Monthly Archives

October 2013

Complex regional pain

By Applying for disability benefits when you have:

Can I Get Social Security Disability Benefits for Reflex Sympathetic Dystrophy Syndrome / Complex Regional Pain Syndrome?

  • How Does the Social Security Administration Decide if I Qualify for Disability Benefits for RSDS / CRPS?
  • About RSDS / CRPS and Disability
  • Winning Social Security Disability Benefits for RSDS / CRPS by Meeting a Listing
  • Residual Functional Capacity Assessment for RSDS / CRPS
  • Getting Your Doctor’s Opinion About What You Can Still Do

How Does the Social Security Administration Decide if I Qualify for Disability Benefits for RSDS / CRPS?

If you have reflex sympathetic dystrophy syndrome, Social Security disability benefits may be available to you. To determine whether you are disabled by your reflex sympathetic dystrophy syndrome (also called complex regional pain syndrome), the Social Security Administration will consider whether your condition qualifies as a severe medically determinable impairment at Step 2 of the Sequential Evaluation Process. See RSDS / CRPS as a Medically Determinable Severe Impairment. If your reflex sympathetic dystrophy/complex regional pain syndrome qualifies at Step 2, the Social Security Administration next considers whether your condition is severe enough to equal a listing atStep 3 of the Sequential Evaluation Process. See Winning Social Security Disability Benefits for RSDS / CRPS by Meeting a Listing.

If your reflex sympathetic dystrophy/complex regional pain syndrome is not severe enough to equal a listing, the Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite your condition), to determine whether you qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process. See Residual Functional Capacity Assessment for RSDS / CRPS.

About RSDS / CRPS and Disability

RSDS stands for reflex sympathetic dystrophy syndrome. CRPS stands for complex regional pain syndrome. RSDS and CRPS are two names for the same condition. RSDS / CRPS is a chronic, progressive neurological syndrome, characterized by severe pain, swelling, and changes in the skin.

The National Institute of Neurological Disorders and Stroke (NINDS) has defined RSDS as “a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems.”

RSDS usually affects one of the extremities (arms, legs, hands, or feet). The primary symptom is intense, continuous pain. Other symptoms include:

  • Increased skin sensitivity.
  • Skin temperature changes (warmer or cooler than opposing extremity).
  • Skin color changes (blotchy, purple, pale, red).
  • Skin texture changes (shiny, thin, sweaty).
  • Changes in nail and hair growth patterns.
  • Stiffness and swelling in affected joints.
  • Decreased ability to move affected extremity.

The cause of RSDS/CPRS is unknown. Sometimes the syndrome is precipitated by injury and surgery, but some cases have no demonstrable injury to the original site.

RSDS / CRPS as a Medically Determinable Severe Impairment

You must have a medically determinable impairment that is severe to satisfy Step 2 of the Sequential Evaluation Process. The Social Security Administration has issued a ruling that focuses on proof that RSDS / CRPS is a medically determinable impairment. Below are some pertinent excerpts from that ruling.

Description of RSDS / CRPS

RSDS / CRPS is a chronic pain syndrome most often resulting from trauma to a single extremity. It can also result from diseases, surgery, or injury affecting other parts of the body. Even a minor injury can trigger RSDS / CRPS. The most common acute clinical manifestations include complaints of intense pain and findings indicative of autonomic dysfunction at the site of the precipitating trauma. Later, spontaneously occurring pain may be associated with abnormalities in the affected region involving the skin, subcutaneous tissue, and bone. It is characteristic of this syndrome that the degree of pain reported is out of proportion to the severity of the injury sustained by the individual. When left untreated, the signs and symptoms of the disorder may worsen over time.

Although the pathogenesis of this disorder (the precipitating mechanism(s) of the signs and symptoms characteristic of RSDS / CRPS) has not been defined, dysfunction of the sympathetic nervous system has been strongly implicated.

The sympathetic nervous system regulates the body’s involuntary physiological responses to stressful stimuli. Sympathetic stimulation results in physiological changes that prepare the body to respond to a stressful stimulus by “fight or flight.” The so-called “fight or flight” response is characterized by constriction of peripheral vasculature (blood vessels supplying skin), increase in heart rate and sweating, dilatation of bronchial tubes, dilatation of pupils, increase in level of alertness, and constriction of sphincter musculature.

