Hep B Blog

Hepatitis B and Social Security Disability Benefits

Please welcome guest blogger, Ram Meyyappan, senior editor of Social Security Disability Help as he provides advice on applying for Social Security Disability Insurance or Supplemental Security  Income should your HBV prevent you from working.

Hepatitis B (HBV)  is often referred to as a “silent infection” because those chronically infected may have few or no symptoms, or may not be unaware of their infection for decades. However, over time, the risk of serious liver disease is certainly possible and symptoms can range from mild to severe.  Severe symptoms rarely occur with an acute HBV infection, but can have very serious outcomes.  If your condition is severe to the point that you can no longer continue to work, you may qualify for SSDI (Social Security Disability Insurance) or Supplemental Security Income (SSI) benefits from the Social Security Administration (SSA).

You can learn more about SSDI and SSI here

Hepatitis B and Qualifying for Benefits

When you submit an application for Social Security Disability benefits an adjudicator will review your file and compare your condition with a listing of conditions known as the SSA Blue Book (http://www.ssa.gov/disability/professionals/bluebook/). This Blue Book contains a listing of conditions and qualifying criteria that may qualify an individual for Social Security Disability benefits. Unfortunately Hepatitis B does not have its own listing in the Blue Book. You may still be able to qualify for disability benefits, however, if you are able to prove that you suffer from an associated condition (such as depression) that is included in the Blue Book. Some of the conditions that may qualify an individual for Social Security Disability benefits that are listed in the Blue Book and that may be associated with Hepatitis B include:

  • 5.05 Chronic liver disease
  • 5.08 Unexplained weight loss
  • 5.09 Liver transplant
  • 12.04 Affective disorders

If you are applying for disability benefits based on an associated condition that is listed in the Blue Book, you must provide medical documentation proving that your condition is severe enough to meet the criteria of that specific listing. For example, in the case of chronic liver disease, you must be able to prove that:

  • You are hemorrhaging from esophageal, gastric, or ectopic varices or from portal hypertensive gastropathy and it has resulted in hemodynamic instability and required hospitalization for transfusion of at least 2 units of blood; or
  • You suffer from ascites or hydrothorax that is not attributable to other causes, despite continuing treatment, as prescribed, and that the condition was present during at least 2 evaluations that were at least 60 days apart within a consecutive 6-month period; or
  • You suffer from spontaneous bacterial peritonitis with peritoneal fluid containing an absolute neutrophil count of at least 250 cells/mm3; or
  • You are suffering from end-stage liver disease with SSA CLD scores of 22 or greater.

If you are not suffering from a condition that is listed in the SSA’s Blue Book, you may still be able to qualify for disability benefits under what is known as a vocation allowance. In order to do this, however, you will have to prove that you are unable to perform any type of work activity whatsoever. This can be done through medical findings, laboratory reports and a residual functional capacity form. In the case of Hepatitis B, your condition must be very advanced and severe in order to qualify. Unless you are suffering from end-stage liver disease, you may have a hard time qualifying for benefits based on this condition.

Applying for Social Security Disability Benefits with Hepatitis B

To apply for Social Security Disability benefits, you can apply online at the SSA’s website (http://www.socialsecurity.gov/pgm/disability.htm) or apply in person at your local Social Security office. You will want to make sure that you have all of your medical evidence ready when you go to submit your application for benefits.

It can be very hard to prove that you qualify for Social Security Disability benefits when you are applying based on a condition that is not included in the SSA’s Blue Book. Because of this, you may want to consider retaining the services of a disability attorney prior to submitting your application. A disability lawyer can help you gather the evidence that you will need to prove your case. These attorneys will know which condition, if any, may qualify you under the SSA’s Blue Book or how to prove that you qualify based on a vocational allowance.

Article written by Ram Meyyappan, senior editor of Social Security Disability Help. Please refer to the Social Security Disability Benefits Help website for additional information. (www.disability-benefits-help.org)


Big Thank You to 2 Hep B Heroes


HBF would like to thank Hep B Heroes Nina and Richie Kahn. Richie recently ran the Delaware Marathon, and he and Nina used this opportunity to raise money for the Hepatitis B Foundation. Nina and Richie, thank you for your generous donation and your commitment to those living with hepatitis B!

“Back in 2008, I suffered a pretty horrific knee injury running the Philadelphia Half-Marathon. Several years, surgical procedures, and rehabilitation sessions later, I’m running again. So, I figured why not put my stamina to the test by running my first marathon while raising money for a wonderful cause?

On May 12th, I ran the Delaware Marathon to raise money for the Hepatitis B Foundation (HBF). For those of you who haven’t had the pleasure of working with HBF, the foundation is the only national non-profit organization solely dedicated to the global problem of hepatitis B. They are dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide. This commitment includes funding focused research, promoting disease awareness, supporting immunization and treatment initiatives, and serving as the primary source of information for patients and their families, the medical and scientific community, and the general public.

