Pancreatitis is a disorder involving the pancreas that causes severe, debilitating abdominal pain. It is impossible to work while one is stricken with acute pancreatitis. This article discusses how a person with pancreatitis can obtain Social Security disability benefits.
In order to understand pancreatitis, it is first necessary to understand the pancreas. “The pancreas is about 6 inches long and sits across the back of the abdomen, behind the stomach. The head of the pancreas is on the right side of the abdomen and is connected to the duodenum (the first section of the small intestine) through a small tube called the pancreatic duct. The narrow end of the pancreas, called the tail, extends to the left side of the body.” See WebMD at http://www.webmd.com/digestive-disorders/picture-of-the-pancreas.
“The pancreatic duct is the main duct that extends transversely though the pancreas. Digestive fluids secreted by the pancreas drain into the pancreatic duct that leads to the small intestine…. Water and ions are secreted from the epithelial cells that line the thin-walled ducts in order to dilute and buffer the acids from the stomach. The pancreatic duct converges with the common bile duct at the duodenal papilla….” See visiblebody.com, Digestive Anatomy, and Argosy Publishing. The digestive enzymes produced by the pancreas enable the body to metabolize carbohydrates, fats, and the hormone insulin.
Pancreatitis is a condition in which the pancreas becomes inflamed and damaged by its own digestive chemicals. Although the cause of pancreatitis is often unknown, excessive alcohol drinking is frequently associated with acute pancreatitis.
The symptoms of acute pancreatitis are severe and require medical treatment. Chronic pancreatitis develops over a number of years, usually after a history of acute attacks. Chronic pancreatitis causes the body to lose the ability to secrete the enzymes the body needs to digest food. Chronic pancreatitis can cause Type 2 diabetes in which the body loses the ability to produce and process insulin, causing a rise in blood sugar. Further, chronic pancreatitis can cause pancreatic calcification, in which small, hard calcium deposits develop in the pancreas. See WebMD at http://www.webmd.com/digestive-disorders/picture-of-the-pancreas.
There are several tests available to evaluate pancreatitis.
Amylase and Lipase are pancreatic enzymes. Blood tests that show elevated levels of these enzymes suggest pancreatitis.
Endoscopic retrograde cholangio-pancreatography (ERCP) is a diagnostic test to examine the duodenum, the bile ducts, the gallbladder and the pancreatic duct. The procedure is performed by using a long, flexible, viewing instrument about the diameter of a pen advanced from the mouth to the pancreas.
Endoscopic ultrasound (EUS) involves “the passage of a specialized endoscope through the esophagus and stomach and into the duodenum. The scope has a very small ultrasound probe at the tip, allowing detailed imaging of the upper gastrointestinal tract and surrounding organs.” Cleveland Clinic Journal of Medicine, Vol. 79, No. 3, p. 202, March 2012. The endosonoscope produces an ultrasound image from the interior of upper intestines, including the pancreas. The images produced are high resolution and provide valuable diagnostic data. This instrument is also advanced from the mouth into the upper intestines.
Magnetic resonance imaging (MRI) is a test involving magnetic waves that create highly detailed images of the abdomen. Magnetic resonance cholangiopancreatography (MRCP) is an MRI that focuses on the pancreas, liver and bile system.
See WebMD at http://www.webmd.com/digestive-disorders/picture-of-the-pancreas; National Cancer Institute: “Pancreatic and Biliary Tract Cancers”; Ohio State University Medical Center: “The Pancreas: Anatomy and Functions.”
The 12 month rule. One of the requirements for disability is that the impairment must last, or be expected to last, for 12 continuous months. Acute pancreatitis is debilitating and often requires hospitalization. However, disability benefits are not available for acute pancreatitis because this illness does not last 12 continues months.
The Listings. Listing 9.00 on endocrine disorders discusses pancreatitis. However, 9.00 does not contain specific criteria that establishes disability due to pancreatitis. Thus, the Listings do not provide for disability due to this impairment.
RFC. Because there is no Listing on pancreatitis, the legal issue in these cases is whether the pancreatitis, alone or in combination with other impairments, prevents the claimant from engaging in substantial gainful activity. The primary question is does the individual have the have the residual functional capacity to perform his/her past relevant work (Step 4) or other work (Step 5)?
The legal framework to analyze this type case is provided by SSR 16-3p. This Ruling sets forth a 2 step process for the evaluation of the severe, debilitating abdominal pain pancreatitis can cause. First, the claimant must have an impairment “shown by medically acceptable clinical and laboratory diagnostic techniques that could reasonably be expected to produce the individual’s pain or other symptoms”. Thus, one or more of the tests described above must document an abnormality in the pancreas.
Second, once the claimant has produced objective evidence of an impairment that could cause the subjective pain symptoms alleged, SSR 96-7p requires the Social Security Administration to evaluate how the alleged subjective symptoms affect the individual’s ability to perform work. Evidence that supports a finding of disabling pain includes:
1. Grossly abnormal results in the Amylase and Lipase tests.
2. Widespread calcifications shown by ERCP, MRCP, EUS or similar procedures.
3. One or more strictures in the pancreatic, biliary or other related ducts.
4. Diffuse pancreatic atrophy.
5. Frequent attacks of acute pancreatitis.
6. Numerous doctor visits in which the individual has sought medical treatment for abdominal pain.
7. Numerous medical procedures in which the individual has tried to get pain relief.
8. Powerful pain medications the individual is taking to manage abdominal pain, as well a history of trying numerous pain medications in the past.
Alcohol. One of the primary causes of pancreatitis is excessive use of alcohol. If any of the medical records attribute the individual’s pancreatitis to alcohol, I recommend the individual stop all use of alcohol, and have medical records showing the abdominal pain persists even in the absence of alcohol. Moreover, I believe the individual needs to be alcohol free for an extended period of time in order to overcome the 12 month rule, and to convince SSA the pancreatitis is not due to alcoholism.
In summary, my experience has been that it is difficult to get Social Security disability benefits for pancreatitis, primarily due to the 12 month rule. However, if pancreatitis persists for more than a year, while abstaining from alcohol, with documented pancreatic atrophy, disability benefits can be obtained.