Abnormal sympathetic nervous system function may produce inappropriate or exaggerated neural signals that may be misinterpreted as pain. In addition, abnormal sympathetic stimulation may produce changes in blood vessels, skin, musculature and bone. Early recognition of the syndrome and prompt treatment, ideally within 3 months of the first symptoms, provides the greatest opportunity for effective recovery.

How Is RSDS / CRPS Identified as a Medically Determinable Impairment?

For purposes of Social Security disability evaluation, RSDS/CRPS can be established in the presence of persistent complaints of pain that are typically out of proportion to the severity of any documented precipitant and one or more of the following clinically documented signs in the affected region at any time following the documented precipitant:

Swelling;

Autonomic instability–seen as changes in skin color or texture, changes in sweating (decreased or excessive sweating), changes in skin temperature, and abnormal pilomotor erection (gooseflesh);

Abnormal hair or nail growth (growth can be either too slow or too fast);

Osteoporosis; or

Involuntary movements of the affected region of the initial injury.

When longitudinal treatment records document persistent limiting pain in an area where one or more of these abnormal signs has been documented at some point in time since the date of the precipitating injury, disability adjudicators can reliably determine that RSDS / CRPS is present and constitutes a medically determinable impairment.

It may be noted in the treatment records that these signs are not present continuously, or the signs may be present at one examination and not appear at another. Transient findings are characteristic of RSDS / CRPS, and do not affect a finding that a medically determinable impairment is present.

Winning Social Security Disability Benefits for RSDS / CRPS by Equaling a Listing

To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration considers whether your impairment is severe enough to meet or a listing. The Social Security Administration has developed rules called Listing of Impairmentsfor most common impairments. The listing for a particular impairment describes a degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work. If your impairment is severe enough to meet or equal a listing, you will be considered disabled.

The Social Security Administration has no listing for RSDS / CRPS. Since RSDS / CRPS is not a listed impairment, you cannot be found to meet a listed impairment based on your RSDS/ CRPS alone. However, the specific findings in your case should be compared to any pertinent listing to determine whether “medical equivalence” may exist. In other words, you may be entitled to Social Security disability benefits if the severity of your condition equals an existing listing for a different impairment.

If you have psychological problems related to RSDS / CRPS, they should be evaluated under the mental disorders listings. The Social Security Administration should consider whether your impairments meet or equal the severity of a mental listing. See Can I Get Social Security Disability Benefits for Depression, Bipolar Disorder, or Mania? and Can I Get Social Security Disability Benefits for Anxiety, Phobias, Panic Attacks, Obsessive Compulsive Disorder, or PTSD?

Continue to Residual Functional Capacity Assessment for Complex Regional Pain Syndrome.

Congestive heart failure

By Applying for disability benefits when you have:

Can I Get Social Security Disability Benefits for Congestive (Chronic) Heart Failure?

How Does the Social Security Administration Decide if I Qualify for Disability Benefits for Congestive Heart Failure?

If you have congestive heart failure, Social Security disability benefits may be available. Congestive heart failure (CHF) is called chronic heart failure by the Social Security Administration. To determine whether you are disabled by CHF, the Social Security Administration first considers whether your heart failure is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. See Winning Social Security Disability Benefits for Congestive Heart Failure by Meeting a Listing. If you meet or equal a listing because of CHF, you are considered disabled.

If your chronic heart failure 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 your heart disease), to determine whether you qualify for disability benefits at Step 4 and Step 5 of the Sequential Evaluation Process. See Residual Functional Capacity Assessment for Congestive Heart Failure.

About Congestive Heart Failure and Disability

The Cardiovascular System

Before discussing heart failure, a brief description of the cardiovascular system is needed. The heart is normally a four-chambered muscle situated behind and to the left of the sternum (breast bone). The upper chambers are the left atrium and right atrium. The lower chambers are the left and right ventricles. The ventricles are much larger than the atria (see Figure 1 below).

Anterior view of the heart

Figure 1: An anterior view of the heart, featuring the atria, ventricles, and arteries.

