Patients with gastroparesis may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their gastroparesis may qualify for disability benefits under a long term disability insurance policy or Social Security Disability from the Social Security Administration (SSA). The insurance company will review their claim to see if they qualify for disability benefits under the conditions of the policy, whereas the SSA will check to see if they meet a Listing of Impairment. So, is gastroparesis a disability? Below we will explain what gastroparesis is and how to qualify due to gastroparesis
What is Gastroparesis?
Gastroparesis is a condition of the digestive system in which the spontaneous movement of the muscles (motility) in one’s stomach does not function normally, often as a result of damage to the vagus nerve. Also known as delayed gastric emptying, gastroparesis is a condition that prevents the body from moving food from the stomach to the small intestine. In some cases, it can be caused by damage to the vagus nerve, but it is not always clear what led to gastroparesis.
The effects of gastroparesis can be severe and may be unpredictable. Symptoms may include severe gastritis, abdominal pain, nausea and vomiting, and weight loss. Because of this, individuals suffering from gastroparesis may find that their symptoms make it impossible to continue working. It is also possible that you may qualify for benefits.
Does Gastroparesis Qualify for Long Term Disability?
Definition of Disability
Long term disability benefits are intended to provide financial assistance to individuals with long-term health conditions. Although gastroparesis is not typically thought of as a totally disabling medical condition, applicants with this condition may be able to receive benefits if they meet the LTD policy’s definition of disability.
This definition of the term “disability” or “totally disabled” is defined in each LTD insurance policy. You should review your own policy to determine your specific definition. A sample definition states:
“Total Disability or Totally Disabled means that during the first 24 consecutive months of benefit payments due to Sickness or Injury:
You are continuously unable to perform the Material and Substantial Duties of Your Regular Occupation, andYour Disability Earnings, if any, are less than 20% of Your pre-disability Indexed Monthly Earnings.
After the LTD Monthly Benefit has been paid for 24 consecutive months, Total Disability or Totally Disabled means that due to Injury or Sickness:
You are continuously unable to engage in any Gainful Occupation, andYour Disability Earnings, if any, would be less than 20% of Your pre-disability Indexed Monthly Earnings.”
If you do not meet your LTD policy’s definition of “Total Disability” or “Totally Disabled”, it is not likely that you will qualify for benefits. However, if you do meet the policy’s definition, you will be further evaluated based on specific technical and medical requirements.
Medical Eligibility and Residual Functional Capacity (RFC)
It is important to note that applicants should inform the disability insurance company of any and all health conditions that they have, not just their digestive disorder. This means that if your gastroparesis is caused by another condition or you have another serious condition in addition to gastroparesis, you should inform the insurance company. This is due to the fact that the insurance carrier will evaluate you based on the combined effects of all conditions that you may have. You may qualify for benefits based on multiple disabling conditions.
For example, gastroparesis is often associated with neuropathy secondary to diabetes. Someone with gastroparesis alone may have his or her application denied. However, if the same person has an endocrine system disorder and gastroparesis, he or she may stand a better chance of approval. A Residual functional capacity (RFC) form can also improve a claimant’s chance of being approved.
You will be evaluated based on your ability to perform work-related activities. To do this, the insurance company will send your medical records to an “independent medical examiner” who will review your records and give a Residual Functionality Capacity (RFC) assessment. The RFC will determine what type(s) of work you can be expected to perform. Depending upon the results of your RFC, you will either be awarded benefits or recommended to return to work.
