Achalasia is a rare, chronic disorder of the esophagus. Nerve damage prevents the muscle contractions (peristalsis) from moving food down correctly. Additionally, the lower esophageal sphincter, a muscle at the junction of the esophagus and stomach, fails to relax and open fully. This combination causes food and liquid to become stuck, leading to discomfort and health complications. Many individuals living with this disorder question whether this chronic condition qualifies as a legal disability.
How Achalasia Impairs Daily Function
The primary symptom of achalasia is dysphagia, or difficulty swallowing, which impacts the ability to consume solids and liquids. The sensation of food being stuck makes mealtimes stressful. Many patients also experience regurgitation of undigested food and saliva due to the impaired passage into the stomach.
Difficulty with sustenance intake often leads to chronic weight loss and a high risk for malnutrition. Insufficient nutritional intake causes a profound loss of energy, compromising the ability to engage in physical activity. A serious functional limitation is the risk of aspiration, where regurgitated contents enter the lungs, potentially leading to chronic cough or recurrent aspiration pneumonia.
Managing achalasia requires medical interventions. Treatments aimed at forcing the lower esophageal sphincter open, such as pneumatic dilation or myotomy, are often necessary. While some find temporary relief from Botox injections, these procedures are not curative and may need repetition. Undergoing these treatments and recovery time can create persistent interruptions to employment and normal routines.
Legal Recognition of Achalasia as a Disability
Achalasia is not automatically classified as a disability; its legal status depends on the severity of the functional limitations it imposes. The Social Security Administration (SSA) evaluates chronic conditions based on their impact on a person’s ability to engage in substantial gainful activity. Although achalasia lacks a specific listing in the SSA’s Blue Book of Impairments, it is evaluated under the broader criteria for Digestive Disorders, Section 5.00.
This category covers conditions affecting the esophagus, stomach, and intestines that lead to severe dysfunction. To qualify, the impairment must be medically determinable and expected to last for at least 12 continuous months, or result in death. The SSA considers the effects of treatment, including medications and surgery, when determining severity. The diagnosis itself is less important than the documented, long-term consequences of the disorder.
Achalasia can also provide protective status under the Americans with Disabilities Act (ADA), which is distinct from disability benefits. The ADA protects against employment discrimination and requires employers to provide reasonable accommodations. A condition is considered a disability under the ADA if it substantially limits one or more major life activities. However, for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), the condition must meet the SSA’s strict definition of an inability to work.
Proving Severity for Disability Benefits
To secure disability benefits, evidence must demonstrate that functional limitations from achalasia are severe and persistent, even with treatment. The SSA relies on objective medical evidence of malnutrition, addressed under Listing 5.08 for Weight loss. To meet this listing, an applicant must have a Body Mass Index (BMI) of less than 17.50, calculated from at least two evaluations taken 60 days apart within a 12-month period.
Another pathway involves documenting repeated, debilitating complications that prevent sustained work. This documentation includes medical records showing dependence on alternative nutrition sources. Evidence of recurrent hospitalizations for complications, such as severe aspiration pneumonia or other respiratory issues caused by achalasia, can also demonstrate the necessary level of impairment.
Medical records must be longitudinal, covering an extended period, to show the impairment has persisted despite ongoing medical management. This includes reports of imaging studies, manometry results, and operative reports of repeated procedures. The case rests on a comprehensive medical history that objectively shows the condition prevents any substantial gainful activity for at least one year.