Oxygen depleted blood from the veins returns to the heart from the body’s tissues. It enters the right atrium and flows through the tricuspid valve into the right ventricle. The right ventricle pumps blood through the pulmonary valve and into the pulmonary arteries for re-oxygenation by the lungs.

Oxygenated blood from the lungs returns to the left atrium of the heart by pulmonary veins and passes through the mitral valve into the left ventricle. From the left ventricle, newly oxygenated blood is ejected through the aortic valve into the aorta, which is the parent artery of all of the body’s other arteries (see Figure 2 below).

The heart during contraction

Figure 2: The heart during contraction.

The arterial system of the body that receives blood pumped out of the left ventricle is known as the systemic circulation. The blood moving from the right ventricle through the lungs is called the pulmonary circulation. The valves are important because they open only in one direction, so that blood flow always moves the right way when the heart contracts.

What Is Congestive (Chronic) Heart Failure?

Congestive heart failure, called chronic heart failure by the Social Security Administration, is the inability of the heart to pump enough oxygenated blood to the body tissues (see Figure 3 below). Congestive or chronic heart failure (CHF) affects about 5 million people in the U.S., and is increasing due to the aging of the population.

The heart’s ability to pump blood may be impaired by a variety of causes including myocardial infarction (heart attack), ischemic heart disease (decreased blood flow to heart muscle, usually as a result of coronary artery disease), and cardiomyopathy. The failure of the ventricles to pump blood efficiently results in blood accumulating in the heart, and enlargement of the ventricles.

Arteries and veins in the human body

Figure 3: The heart pumps blood through an immense network of veins and arteries.

Right Heart Failure

Failure of the right ventricle is known as right heart failure. In right-sided failure, there tends to be congestion (fluid accumulation) in organs such as the liver and peripheral edema (swelling) in the feet, because of pressure transmitted back through the venous system. Cor pulmonale—heart disease caused by lung disease—is the main cause of right-sided failure.

Left Heart Failure

Failure of the left ventricle is known as left heart failure. In left-sided failure, pulmonary edema is expected because of increased pressures transmitted back to the pulmonary vascular system.

Ischemic heart disease affecting the left ventricle is usually responsible for left-sided failure. However, the two sides of the heart do not operate in isolation: failure on one side will be associated with failure of the other side, so there are no abnormal findings that are characteristic of only right or left types of heart failure. See Can I Get Social Security Disability Benefits for Ischemic Heart Disease?

Systolic Failure

Predominant systolic dysfunction or systolic failure is the inability of the heart to contract normally and expel sufficient blood. It is characterized by an enlarged, poorly contracting left ventricle and reduced ejection fraction. Ejection fraction (EF) is the percentage of the blood in the ventricle pumped out with each contraction. Most of the claims for disability benefits seen by the Social Security Administration involve systolic heart failure.

Diastolic Failure

Predominant diastolic dysfunction or diastolic failure is the inability of the heart to relax and fill normally. It is characterized by a thickened ventricular muscle, poor ability of the left ventricle to distend (stretch), increased ventricular filling pressure, and a normal or increased EF. Twenty to 40% of heart failure is due to diastolic dysfunction. Some people have both systolic and diastolic dysfunction.

Symptoms and Signs of Congestive Heart Failure

To establish that you have chronic heart failure for the purpose of receiving Social Security disability benefits, your medical history and physical examination should describe characteristic symptoms and signs of pulmonary or systemic congestion or of limited cardiac output. And these signs and symptoms should be associated with the abnormal findings on appropriate medically acceptable imaging. Factors that cause heart failure, but that can be improved or eliminated, such as heart failure induced by high altitude, arrhythmias, and dietary sodium overload, would not be expected to result in chronic failure.

Symptoms of congestion or of limited cardiac output include:

      • Easy fatigue.
      • Weakness.
      • Shortness of breath (dyspnea) on exertion.
      • Coughing.
      • Chest discomfort at rest or with activity.
      • Shortness of breath on lying flat (orthopnea).
      • Sudden shortness of breath while sleeping (paroxysmal nocturnal dyspnea (PND)).
      • Cardiac arrhythmias resulting in palpitations, lightheadedness, or fainting.

