Disorders of the gastrointestinal or (GI) system that result in a marked impairment usually do so because of interference with nutrition, inflammatory lesions or complications of the gastrointestinal disease.  Complications include such disorders as fistulas, abscesses or recurrent bowel obstructions. As with any other impairment, these gastrointestinal complications must be shown to last or reoccur over a period of twelve months.

General Evaluation

When a gastrointestinal disorder has been established as a primary cause of a claimant's inability to work, the resulting interference with nutrition must be evaluated.  The most common manifestation of GI nutritional interference is significant weight loss and physical weakness.  If the claimant has experienced significant weight loss due to any GI disorder, the degree of weight loss must be evaluated per weight tables provided by Social Security.  Try to establish the claimant's normal weight and the number of pounds lost in a given period of time.  Severe weight loss will have a profound effect on the claimant's activity level, as would chronic severe abdominal pain or incontinence of the bowel.

Surgical procedures of the gastrointestinal tract such as a colostomy or ileostomy should be evaluated as to the degree of inconvenience and psychological anxiety caused by these procedures.  A colostomy, for example, is a surgical procedure whereby a part of the claimant's bowel is brought to the surface of the abdomen.  The claimant must relieve himself of waste materials through this abdominal opening into an attached plastic bag.  Although this condition is not totally disabling in and of itself, most people would argue that this situation represents a real barrier to work activity.

Other GI problems such as the dumping syndrome should also be evaluated as to how it affects the claimant's ability to function in a normal work setting.  After certain types of GI surgeries such as gastric resection, the claimant must defecate numerous times a day.  Imagine trying to function effectively on the job if you were forced by a condition to visit the bathroom ten times a day.  There should be no doubt that this problem would greatly affect the claimant's performance on the job.  Do not hesitate to argue the effects of any GI disorder on the claimant's ability to function in a real world working environment.

In the Social Security Guide, section 20/11, there are a couple of height /weight tables for both males and females.  To use these tables, first identify the claimant's normal height to weight ratio.  Then identify the claimant's current height and weight to determine the degree of abnormal weight.  If the claimant has lost a significant amount of weight due to a GI disorder, simply compare the claimant's current height and weight to that shown for a normal individual of the same size. 

The following is a list of the most common gastrointestinal disorders seen by Social Security.  I'll provide a brief  discussion of each disorder listed below, explaining their symptoms and best supporting evidence.

Malnutrition
Diseases of the esophagus
Peptic ulcers (gastric or duodenal)
Hernias
Regional enteritis
Cirrhosis of the Liver
GI bleeding

 
Malnutrition

Malnutrition is a disorder of both food intake and uptake.  Intake denotes the amount of food eaten by the claimant.  Uptake refers to the claimant's digestive system’s ability to actually use the nutrition it is given.  Malnutrition may be a primary or secondary cause.  The primary cause of malnutrition is inappropriate dietary intake.  This can be either inadequate or excessive intake.  Secondary malnutrition arises from inappropriate digestion of food, poor food absorption from the stomach or intestines, malfunctioning metabolism or mechanical problems with food transport through the digestive tract.

Symptoms of over nutrition include extreme weight gain, weight bearing joint pain, decreased physical mobility, increased cardiac work, easy fatigability and a host of other problems associated with obesity.  Under nutrition is manifested by slow healing, weakness, excessive weight loss, decreased intellectual functioning, memory loss and brain damage in extreme cases.

Diseases of the esophagus

Disorders of the esophagus can cause mechanical problems with the transport of food from the mouth to the stomach.  The primary symptoms of these disorders are difficulty swallowing and chest pain.  These conditions can lead to early signs of malnutrition if a claimant is unable to take in nourishment.  The best supportive evidence for such disorders is an endoscopy and the old Berstein test.  If the claimant is suffering from an impairment of an esophageal origin, one of the above tests should be present in the claimant's medical records.

Peptic ulcers (gastric or duodenal)

Ulcers are a treatable disorder that does not usually result in a complete disability.  There is a current belief that ulcers are caused by bacteria because antibiotic treatment has shown excellent results.  However, if the claimant has chronic episodes of ulcers that cause severe pain, weight loss or bleeding, this may result in an inability to perform work.  Ulcers are diagnosed on physical exam and endoscopy.  Look for a pattern of recurrence with this disorder.  If the claimant has suffered two or more severe episodes in one year, you may be able to present a reasonable argument for disability.

Hernias

There are several types of hernias that are named for their locations.  Hernias cause pain and discomfort on exertion and are usually surgically repairable.  If a claimant refuses surgical treatment for a hernia, he is within his rights and should be evaluated as to how he functions with the disorder.  The claimant may be restricted to light to sedentary lifting levels if the condition warrants.   These conditions are usually diagnosed on physical examination.

Regional enteritis

This is an extremely painful inflammatory disorder of the small or large intestines.   This disorder causes chronic diarrhea associated with extreme abdominal pain, fever, loss of appetite and weight loss.  This disorder is usually diagnosed by a combination of physical symptoms and x-ray studies of the lower bowel (colonoscopy).  Regional enteritis can have a single episode without recurrence or it may last for years.  This condition can result in the surgical removal of the infected portion of the intestine, which may result in side effects like chronic pain and diarrhea.  Pain is an important factor in the evaluation of this disorder and may significantly reduce the claimant's ability to work.

Cirrhosis

Liver disorders such as cirrhosis are common impairments seen by Social Security disability.  This condition can be without symptoms until a progressive stage of the disease is reached.  The most common symptoms are generalized weakness, loss of appetite, malaise, weight loss and loss of sexual interest.  Cirrhosis is diagnosed via physical examination and laboratory tests that evaluate liver function.  When evaluating this and other liver disorders, look at the overall effect on the claimant’s ability to maintain physical activity.

If you address the issues as set forth in this report concerning claimants with severe GI disorders, you'll be able to extract enough supportive evidence to produce at least a fair argument for disability. 

There are several other important considerations when evaluating gastrointestinal disorders that are not discussed here.  For additional information about gastrointestinal disorders and how they are evaluated by Social Security, see full discussion link.