I had long ago filled the quarters worked requirement when I applied for SSD. I'm sure that helped. More importantly, I had recent work quarters, thank goodness, as I hadn't known about the recent work requirement until somebody told me. The first job I had where SS taxes were taken out was as a teenager working in the summer at Woolworth's. I had worked from then on (not at Woolworth's), right up until I applied for SSD. I only missed a couple of years (when I was pregnant with my daughter and until she was 2 and a collective year or so of unemployment because I couldn't find a job.) Oh, yes...I was born and raised here in the good ole US of A. And after all that productivity, I had to practically beg for SSD. Sorry state of affairs.

Hugs,
Connie