Signs of congestion may include:

      • An enlarged liver (hepatomegaly).
      • Fluid accumulation in the abdomen (ascites).
      • Increased jugular vein distention or pressure.
      • Rales (abnormal breath sounds heard with a stethoscope listening over the lungs, especially the bases of the lungs).
      • Peripheral edema (fluid retention and swelling in the extremities).
      • Rapid weight gain.

However, these signs need not be found on all examinations because fluid retention may be controlled by treatment.

Prognosis and Mortality in Heart Failure

Available statistics regarding mortality vary, but there is general agreement that, at the time of diagnosis, CHF has a 5-year mortality in the 35-50% range. This very general number shows what a serious diagnosis is involved, but there are great differences in individual mortalities that are determined by age, sex, race, cause of failure, as well as the nature and severity of other medical disorders. For example, mortality is higher for African-Americans than Caucasians, higher for males than females, higher for age than youth, higher in diabetics, and higher in those with hypertension.

Continue to Winning Social Security Disability Benefits for Congestive Heart Failure by Meeting a Listing.

Chronic fatigue

By Applying for disability benefits when you have:

Can I Get Social Security Disability Benefits for Chronic Fatigue Syndrome?

    • How Does the Social Security Administration Decide if I Qualify for Disability Benefits for Chronic Fatigue Syndrome?
    • About Chronic Fatigue and Disability
    • Winning Social Security Disability Benefits for Chronic Fatigue Syndrome by Equaling a Listing
    • Residual Functional Capacity Assessment for Chronic Fatigue Syndrome
    • Getting Your Doctor’s Opinion About What You Can Still Do

How Does the Social Security Administration Decide if I Qualify for Disability Benefits for Chronic Fatigue Syndrome?

If you have chronic fatigue, Social Security disability benefits may be available to you. To determine whether you are disabled by chronic fatigue, the Social Security Administration will consider whether your chronic fatigue qualifies as a severe medically determinable impairment at Step 2 of the Sequential Evaluation Process. See Chronic Fatigue Syndrome as a Medically Determinable Severe Impairment.If your chronic fatigue qualifies at Step 2, the Social Security Administration considers whether your chronic fatigue is severe enough to equal a listing atStep 3 of th eSequential Evaluation Process. See Winning Social Security Disability Benefits for Chronic Fatigue by Equaling a Listing.

If your chronic fatigue is not severe enough to equal a listing, the Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite your chronic fatigue), to determine whether you qualify for benefits at Step 4 andStep 5 of the Sequential Evaluation Process. See Residual Functional Capacity Assessment for Chronic Fatigue Syndrome.

About Chronic Fatigue and Disability

Chronic fatigue is also known as chronic fatigue syndrome (CFS) and immune dysfunction syndrome (CFIDS). It is a very misunderstood disorder, and has been the center of much debate. It has no known proven causes, no definite tests to prove its validity, and no known cures.

It is a complex disorder that is has many signs and symptoms. The most common symptom is extreme fatigue for no reason that is not improved by rest and may get worse with light physical or mental activity.

Over one million people in the United States have been diagnosed with chronic fatigue.

The general pattern is that the person experiences “flu-like” symptoms that do not go away. This usually occurs during a period of great stress in the person’s life. When it first occurs, people think it will pass like the flu.

Chronic Fatigue Syndrome as a Medically Determinable Severe Impairment

The Center for Disease Control Definition

You must have a medically determinable impairment that is severe to satisfy Step 2 of the Sequential Evaluation Process.The Social Security Administration has ruled that chronic fatigue can constitute a medically determinable impairment if a diagnosis is made under the current Center for Disease Control (CDC) diagnostic criteria for chronic fatigue.

The Center for Disease Control defines chronic fatigue as the presence of clinically evaluated, persistent or relapsing chronic fatigue that is new or has a definite beginning (that is, it has not been lifelong) that cannot be explained by any other diagnosed physical or mental disorder, or the result of ongoing exertion. Chronic fatigue is not substantially alleviated by rest, and it results in substantial reduction of previous levels of occupational, educational, social, or personal activities.

