Disorders of the gastrointestinal or (GI) system that result in a marked impairment, usually does 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.  These GI complications must be shown to last or reoccur over a period of twelve months as with any impairment.

General Evaluation

     When a gastrointestinal disorder has been established as a primary cause of claimant's inability to work, the resultant interference with nutrition must be evaluated.  The most common manifestation of GI nutritional interference is 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 supplied on the following page.   Always try to establish the claimant's normal weight and the number of pounds lost in a given period of time.  Severe loss in weight will have a profound effect on the claimant's activity level as would chronic severe abdominal pain or incontinence of 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, few would argue that for some claimants this situation would represent 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 the real world.

     The following table contains a list of heights and weights for both men and women who are suffering from significant GI disorders.  To use this table, first identify the claimant's normal weight.  Then identify the claimant's current height and 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 in table below.

     This table reflects the degree of malnutrition being suffered by the claimant due to any GI disorder.  If the claimant is at or less than the values shown on this weight per height scale, consider that claimant to be suffering from malnutrition.

    The following is a list of the most common GI disorders seen by SSA.  There will be a brief discussion of each disorder explaining supportive evidence and general symptoms.

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 body's ability to actually use the nutrition it is being given.

     Malnutrition  may be of 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, joint pain due to weight, 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 claimant is unable to take in nourishment.  The best supportive evidence for such disorders will come from esophagoscopy, upper GI x-ray test and the Berstein test.  If claimant is suffering from an impairment of 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 and antibiotic treatment has shown excellent results.  However, if the claimant has chronic repeated episodes of ulcers causing severe pain, weight loss or bleeding, this may result in an inability to perform work.  Ulcers are diagnosed on physical exam, upper GI x-ray test or endoscopy.  Look for a pattern of recurrence with this disorder.  If claimant has suffered two or more episodes in one year, you may be able to present a reasonable argument for disability.

Hernias:

     There are several types of hernias which are named for their locations.  Hernias cause pain and discomfort on exertion and are usually surgically repairable.  If claimant refuses surgical treatment of 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 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 with a combination of physical symptoms and x-ray studies of the lower bowel.  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 that 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 SSA.  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 which evaluate liver function.  Evaluate this and other liver disorders as to the overall effect on the claimant's ability to do and maintain physical activity.