Chronic liver disease (CLD) SSDI Claims in Kentucky

Medical criteria

SSA Blue Book listing

5.05 Chronic liver disease (CLD)

Listing criteria (20 CFR Appendix 1, Part A)

(see 5.00C) with A, B, C, D, E, F, or G: A. Hemorrhaging from esophageal, gastric, or ectopic varices, or from portal hypertensive gastropathy (see 5.00C2a), documented by imaging (see 5.00B3); resulting in 1 and 2: 1. Hemodynamic instability indicated by signs such as pallor (pale skin), diaphoresis (profuse perspiration), rapid pulse, low blood pressure, postural hypotension (pronounced fall in blood pressure when arising to an upright position from lying down), or syncope (fainting); and 2. Requiring hospitalization for transfusion of at least 2 units of blood. Consider under a disability for 1 year following the documented transfusion; after that, evaluate the residual impairment(s). OR B. Ascites or hydrothorax not attributable to other causes (see 5.00C2b), present on two evaluations within a consecutive 12-month period and at least 60 days apart. Each evaluation must document the ascites or hydrothorax by 1, 2, or 3: 1. Paracentesis; or 2. Thoracentesis; or 3. Imaging or physical examination with a or b: a. Serum albumin of 3.0 g/dL or less; or b. INR of at least 1.5. OR C. Spontaneous bacterial peritonitis (see 5.00C2c) documented by peritoneal fluid containing a neutrophil count of at least 250 cells/mm 3 . OR D. Hepatorenal syndrome (see 5.00C2d) documented by 1, 2, or 3: 1. Serum creatinine elevation of at least 2 mg/dL; or 2. Oliguria with 24-hour urine output less than 500 mL; or 3. Sodium retention with urine sodium less than 10 mEq per liter. OR E. Hepatopulmonary syndrome (see 5.00C2e) documented by 1 or 2: 1. Arterial P a O 2 measured by an ABG test, while at rest, breathing room air, less than or equal to: a. 60 mm Hg, at test sites less than 3,000 feet above sea level; or b. 55 mm Hg, at test sites from 3,000 through 6,000 feet above sea level; or c. 50 mm Hg, at test sites over 6,000 feet above sea level; or 2. Intrapulmonary arteriovenous shunting as shown by contrast-enhanced echocardiography or macroaggregated albumin lung perfusion scan. OR F. Hepatic encephalopathy (see 5.00C2f) with documentation of abnormal behavior, cognitive dysfunction, changes in mental status, or altered state of consciousness (for example, confusion, delirium, stupor, or coma), present on two evaluations within a consecutive 12-month period and at least 60 days apart and either 1 or 2: 1. History of transjugular intrahepatic portosystemic shunt (TIPS) or other surgical portosystemic shunt; or 2. One of the following on at least two evaluations at least 60 days apart within the same consecutive 12-month period as in F: a. Asterixis or other fluctuating physical neurological abnormalities; or b. EEG demonstrating triphasic slow wave activity; or c. Serum albumin of 3.0 g/dL or less; or d. INR of 1.5 or greater. OR G. Two SSA CLD scores (see 5.00C3) of at least 20 within a consecutive 12-month period and at least 60 days apart. Consider under a disability from at least the date of the first score.

Body system category

5.00 Digestive Disorders

Common denial reason

Chronic liver disease claims are often denied when bilirubin, INR, ascites, encephalopathy, or hospitalization history does not meet listing criteria.