Common Variable Immunodeficiency (abbreviated as CVID) is a genetic disorder of the immune system in which the body does not produce anti-bodies in response to infections. As a result, patients with CVID are extremely susceptible to infections, and often do not respond well to vaccines. Patients are more susceptible to autoimmune conditions such as lupus and are at increase risk for cancers such as lymphoma
According to the National Instutites for Health, about 20% of CVID patients experience gastrointestinal symptoms, including malabsorbtion of nutrients, chronic gut inflammation and small intestine bacterial overgrowth. These patients are likely to experience nausea and chronic diarrhea, somes developing Crohn's disease.
Patients with CVID are usually treated with infusions of immunoglobulin to boost their immune response.
Winning Strategies in CVID Cases
Meeting or Equaling a Listing
At this point there is no listing specifically for CVID. However, several of the listings at 14.00 (Immune System Disorder) describe symptoms commonly expereinced by CVID patients, thus we can argue a claimant's condition equals a listing. For example:
Listing 14.07 – Immune Deficiency Disorders, Excluding HIV Infection describes infections resistant to treatment or require hospitalization or intravenous treatment three or more times in a 12-month period. Listing 14.07 can also be met by documenting a condition that includes repeated manifestations of an immune deficiency disorder, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
1. Limitation of activities of daily living.
2. Limitation in maintaining social functioning.
3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.
Listing 14.08 describes HIV infections but includes references to chronic diarrhea, suggesting that SSA recognizes the functional implications of uncontrollable diarrhea in terms of one's ability to absorb nutrients and to sustain energy.
Listing 5.06 describes Inflammatory Bowel Disease and obstructions or damage to the colon, and/or involuntary weight loss due to malabsorption.
Listing 5.08 describes weight loss due to any digestive disorder
In practice, judges will look to a narrative report from a treating physician (ideally an immunologist or gastroenterologist) that describes the claimant's condition, treatment and prognosis and specifically notes that the claimant's condition equals one of the listings. If there is no such narrative in the record, the judge may call a medical expert to offer hearing testimony about listing equivalence. Absent medical support, however, a Social Security judge will not likely reach a listing equivalence conclusion.
Meeting the Grid Rules
Generally the grid rules will not be applicable in a CFID case because the grid rules apply only when a claimant expereinces exertional (physical) limitations.
Arguing for Reduced Functional Capacity
Most CFID cases will be decided by a judge on the basis of reduced functional capacity for work. The functional limitations I rely upon in CFID cases include:
- excessive missed time from work due to illness
- excessive missed time from work due to immunoglobulin infusion treatments (which are often administered weekly and can take several hours)
- excessive bathroom breaks required because of chronic diarrhea
- reduced attention and concentration because of abdominal pain and cramping
- inability to work in close proximity to co-workers, supervisors or the general public because of susceptibility to illness
- depression symptoms which interefere with emotional stability on a job
- need to avoid extremes of heat and cold, dust and fumes
CFID cases are often approved because patients usually have long standing medical treatment records.
CVID Case Study 1 – 62 year old female with chronic diarrhea associated with her condition