To meet Listing 5.02, you must document three blood transfusions of at least two units each within a 12-month period, with each event at least 30 days apart. Most denials occur because medical records fail to clearly link the transfusions to the required timeline. Getting your hospital records to explicitly confirm these transfusion details is the most critical step in winning your claim, and an attorney can help you gather this evidence.
What this listing covers
Gastrointestinal hemorrhaging is bleeding within your digestive tract, including your stomach, intestines, and esophagus. This condition can stem from various causes, including chronic liver disease, ulcers, or other severe digestive disorders. When this bleeding becomes significant, it poses a major threat to your health and requires immediate medical intervention.
The physical impact of chronic GI bleeding is often debilitating, leading to severe fatigue, anemia, and weakness. These symptoms make it difficult to maintain the physical stamina required for a standard work shift. You may find that the unpredictable nature of these bleeding episodes prevents you from performing basic tasks, such as standing for long periods or concentrating on work duties.
How SSA evaluates a claim under this listing
Under Listing 5.02, the SSA evaluates gastrointestinal hemorrhaging based on the frequency and intensity of medical intervention required. To meet the criteria, you must have documented evidence of three separate blood transfusions, with each transfusion consisting of at least two units of blood.
These transfusions must occur within a consecutive 12-month period and be spaced at least 30 days apart. If you meet these requirements, you are considered disabled for one year following your last documented transfusion. After that year, your condition is reevaluated to see if your residual impairment still prevents you from working. An attorney can help you organize your medical records to prove you meet these specific criteria.
Severe digestive bleeding? Check your disability benefits.
Check My BenefitsEvidence that strengthens a claim
Strong claims rely on detailed medical records that clearly document each transfusion event. You should provide hospital discharge summaries, operative reports, and laboratory findings that confirm the need for blood replacement. Imaging results, such as endoscopies or CT scans, are also essential to establish the underlying cause of the hemorrhaging.
Beyond hospital records, statements from your treating physicians regarding your ongoing symptoms and functional limitations are vital. Evidence of your treatment history, including failed conservative therapies or ongoing medication management, helps show the severity of your condition. A consistent record of your symptoms over time provides the most compelling case for your disability claim.
Why claims fail
Many claims are denied because the medical evidence fails to show the required frequency of transfusions. If your records do not clearly document three separate transfusion events at least 30 days apart, your condition may not meet the specific threshold of Listing 5.02. Additionally, incomplete hospital reports that omit the number of blood units administered often lead to unnecessary denials during the initial review process.
How an attorney helps
A disability attorney helps by ensuring your medical file is complete and directly aligned with the requirements of Listing 5.02. They can work with your medical providers to obtain clear documentation of your transfusion history and functional limitations. By organizing your evidence and preparing your case for potential appeals, an attorney helps you navigate the complexities of the SSA system and ensures your claim is presented as effectively as possible.