I finished the race in 3:59:23, 218th overall. More importantly, thanks to the generous support of friends, co-workers, and colleagues, we were able to raise nearly $3,000 for the Hepatitis B Foundation. Be sure to check out the Hepatitis B Foundation’s website to learn about the excellent work they do at http://hepb.org/.”



High HBV Viral Load Tied to Low Serum Vitamin D Levels

An interesting study published in Healio Hepatology:  “High HBV viral load tied to low serum vitamin D levels” discusses the relationship between the HBV viral load and vitamin D levels. In fact is shows seasonal fluctuations of HBV viral load associated with vitamin D levels. Vitamin D has been on the radar for years, but this interesting correlation between HBV virus flucuations and vitamin D levels warrants additional research to investigate how adequate vitamin D levels can positively impact treatment for those living with chronic HBV. Please refer to earlier blogs, Hepatitis B and Vitamin D and Got HBV? Adding Vitamin D to Your Diet for additional information.  As always, please talk to your doctor and have your serum vitamin D levels checked before making any drastic changes to your diet or supplements you may be taking. Don’t forget that vitamin D is the sunshine vitamin, so be sure to keep in mind the impact of the seasons on your levels. 

Patients with chronic hepatitis B who also were vitamin D deficient had significantly higher HBV DNA levels than patients with adequate vitamin D concentrations in a recent study.

In a retrospective study, researchers measured the serum levels of 25-hydroxyvitamin D (25OHD) in 203 treatment-naive patients with chronic hepatitis B seen between January 2009 and December 2012. Patients with 25OHD levels less than10 ng/mL were considered severely deficient, levels below 20 ng/mL were considered deficient, and levels of 20 ng/mL or greater were considered adequate. Patients’ samples were collected upon initial presentation, except 29 participants whose samples were taken at antiviral therapy initiation.

The mean 25OHD concentration for the cohort was 14.4 ng/mL. Forty-seven percent of participants were considered 25OHD deficient; 34% were severely deficient. 25OHD levels were similar between Caucasians (14.38 ng/mL) and non-Caucasians (14.59 ng/mL) (P=.7).

An inverse correlation was observed between levels of HBV DNA and 25OHD (P=.0003). Multivariate analysis indicated that HBV DNA was strongly predictive of low 25OHD levels (P=.000048), and vice versa (P=.0013). Patients with HBV DNA levels less than 2,000 IU/mL had 25OHD concentrations of 17 ng/mL; those with 2,000 IU/mL or higher had concentrations of 11 ng/mL (P<.00001 for difference). Participants who tested positive for hepatitis B e antigen (HBeAg; n=26) had significantly lower 25OHD levels than HBeAg-negative participants (P=.0013); this association was significant only under univariate analysis.

Investigators also noted fluctuations in HBV DNA and 25OHD levels according to season. Significantly lower HBV DNA levels were observed among samples taken during spring or summer than in autumn or winter (P=.01).

“The present study demonstrates a profound association between higher levels of HBV replication and low [25OHD] serum levels in chronic hepatitis B patients,” the researchers wrote. “At least in patients without advanced liver disease … HBV DNA viral load appears to be the strongest determinant of low [25OHD] serum levels. … Future studies to evaluate a therapeutic value of vitamin D and its analogs in HBV infection may be justified.”

HBV Journal Review – June 2013

HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

• U.S. Doctors Failing to Treat Patients Who Need Treatment
• Doctors Say Poor Training and Limited Resources Contribute to
Substandard Care • More Proof—Many Patients with Slightly Elevated ALTs
Have Fibrosis • Tenofovir Reduces Viral Load in HBeAg-Positive Patients
Faster than Entecavir • Researchers Find Tenofovir Does Not Damage
Kidneys • Tenofovir and Entecavir Highly Effective—If Taken as
Prescribed • Family History of Liver Cancer Boosts Cancer Risk to 15.8%
Among HBV-Infected • Vitamin D Deficiencies Found in People with High
Viral Loads • More Evidence Shows Breastfeeding Does Not Transmit HBV
Infection • Cesareans Do Not Reduce Mother-to-Child HBV Infection
• 2% of HBV Genotype D Adults Lose HBsAg Annually

HBV Journal Review

June 1, 2013, Vol 10, no 6
by Christine M. Kukka

U.S. Doctors Failing to Treat Patients Who Need Treatment
Fewer than 50% of patients infected with the hepatitis B virus (HBV) who need treatment get antivirals or interferon from their primary care doctors and fewer than 70% of patients who go to university liver clinics get appropriate treatment, according to research presented at the Digestive Disease Week medical conference held in Orlando in May.

Stanford University researchers conducted a real-life study to see what percentage of 1,976 hepatitis B patients treated in various clinical settings over four years received treatment. They used current medical guidelines when evaluating whether patients received appropriate treatment.

Continue reading about this and additional studies…