Can I Get Disability Benefits for Gastrointestinal Hemorrhaging?
- About Gastrointestinal Hemorrhaging and Disability
- How to Get Disability Benefits for Gastrointestinal Hemorrhaging by Meeting a Listing
- Residual Functional Capacity Assessment for Gastrointestinal Hemorrhaging
- Getting Your Doctor’s Medical Opinion About What You Can Still Do
If you have gastrointestinal hemorrhaging, Social Security disability benefits may be available. To determine whether you are disabled by your gastrointestinal hemorrhaging, the Social Security Administration first considers whether it is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. See How to Get Disability Benefits for Gastrointestinal Hemorrhaging by Meeting a Listing. If you meet or equal a listing because of your gastrointestinal hemorrhaging, you are considered disabled. If your gastrointestinal hemorrhaging is not severe enough to equal or meet a listing, the Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite the gastrointestinal hemorrhaging), to determine whether you qualify for disability benefits at Step 4 and Step 5 of the Sequential Evaluation Process.
The upper GI tract consists of the esophagus, stomach, and small intestine. Any hemorrhage from these locations is “upper GI bleeding.” Gastrointestinal hemorrhaging can result in hematemesis (vomiting of blood), melena (tarry stools), or hematochezia (bloody stools) and anemia. The major symptoms of anemia are a feeling of tiredness, easy fatigability with exertion, shortness of breath, and awareness of forceful heart beats (palpitations). See Residual Functional Capacity Assessment for Gastrointestinal Hemorrhaging.
Abnormalities that Can Cause Gastrointestinal Hemorrhaging
- Esophageal varices – Dilated and weakened areas of veins near the inner surface of the esophagus are probably the most common cause of upper GI bleeding seen by the SSA. Esophageal varices are caused by portal hypertension, or high blood pressure inside the venous system connecting the liver and GI tract. The esophageal veins connect to the portal system. The portal hypertension most often results from alcohol-associated liver damage. Esophageal varices are associated with about 10% of cases of upper GI bleeding, but studies vary considerably in reported percentages.
- Esophagitis – Esophageal inflammation contributing to the ease of bleeding is most frequent in alcoholics. Esophagitis is also commonly caused by reflux of stomach acid into the stomach, but gastroesophageal reflux disease (GERD) is much less likely to cause bleeding than alcohol abuse. In either event, esophagitis is a rare primary cause of bleeding.
- Esophageal ulcers – Ulcerations in the esophagus can erode into the superficial venous plexus and cause bleeding. A number of oral drugs, especially nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen, diclofenac, naproxen, and indomethacin can cause ulcers of the esophagus.
- Gastritis – Gastritis is an inflammation of the stomach’s inner surface. Alcoholic gastritis is the most common kind, and accounts for about 5% of cases of upper GI bleeding of all causes. Extremely ill patients, such as those with serious traumatic injuries or burns, have a tendency to develop stress-induced bleeding from multiple locations within the stomach. Major stress-related gastric bleeding not a common event, because its risk is understood by physicians and steps are taken to prevent it. When severe stress-related gastritis does occur, there is a high associated mortality because it is difficult to control bleeding from many small locations inside the stomach.
- Gastric ulcers – These lesions can bleed when they erode into an artery in stomach wall, and they are associated with about 15% of cases of upper GI bleeding. Gastric ulcers are more common in alcoholics and may be associated with alcoholic gastritis.
- Peptic ulcer disease (PUD) – PUD is the most common cause of upper GI bleeding; in both alcoholics and non-alcoholics it is the cause of about 20% of cases of upper GI bleeding. Most peptic ulcers can be healed if the patient 1) abstains from nonsteroidal anti-inflammatory drugs (see below); 2) takes prescribed medications to eradicate Helicobacter pylori bacteria in the stomach and block excess stomach acid secretion; and 3) abstains from heavy alcohol use.
- Tumors – Tumors such as carcinomas of the esophagus or stomach can be associated with arterial rupture and bleeding. Such tumors are more common in alcohol and tobacco product users.
- Drugs – Various drugs can increase the risk of upper GI bleeding. For example, anticoagulant drugs like warfarin (Coumadin) present a major bleeding risk. Nonsteroidal anti-inflammatory drugs of all kinds, such as aspirin, ibuprofen, diclofenac, naproxen, and indomethacin, can result in spontaneous serious bleeding without warning when taken on a chronic basis. In fact, NSAIDS are the major cause of upper GI bleeding from peptic ulcer disease. Moreover, an astounding 65% of cases of upper GI bleeding have been found to be associated with some type of NSAID. The over-the-counter availability of these drugs therefore presents a substantial hemorrhage risk when such pills are used on a regular basis.
- Blood disorders – Low platelet counts, such as with inherited or drug-induced thrombocytopenia can be associated with upper GI bleeding. Hereditary disorders of coagulation, such as hemophilia, may be associated with upper GI bleeding. The liver produces coagulation factors necessary for the clotting of blood, so liver disease—such as alcoholic cirrhosis—results in decreased ability of the coagulation system to stop bleeding by the formation of clots.
- Vascular malformations – Disorders associated with the formation of abnormal blood vessels with a tendency to bleed, such as hereditary telangiectasia or vascular malformations associated with aging, may be associated with upper GI bleeding.
- Mallory-Weiss tear – Vomiting blood (hematemesis) can be caused by tearing of the lower part of the esophagus where it joins the stomach, and accounts for about 5 – 15% of cases of upper GI bleeding. The tearing is caused by vomiting, coughing, or retching. Most (80 – 90%) will stop bleeding without specific intervention.