Additionally, the current definition of chronic fatigue requires four or more of the following symptoms, all of which must have persisted or recurred during 6 or more consecutive months of illness and must not have pre-dated the fatigue:

      • Self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities.
      • Sore throat.
      • Tender cervical or axillary lymph nodes.
      • Muscle pain.
      • Multi-joint pain without joint swelling or redness.
      • Headaches of a new type, pattern, or severity.
      • Unrefreshing sleep.
      • Postexertional malaise lasting more than 24 hours.

Chronic fatigue syndrome usually must be present for at least six months before it is diagnosed and can last for years.

Medical Signs or Laboratory Findings

In addition to the Center for Disease Control criteria, the Social Security Administration requires the presence of medical signs or laboratory findings to demonstrate that a claimant with chronic fatigue syndrome has a medically determinable impairment.

However, no specific etiology or pathology has been established for chronic fatigue. Therefore, any possible signs and laboratory findings to establish the existence of a medically determinable impairment are only examples and are not all-inclusive.

For purposes of Social Security disability evaluation, one or more of the following medical signs clinically documented over a period of at least 6 consecutive months establishes the existence of a medically determinable impairment for individuals with CFS:

      • Palpably swollen or tender lymph nodes on physical examination.
      • Nonexudative pharyngitis.
      • Persistent, reproducible muscle tenderness on repeated examinations, including the presence of positive tender points.
      • Any other medical signs that are consistent with medically accepted clinical practice and are consistent with the other evidence in the case record.

Therefore, the following laboratory findings establish the existence of a medically determinable impairment in individuals with chronic fatigue:

      • An elevated antibody titer to Epstein-Barr virus (EBV) capsid antigen equal to or greater than 1:5120, or early antigen equal to or greater than 1:640.
      • An abnormal magnetic resonance imaging (MRI) brain scan.
      • Neurally mediated hypotension as shown by tilt table testing or another clinically accepted form of testing.
      • Any other laboratory findings that are consistent with medically accepted clinical practice and are consistent with the other evidence in the case record; for example, an abnormal exercise stress test or abnormal sleep studies, appropriately evaluated and consistent with the other evidence in the case record.

Individuals with chronic fatigue may also exhibit medical signs, such as anxiety or depression, indicative of the existence of a mental disorder. When such medical signs are present and appropriately documented, the existence of a medically determinable impairment is established.

Winning Social Security Disability Benefits for Chronic Fatigue Syndrome by Equaling a Listing

To determine whether you are disabled at Step 3 of the Sequential Evaluation Process,the Social Security Administration usually considers whether your impairment is severe enough to meet or a listing. The Social Security Administration has developed rules called Listing of Impairmentsfor most common impairments. The listing for a particular impairment describes a degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work. If your impairment is severe enough to meet or equal the listing, you will be considered disabled.

The Social Security Administration has no listing for chronic fatigue syndrome. Since CFS is not a listed impairment, you cannot be cannot be found to meet a listed impairment based on your CFS alone. However, the specific findings in your case should be compared to any pertinent listing to determine whether “medical equivalence” may exist. In other words, you may be entitled to Social Security disability benefits if the severity of your condition equals an existing listing for a different impairment.

If you have psychological problems related to CFS, they should be evaluated under the mental disorders listings. The Social Security Administration should consider whether your impairments meet or equal the severity of a mental listing. See Can I Get Social Security Disability Benefits for Depression, Bipolar Disorder, or Mania? and Can I Get Social Security Disability Benefits for Anxiety, Phobias, Panic Attacks, Obsessive Compulsive Disorder, or PTSD?

Continue to Residual Functional Capacity Assessment for Chronic Fatigue Syndrome.

Crohn’s disease

By Applying for disability benefits when you have:

Can I Get Social Security Disability Benefits for Crohn’s Disease?

  • How Does the Social Security Administration Decide if I Qualify for Disability Benefits for Crohn’s Disease?
  • About Crohn’s Disease and Disability
  • Winning Social Security Disability Benefits for Crohn’s Disease by Meeting a Listing
  • Residual Functional Capacity Assessment for Crohn’s Disease
  • Getting Your Doctor’s Medical Opinion About What You Can Still Do

How Does the Social Security Administration Decide if I Qualify for Disability Benefits for Crohn’s Disease?

