Primary Sclerosing Cholangitis and Long Term Disability

What is Primary Sclerosing Cholangitis?

Primary sclerosing cholangitis (PSC) is a rare liver disease that involves hardening and inflammation of the bile ducts within and around the liver. PSC is a progressive disease, often leading to primary biliary cirrhosis (also known as primary biliary cholangitis or PBC) within 10 to 15 years. Like other forms of chronic liver disease, PSC and PBC can cause troublesome symptoms that may eventually lead to liver failure. If you suffer from primary sclerosing cholangitis you may qualify for disability benefits.

Primary Sclerosing Cholangitis and Long Term Disability Claims

Primary sclerosing cholangitis may prevent someone from working, especially at the later stages of the disease. People who cannot work due to PSC should apply for Long Term Disability (LTD) benefits. The disability insurance company will conduct an evaluation of their claim to see if they qualify under the plan’s definition of disability.

Definition of Disability

Most disability insurance plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their work duties for the first two years of the policy and 2) be unable to complete the work duties of almost any occupation for the years following the initial 2-year period. Some plans are a bit different, so it’s essential to understand your specific policy and its limitations when applying for benefits.

Evaluating Disability for People Who Have Primary Sclerosing Cholangitis

The severe fatigue associated with decreased liver function may keep someone from working in a strenuous job, as they may not have the energy to complete tasks, and fatigue may interfere with cognition and concentration. If someone is struggling to understand or stay on task, even sedentary work may be impossible. Patients may need to miss periods of work for treatment. In cases where liver transplants are necessary, long stretches of hospitalization and rest are required.

Primary sclerosing cholangitis can also lead to severe complications. Colon and bile duct cancer, which are both possible results of PSC, can be disabling. Repeated infections can lead to extensive treatments. If an infection is a concern, a person may not be able to work in an environment that can cause transmission of diseases such as a hospital or pharmacy setting.

Since primary sclerosing cholangitis can lead to other severe forms of liver disease, it is vital to communicate to the insurance company the entire picture of your health. Even if your PSC alone is not severe enough to be considered disabling, you may still qualify for disability benefits when your other conditions are taken into consideration.

What the Insurance Company Needs From You and Your Medical Providers

You will need to tell your insurance company about any doctors that have treated you for your primary sclerosing cholangitis. They will need to review your medical records from those doctors when they are evaluating your claim. If the insurance company cannot get those medical records directly, you may need to get them from your doctors and send them in yourself.

The insurance company will need to see proof of your diagnosis and your ongoing symptoms, as well as evidence of how they affect your life before they will approve a claim for disability benefits. You may think this information will be contained in your medical records, but most records are too brief to elaborate on your various symptoms. You may need to obtain additional evidence in the form of an RFC assessment to supplement your medical records and further support your disability benefits claim.

Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform. Make sure that you are as honest as possible with your doctors so that they can complete a correct RFC for you. Some law firms, such as the Ortiz Law Firm, will even prepare custom RFC forms that are specific to your conditions.

Social Security Disability for Primary Sclerosing Cholangitis

Primary sclerosing cholangitis is listed in the SSA impairment listing manual known as the “Blue Book”, where it is classified as chronic liver disease. However, a diagnosis of PSC is not enough evidence on its own to qualify you to receive Social Security Disability benefits. In order to qualify for Social Security Disability benefits, you must meet certain diagnostic criteria:

Hemorrhaging from esophageal, gastric, or ectopic varicose veins or from portal hypertensive gastropathy resulting in unstable blood pressure and requiring admission to a hospital for transfusion of at least 2 units of blood, or one of the following:

• Accumulation of fluid in the pleural or abdominal cavities which cannot be attributed to other causes, in spite of continuing treatment, that is present on at least 2 evaluations at least 60 days apart during a 6 month period, or
• Spontaneous bacterial peritonitis of a specific severity, or
• Failure of the kidneys due to liver disease, or
• Hepatic encephalopathy of a specific severity, or
• End-stage liver disease of a specific severity.

If you need help obtaining your Social Security Disability benefits we offer a free disability case evaluation. A disability attorney at our firm can help with Social Security Disability claims at the following stages:

• Initial Application,
• Request for Reconsideration, and
• Request for Hearing before an Administrative Law Judge

Symptoms of Primary Sclerosing Cholangitis

Symptoms of PSC can appear like any other chronic liver disease. Fatigue, fever, chills, loss of appetite, unexplained weight loss, and pain in the upper abdomen all point to liver disease. In cases of severe bile duct obstruction, bile can leak into the bloodstream. Bile salts building up in body tissues can cause chronic itching.

In its earlier stages, primary sclerosing cholangitis can cause enlarged liver and spleen. Hepatic encephalopathy, which is a decline of brain function with results from an accumulation of toxins in the blood, is another risk associated with PSC. If it is not adequately treated, PSC can lead to cirrhosis and possibly end-stage liver failure. People with PSC are at a higher risk of getting cholangiocarcinoma (bile duct cancer).

Approximately 80% of patients with PSC have inflammatory bowel disease, more commonly ulcerative colitis than Crohn’s disease. Some research suggests that PSC may also be an autoimmune condition. People who are related to someone with a history of primary sclerosing cholangitis or who have been exposed to certain environmental toxins are more likely to develop the disease. People who are descendants of Northern Europeans are also at a higher risk of developing the condition.

Diagnosing Primary Sclerosing Cholangitis

Since symptoms of PSC can look like symptoms of other liver conditions, such as PBC, doctors must determine which condition is causing symptoms. A doctor will examine the patient and ask questions about symptoms, lifestyle, and medical history. Diagnostic testing can include:

• Medical imaging tests can show the characteristic patterns of widening and narrowing within the bile ducts that resemble beads on a string.
• Endoscopic retrograde cholangiopancreatography (ERCP), where contrast is injected directly into the bile ducts so that X-rays will show narrowing and hardening of the tissue.
• Blood tests for elevated bilirubin, liver enzymes.
• Urine tests for an absence of urobilinogen, which is produced when bile is broken down in the gastrointestinal tract.

Treating Primary Sclerosing Cholangitis

Unfortunately, there is not a medication that is on the market that can prevent this chronic liver disease from progressing to the end-stage. Most treatment for PSC is focused on minimizing symptoms. Once the liver is no longer functioning correctly, a liver transplant is necessary. In order to receive a liver transplant, you will need a matching donor. If a match is not found, liver failure can be fatal.

Working With a Disability Attorney

If you are unable to work due to primary sclerosing cholangitis or some other form of chronic liver disease you may qualify for disability benefits. Fortunately, you do not have to fight the insurance companies or the Social Security Administration alone.

The experienced disability attorneys at the Ortiz Law Firm can help you obtain the disability benefits you deserve. Your attorney will only get paid if you win, so you can seek help without worrying about upfront costs or unexpected bills. Our law firm will focus on your disability claim so you can focus on your health.

Ortiz Law Firm would welcome the opportunity to review your disability claim to see how we can help you qualify for disability benefits. To see how we can help you win your long-term disability or Social Security Disability claim and get you the benefits you deserve for your primary sclerosing cholangitis, call us at (888) 321-8131. We offer a free disability case evaluation for long-term disability claims that have been denied or terminated, as well as for Social Security Disability claims at the trial phase of the process.