Is Diverticulitis a Disability?
Getting diagnosed with a physical illness can limit your ability to perform daily activities, including work. Diverticulitis is a digestive system disorder that, in severe cases, may significantly impact a person’s quality of life and ability to maintain employment.
Diverticulitis occurs when small bulges or pockets (diverticula) form in the digestive tract, typically in the lower part of the large intestine or colon. When these pouches get swollen or infected, it’s called diverticulitis.
Diverticulitis can range from mild to severe. Mild cases may be managed with dietary changes and antibiotics, while severe cases may require hospitalisation and surgery. Individuals suffering from severe and recurring diverticulitis who are unable to work may consider applying for Social Security Disability Insurance (SSDI). However, since diverticulitis is not explicitly listed in the Social Security Administration’s (SSA) Blue Book, qualifying for benefits requires meeting certain criteria. This guide will help you understand the SSDI qualification process and how to strengthen a claim.
Symptoms and Complications of Diverticulitis
When a patient is diagnosed with diverticulitis, symptoms can range from mild discomfort to life-threatening complications. Common symptoms include:
- Abdominal pain that worsens with movement
- Fever and chills
- Bloating and gas
- Diarrhea, nausea, constipation, and vomiting
- Loss of appetite
If left untreated, diverticulitis can lead to severe complications such as:
- Rectal bleeding
- Infection of the abdominal lining (peritonitis)
- Blockages in the colon or small intestine
- Perforations (holes) in the diverticula or colon
- Abscesses (pus-filled pockets)
- Fistulas (abnormal passageways between intestines and other organs)
When serious complications occur, hospitalization and surgery may be required. In cases where surgery becomes necessary, individuals may become eligible for SSDI benefits if they meet the SSA’s disability requirements.
Can You Get Social Security Disability for Diverticulitis?
Since diverticulitis is not listed in the SSA’s Blue Book, individuals must prove that their symptoms prevent them from engaging in substantial gainful activity (SGA) and that their condition is expected to last at least 12 months.
How to Qualify for SSDI with Diverticulitis
To be eligible for SSDI, you must prove:
- Your condition prevents you from working. Your diverticulitis symptoms must be severe enough to prevent you from performing any substantial work, including sedentary jobs.
- Your condition is long-term or expected to last at least 12 months. SSDI benefits are only available for conditions that result in long-term disability.
- Your condition meets or equals another listing in the Blue Book. Since diverticulitis does not have a specific listing, you may qualify under:
- Digestive Disorders (Section 5.00), which covers conditions like inflammatory bowel disease (IBD) or chronic gastrointestinal hemorrhaging.
- Weight Loss Due to a Digestive Disorder (5.08), if you experience significant malnutrition and weight loss despite treatment.
- Medical evidence supports your claim. Your medical records, test results (e.g., colonoscopies, CT scans), doctor’s notes, and history of hospitalizations must demonstrate the severity of your condition.
Strengthening Your SSDI Claim
Since diverticulitis is not explicitly listed as a qualifying condition, it is crucial to present a well-documented case. Here are some steps to strengthen your claim:
1. Provide Comprehensive Medical Records
The SSA requires extensive medical documentation, including:
- Doctor’s evaluations and treatment history
- Imaging results (CT scans, MRIs, or colonoscopy reports)
- Surgical records if you’ve undergone bowel resection or other procedures
- A list of medications and their side effects
- Records of hospital visits and emergency treatments
2. Obtain a Residual Functional Capacity (RFC) Assessment
An RFC assessment is a form completed by your doctor outlining your physical and mental limitations due to diverticulitis. It evaluates your ability to:
- Standing, sitting, or walking for extended periods
- Lift, carry, or perform manual tasks
- Focus and maintain productivity despite chronic pain and fatigue
- Maintain regular attendance at work
If your RFC assessment shows that you are unable to perform even sedentary work, this could significantly improve your chances of SSDI approval.
3. Document the Impact on Daily Activities
Keeping a journal of how diverticulitis affects your daily life can help demonstrate your disability. Note symptoms such as:
- Frequent bathroom trips and incontinence
- Inability to maintain a regular eating schedule due to nausea or pain
- Chronic fatigue and difficulty completing household tasks
- The need for assistance with basic activities like cooking or shopping
Filing an SSDI Claim for Diverticulitis
If you believe your diverticulitis qualifies you for SSDI benefits, follow these steps:
- Gather all necessary medical evidence from doctors, hospitals, and specialists.
- Complete your SSDI application online at SSA.gov, by phone, or at a local SSA office.
- Include an RFC form completed by your doctor to highlight your functional limitations.
- Prepare for a possible denial. Many SSDI claims are initially denied. If this happens, you can appeal.
The Appeal Process
If your initial claim is denied, don’t get discouraged. The majority of SSDI applicants receive a denial at first but later win benefits through an appeal. The appeal process includes:
- Request for Reconsideration – A second review of your claim with additional evidence.
- Administrative Law Judge (ALJ) Hearing – Present your case before a judge.
- Appeals Council Review – If denied again, you can request a review by the SSA Appeals Council.
- Federal Court Review – A final option if all other appeals are exhausted.
Should You Hire a Disability Lawyer?
Because SSDI claims for diverticulitis can be complex, working with a disability attorney or advocate can improve your chances of approval. A lawyer can:
- Helped gather and organise medical evidence
- Ensure your application is correctly completed
- Represent you in an appeal hearing
- Improve your overall chances of winning benefits
Final Thoughts
While diverticulitis is not explicitly listed in the SSA’s Blue Book, individuals suffering from severe complications may still qualify for SSDI. The key to a successful claim is strong medical documentation, an RFC assessment, and persistence through the application and appeal process. If you or someone you know is struggling to work due to diverticulitis, exploring SSDI benefits could provide much-needed financial support.
If you have any questions about the SSDI process or need assistance with your claim, consulting a disability expert or an attorney may be a wise step forward.