You will be found disabled by Social Security if your medical condition gives rise to symptoms that prevent you from reliably performing a job. IC claimants usually experience symptoms including:
- painful urination
- frequent need to urinate
- abdominal pain associated with physical activities
- poor sleep due to need to urinate at night
- poor concentration and cognitive decline associated with narcotic pain medications
Generally, there is no cure for IC and currently the only real treatment for this condition involves pain medications. If your medical record documents these and other symptoms at a level where your attendance and reliability at a job would be compromised, you are likely to be awarded benefits.
How do we Present a Winning Claim?
As discussed elsewhere on this web site, there are three arguments that a disability claimant can use to argue for a finding of disabled by a Social Security judge. There is no listing for interstitial cystitis, although we can argue that your condition equals other listing level pain conditions.
- Social Security ruling SSR-15-1p offers guidance to Social Security judges about how to analyze IC claims. Social Security rulings basically serve as official guidance to Social Security adjudicators and judges about how to analyze various issues that arise in disability claims. According to this ruling, the term IC should be defined broadly to describe “a complex genitourinary disorder involving recurring pain or discomfort in the bladder and pelvic region. ” Your doctor, in accordance with the American Urological Association, may describe your condition as “painful bladder syndrome” or bladder pain syndrome.
- Ruling SSR-15-1p appears to have broadened the definition of interstitial cystitis and therefore made it somewhat easier to qualify for disability based on this condition. This policy shift reflects what I am seeing in my practice – that judges are very receptive to approving well documented IC cases.
The grid rules most likely will not apply because IC impairments relate to pain as opposed to problems with the musculoskeletal system.
Usually the strongest argument we can present considers the numerous limitations on your capacity to work caused by your symptoms. In other words, we would argue that your functional capacity to work has been so reduced by your symptoms that you would not be a reliable employee even if asked to perform a simple, one or two step entry level job with a sit/stand option.
Presenting a Functional Capacity Argument in an interstitial cystitis case
A functional capacity argument is well suited to IC because the symptoms arising from this condition are very likely to impair reliability. For example, most IC patients need to use the restroom several times an hour and frequently experience urinary urgency, or the sensation that they need to urinate.
When these symptoms are considered in light of minimum work reliability standards, an IC patient would need multiple (2 to 4 per hour) unscheduled breaks of 5 to 7 minutes, every hour, and during the time that the patient is attempting to perform work duties, her attention and concentration would be limited by discomfort associated with feeling of urinary urgency.
Further, pain at a level which would interfere substantially with attention and concentration and with pace of work is likely to be present. If pain exists at a level 7 or 8 on a 10 point scale that is usually enough to preclude work functioning. Further, if pain and discomfort requires periods of lying down, that would interfere with work capacity as well.
- Social Security explains how judges should evaluate pain claims at Title 20 of the Code of Federal Regulations, at Section 404.1529 – you can review this section by clicking on the link.
What Evidence do you Need?
Ideally, your medical file should contain records of on-going visits with a urologist and/or pain management physician. Family doctor records are usually acceptable as well, assuming that the family doctor is actively treating the IC.
The most convincing medical records contain documentation that multiple pain medications and other therapies have been tried, and that they have provided minimal relief.
If your treating physician is willing to complete a functional capacity form detailing activity and reliability restrictions, your judge will usually give the conclusions set out in this form controlling weight.
Less Compelling Evidence
Usually, when a judge evaluates an IC case, he will try to determine if your IC results in occasional, mild symptoms, or frequent, severe symptoms. This is why medical records covering several years is especially helpful. There should be no evidence of malingering or drug seeking behavior and you should be compliant with your doctor’s recommendations.
Interstitial cystitis claims are usually given favorable consideration by Social Security judges. There is no cure for this condition and the only treatment usually offered involves strong pain medications. Most IC patients experience significant symptoms that cause reliability problems and if you have support from a treating physician – especially your urologist, you have a strong chance at winning a favorable decision.
Interstitial cystitis case study #1 – 44 year old female with long standing, chronic and severe interstitial cystitis. Her symptoms include severe pain, the need to urinate as many as 3 to 4 times per hour, fatigue and depression.