If you have Crohn’s disease, Social Security disability benefits may be available. To determine whether you are disabled by Crohn’s disease, Social Security Administration first considers whether your Crohn’s disease is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. See Winning Social Security Disability Benefits for Crohn’s Disease by Meeting a Listing. If you meet or equal a listing because of Crohn’s disease, you are considered disabled.

If your Crohn’s disease is not severe enough to equal or meet a listing, Social Security Administration must assess your residual functional capacity (RFC)(the work you can still do, despite your illness), to determine whether you qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process. See Residual Functional Capacity Assessment for Crohn’s Disease.

About Crohn’s Disease and Disability

What Is Crohn’s Disease?

Crohn’s disease is a chronic, inflammatory disease of the gastrointestinal tract (see Figure 1 below) that produces symptoms such as severe abdominal pain, cramping, nausea, fatigue, diarrhea, and insomnia.

With Crohn’s disease, the body’s immune system attacks the gastrointestinal tract, causing inflammation.

Other Symptoms

Crohn’s disease may involve the entire alimentary tract from the mouth to the anus.

In addition to the common symptoms of abdominal pain, cramping, nausea, fatigue, diarrhea, and insomnia, you may also experience fecal incontinence, rectal bleeding, fever, vomiting, arthralgia (joint pain), abdominal tenderness, palpable abdominal mass (usually inflamed loops of bowel) and perineal disease. You may also have weight loss or other indications of malnutrition.

The human intestinal tract

Figure 1: The human gastrointestinal tract.

When Does it Occur?

Crohn’s disease can occur at any age. However, it is most common for it to begin either when you are in your teens and twenties or between your fifties and seventies.

Cause and Treatment

The cause of Crohn’s disease is unknown, and it is rarely curable. Recurrence may be a lifelong problem even after surgery. Treatment is usually limited to controlling the symptoms.

Related Conditions

Crohn’s disease is a form of inflammatory bowel disease (IBD), which includes both Crohn’s disease and ulcerative colitis. The various forms of inflammatory bowel disease share similar symptoms and treatments.

Crohn’s disease affects the small intestine. Ulcerative colitis affects the large intestine (the colon).

Winning Social Security Disability Benefits for Crohn’s Disease 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 Crohn’s disease is severe enough to meet or equal the Crohn’s disease listing. The Social Security Administration has developed rules called Listing of Impairmentsfor 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. You will be considered disabled if your Crohn’s disease is severe enough to meet or equal the Crohn’s disease listing.

The listing for Crohn’s disease is 5.06, which has two parts: A and B. You will be disabled if you meet either part.

Meeting Social Security Administration Listing 5.06A for Crohn’s Disease

A Social Security disability claimant with Crohn’s disease meets listing 5.06A and is disabled if he or she has had sufficient narrowing of the intestine.

Listing 5.06A requires two hospitalizations for bowel obstruction at least 60 days apart within a six-month period. This hospitalization requirement means that only the most severe chronic cases qualify under listing 5.06A.

If the complications are eliminated by surgery, then you do not qualify under part A. In many instances, surgery does produce long-term benefit when combined with the proper diet and medication.

Meeting Social Security Administration Listing 5.06B for Crohn’s Disease

A Social Security disability claimant with Crohn’s disease meets listing 5.06(B) and is disabled if he or she has two of the following within a consecutive 6-month period while being treated:

  • 5.06B.1 Anemia with hemoglobin of less than 10.0 g/dL.
  • 5.06B.2. Serum albumin of 3.0 g/dL or less.
  • 5.06B.3. Clinically documented tender abdominal mass palpable on physical examination with abdominal pain or cramping that is not completely controlled by prescribed narcotic medication.
  • 5.06B.4. Perineal disease with a draining abscess or fistula, with pain that is not completely controlled by prescribed narcotic medication.
  • 5.06B.5. Involuntary weight loss of at least 10 percent from baseline.
  • 5.06B.6. Need for supplemental daily enteral nutrition via a gastrostomy or daily parenteral nutrition via a central venous catheter.

Continue to Residual Functional Capacity Assessment for Crohn’s Disease.