How to Get Disability Benefits for Gastrointestinal Hemorrhaging by Meeting a Listing
To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will consider whether your gastrointestinal hemorrhaging is severe enough to meet or equal the gastrointestinal hemorrhaging listing. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that Social Security Administration presumes would prevent a person from performing substantial work. If your gastrointestinal hemorrhaging is severe enough to meet or equal the listing, you will be considered disabled.
The listing for gastrointestinal hemorrhaging is listing 5.02. To satisfy the listing, you must demonstrate gastrointestinal hemorrhaging from any cause, requiring blood transfusion (with or without hospitalization) of at least 2 units of blood per transfusion, and occurring at least three times during a consecutive 6-month period. The transfusions must be at least 30 days apart within the 6-month period.
Meeting Social Security Administration Listing 5.02 for Gastrointestinal Hemorrhaging
- The bleeding can be anywhere in the gastrointestinal system (esophagus, stomach, small intestine, large intestine, rectum).
- The cause of the bleeding is irrelevant.
- Hospitalization or non-hospitalization is irrelevant.
- Transfusions are required to count as an episode of listing-level severity bleeding, and must consist of at least 2 units of blood. (No distinction is made between whole blood and packed red cells, nor would there be a reason for such distinction in this context.)
- Bleeding frequency must be at least 3 times within a consecutive 6-month period.
- Transfusions must be separated by at least 30 days from any other episode in the 6-month period described in (5).
- Disabled status is irrevocable for at least 12 months from the last documented transfusion, then re-evaluation done.
The listing may appear to leave no room for medical judgment, but that is not necessarily the case. The possibility of equivalency through a combination of impairments must always be borne in mind even if this listing alone is not satisfied. For example, a co-existing cardiac or pulmonary disorder could become disabling when combined with bleeding that in itself does not meet the listing—particularly if there is a combination of such impairments where two or more independently limit the person to no more than sedentary work.
It is entirely possible that listing-level severity could be satisfied for the required 6 consecutive months, then a previously unknown source of GI bleeding be detected and definitive surgery performed long before the basic disability requirement of 12 months is satisfied. In this case, the SSA might argue denial on that basis—prediction of failure to satisfy the fundamental 12-month duration requirement. For example, a claimant has a vascular malformation in the large intestine. For some reason (it doesn’t matter why), the lesion is located in the eighth month from the initial bleeding episode and two months after the last transfusion. Surgery is performed by resection of the abnormal area resulting in what the surgeon thinks is a definitive cure.
Although this argument might be valid medically, it would appear that by failure of the listing to take into account such circumstances by an unqualified statement that a year of benefits be granted from the date of the last transfusion means that such a claim should not be denied. Based on the history of the way SSA writes medical regulations, addresses duration in other listings, and in this instance intentionally leaving out the phraseology “…and expected to last 12 months,” one can only conclude that denial based on presumed future failure to satisfy a basic 12-month duration would not be appropriate in the example given. In other words, once the 6 months is satisfied, then 12 months must be presumed even if the practical evidence says otherwise (in reality, it doesn’t usually take another 6 months to recover from definitive surgery). The case might be different if failure to last 12 months has already been demonstrated by the time of application. In that event, would a closed period that shows definitively (rather than being presumed) that 12 months was not satisfied still be possible for allowance under this listing? Possibly not, but it is clear that this type of situation is one that adjudicators may approach with inconsistency.
Hematocrit values are no longer a part of the listing, because the SSA recognizes that the effect of specific hematocrits is dependent on age and other factors. However, that does not make hematocrits irrelevant for determination of RFC.