Establishing a Claim for Social Security Disability Benefits for Interstitial Cystitis, Part I

When suffering from what can be the very debilitating effects of Interstitial Cystitis (IC), and when considering the need to apply for Social Security disability benefits, it’s very important to understand what the Social Security Administration (SSA) will require an individual to prove in order to qualify for benefits.  Understanding the process by which SSA will evaluate your claim can help make for a much smoother application process.   As we always recommend, however, it remains advisable to seek the assistance of  a Social Security disability lawyer who is familiar with Social Security’s rules and regulations and this guidance should not be viewed a substitute for the legal advice and assistance an attorney can provide with this process.  

SSA has provided some guidance as to how the condition called Interstitial Cystitis (IC) should be evaluated by way of promulgating Social Security Ruling 15-1P.   SSA has looked to the findings of the American Urological Associates (AUA) and the National Institute of Diabetes and Digestive and Kidney Diseases in coming up with a definition for the term Interstitial Cystitis that equates this condition with the medical terms “bladder pain syndrome” and “painful bladder syndrome.”  The UAU guidelines include a definition of IC as “[a]n unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable cause.”

As with any condition being evaluated by SSA, it is initially necessary to prove that one has a “medically determinable impairment” or “MDI” that remains severe and disabling such that an individual is likely to remain totally disabled from all forms of gainful employment for what will be, or has been, a year or longer. We will address this first step of the analysis in part 1 of this blog series.   In evaluating whether an MDI of IC exists, it is first important to understand that SSA will not take into account the words alone of a disability applicant that they are suffering from the symptoms that would be associated with the condition.  Rather, SSA does look for signs and/or findings that are typically associated with the condition in first determining whether there exists a “medically determinable impairment” (or “MDI”) of IC.  It is not unusual to see those who are diagnosed with IC as having had what are deemed to be prodomal or early predictors of the condition, having experienced episodic symptoms of urinary frequency, bladder pain, or pelvic pain for many years.  The UAU guidelines call for the diagnosis to be made after an examination by a physician along with laboratory testing that has included laboratory testing to rule out other causes of the symptomatology: such testing ordinarily includes urinalysis and urine culture, along with diagnostic testing that might include, for example, cystoscopy, biopsy of the bladder well and urethra, and bladder distention procedures.   Likewise, in evaluating whether a particular patient is being diagnosed as suffering from IC, it is noted that IC is frequently seen as a co-occurring condition in those individuals who have additionally been diagnosed as suffering from  fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, inflammatory bowel disease, vulvodynia, chronic headaches, Sjögren’s syndrome, endometriosis, or systemic lupus erythematosus.   Appropriate testing of the condition is noted to include recommendations by the physician for changes in diet, physical therapy which many times includes pelvic floor strengthening exercises, stress management, bladder distention, bladder instillations, medication management that includes medications such as Elmiron and dimethyl sulfoxide, antidepressants and narcotics, among other treatments and medications.

While understood that the symptoms and the frequency and severity of those symptoms may vary from one individual to another, the symptoms associated with the condition are noted to include not only chronic bladder and pelvic pain, pressure and discomfort but also may include urinary frequency to an extreme level, along with the need for frequent night time urination which can serve to interrupt one’s sleep.     Additional associated symptoms are noted to include “suprapubic tenderness on physical examination,” along with sexual dysfunction, sleep dysfunction and associated “chronic fatigue or tiredness.”

SSA will be looking for a longitudinal history from one’s treatment providers that provide ongoing corroborative findings of the above examination findings and symptomatology, from what are deemed to be “acceptable” medical sources: this would mean from licensed medical doctors or osteopathic physicians.  Thus, it does become somewhat concerning if the findings are taking place by way of examinations with solely nurse practitioners or physician assistants, whose opinions concerning ones diagnosed impairments may not be relied upon to establish one’s MDI’s.

In the second part of this blog, we will examine how SSA undertakes the second part of the analysis, which if whether the MDI of IC is severe enough to cause an individual to be found disabled under Social Security’s rules.   In the meantime, if you or someone you care about is suffering from the effects of Interstitial Cystitis or some other debilitating illness or injury, you should feel free to contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622 or by chatting with our online staff by clicking on the chat bar.  We’re happy to discuss with you your concerns.