You can also ask one of your own doctors to assess your residual functional capacity. Your doctors can document symptoms such as nausea and vomiting or weight loss. You can download a free physical RFC form in PDF format on our website. Take the form with you to your next appointment and ask your doctor to complete
Applying for Long Term Disability Due to Gastroparesis
As you begin the disability claim process, you should collect extensive medical and non-medical documentation to support your claim. Medical documentation includes the medical records that serve as proof of your illness or disability. Without sufficient medical documentation, the insurance company will likely deny your claim for disability benefits. If you want to be really proactive, you should work with your doctor to collect copies of the following:
- Record of your diagnosis or diagnoses;
- A history of hospitalizations and/or medical appointments;
- The findings from physical and mental examinations;
- A history of any treatments you have received and your body’s response to these treatments;
- Lab results;
- A written statement from your doctor outlining your condition and the limitations that it causes you to experience; and
- Non- medical documentation may include financial records, employment records, and various forms of identification.
Once you are ready to begin your application, you will need to fill out several forms your insurance company or employer will provide to you. Be sure to answer all questions completely and accurately. Your application should provide the insurance company with an understanding of your condition and the daily limitations that it causes. Any missing or inconsistent information could cause your application to be unreasonably delayed or even denied.
The standard LTD application is processed within weeks to several months. If your claim is denied, you have the right to appeal the decision. Your denial letter should identify any time-limits for the appeal, but you should work diligently to file the appeal in a timely manner.
Although it can be discouraging to receive a denial, the appeals process is your chance to correct any mistakes in your application and provide further medical evidence to support your claim. It is important to note that many LTD applicants are approved during the appeals process. Our office represents long term disability claimants who have been wrongfully denied or terminated. Call us at (888) 321-8131 or contact us online to request a free case evaluation.
Gastroparesis and Social Security Disability
So does gastroparesis qualify for Social Security Disability? Although the Social Security Administration (SSA) does not have its own listing for gastroparesis, you may still qualify for Social Security Disability benefits under another digestive disorder listed in Social Security’s Listing of Impairments. Social Security does not pay short-term disability benefits, so you must be unable to perform a substantial amount of work for at least 12 months.
You can get approved for Social Security Disability under Social Security’s listing for weight loss, but your weight loss must meet specific criteria and be documented appropriately:
- Your body mass index (BMI) falls below 17.50;
- The BMI is documented on two separate occasions;
- The documentation occurs at least 60 days apart during a 6-month consecutive period; and
- You are following your prescribed treatment plan.
If your gastroparesis has an underlying cause you may be able to qualify for Social Security Disability if you meet that listing. Diabetes, scleroderma, Parkinson’s disease, and multiple sclerosis are all risk factors for gastroparesis.
If an adult who has gastroparesis has been denied based on the applicable listings but is still unable to work, you can apply for Social Security Disability based on a medical-vocational allowance. During this process, the individual will have to submit to testing to determine the level of functioning in daily life and your ability to work. Your doctor usually completes this paperwork. They will ask questions like:
- How much can you lift, and how often?
- How long are you able to sit or stand?
- How well can you reach out or overhead?
- How well can you bend down, crouch, or stoop?
- How well can you grasp objects or use your hands?
Based on your answers, you will be assigned a rating of sedentary, light, or medium work. Mental limitations are taken into account i.e., a low IQ, level of education, and working experience. Your mental RFC will assign you a rating of unskilled, semi-skilled, or skilled worker. If you are given a rating of sedentary work and unskilled worker, this will increase your chances of being approved for Social Security Disability benefits.
Legal Representation
Working with an experienced disability attorney will give you the best chance of getting the benefits you deserve for your gastroparesis. Even if you have been denied benefits, that does not mean your fight is over. Many people are denied benefits the first time they apply. You have the right to file an appeal and try to get more information that may help your case. Getting expert help is often the difference between being denied and being approved for benefits.
While the process can be daunting, your experienced disability attorney will be able to guide you through the process. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills. Our law experts will focus on your case so you can focus on your illness.
The Ortiz Law Firm has successfully represented claimants in disability cases across the United States. If you would like to talk to an experienced disability lawyer about your gastroparesis and its impact on your ability to work, call us at (888) 321-8131 or contact us online. We would be happy to evaluate your case and to discuss how we can help you receive the benefits you deserve.