Appeal letter sample: Social Security Disability
Template letter for professionals to provide to IBD patients needing assistance in getting disability insurance. This letter is intended for the Social Security Administration.
SAMPLE LETTER BELOW
Social Security Administration
RE: Patient (file # / SS #)
To Whom It May Concern:
PATIENT is a (XX) year old male/female currently under my care. I am evaluating and caring for him/her in regard to his/her ulcerative colitis/Crohn’s disease. Due to his/her ongoing illness it is not possible for him/her to work in any capacity.
PATIENT currently has severely active Crohn’s disease/ulcerative colitis, which has been ongoing over X years. I performed an extensive evaluation of PATIENT and have found that he/she has active Crohn’s disease/ulcerative colitis involving the small/large intestine. (Much of his/her intestine has been resected leaving him/her with intractable diarrhea). His/Her most recent procedure (specify)/tests (specify) were performed on (DATE). PATIENT has been tried on numerous conventional medications for ulcerative colitis/Crohn’s disease and has not benefited from them for any sustained period of time. His/Her symptoms include: (specify)
- XXXX, Abdominal cramping and pain
- YYYY, Severe diarrhea
- ZZZZ, fatigue
- Any other extraintestinal manifestations (arthritis, mouth sore, fevers, etc…)
I can state, without question, that PATIENT has significantly active ulcerative colitis/Crohn’s disease at this time and we are preparing to embark on a new approach of medical therapy for him/her. With this new medication regimen, which may include an investigational drug trial, I hope to avoid sending PATIENT to surgery.
I recommend that he/she be placed on disability until his/her condition is stabilized. Please do not hesitate to contact me if additional information is required.
For further information, call the Irwin M. and Suzanne R. Rosenthal IBD Resource Center (IBD Help Center): 888.MY.GUT.PAIN (888.694.8872).
The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.
About this resource
Published: May 1, 2012
SS Disability (.doc)
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