Listing 5.05 in 2026: How SSA Evaluates Chronic Liver Disease, the Seven Paths from Variceal Bleeding to the SSA CLD Score of 20, and the Lab Thresholds That Win at Step 3

By Anthony Albert, Benefits Research Director · Published June 14, 2026 · 14 min read

Chronic liver disease (CLD) is one of the more technical listings in the Blue Book. It has seven separate paths under 5.05A through 5.05G, and each one keys on hard numeric thresholds. If your hepatologist's notes hit the numbers, your claim wins at Step 3. If they miss by even a little, the case gets kicked to RFC at Step 5 where it can drag for two more years.

This guide walks through every path under 5.05, the definitions in 5.00C, the imaging and lab evidence SSA needs, and how the SSA Chronic Liver Disease (SSA CLD) score works. We end with two worked examples that show how the rules play out on real files.

What 5.00C calls chronic liver disease

Per 5.00C1, CLD is loss of liver function with cell necrosis, inflammation, or scarring of the liver that persists for more than six months. Common causes include chronic hepatitis B, chronic hepatitis C, alcohol-related liver disease, nonalcoholic steatohepatitis (NASH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis, hemochromatosis, Wilson disease, and alpha-1 antitrypsin deficiency.

SSA wants to see the signs and symptoms documented in your records: jaundice, change in liver and spleen size, ascites, peripheral edema, altered mental status, pruritus, fatigue, nausea, loss of appetite, and sleep disturbance. Acute liver disease without chronicity does not meet 5.05. The six-month duration is a hard floor.

The supporting labs SSA looks for under 5.00C1b include serum albumin, INR, arterial blood gas (for hepatopulmonary syndrome), serum creatinine (for hepatorenal syndrome), and sodium. Liver biopsy results are useful when available, but SSA will not purchase a biopsy.

The seven paths under 5.05

Listing 5.05 reads: "Chronic liver disease (see 5.00C) with A, B, C, D, E, F, or G." You only need one. Most claimants who meet 5.05 hit the SSA CLD score path (5.05G) because two qualifying scores are easier to document than a hospitalization with a 2-unit transfusion. But the others are still alive for the right fact pattern.

5.05A: variceal bleeding with hospitalization

This is the path that closes acute decompensation cases. Per 5.05A, you qualify if you have hemorrhaging from esophageal, gastric, or ectopic varices, or from portal hypertensive gastropathy, documented by imaging (endoscopy or CT), that produces hemodynamic instability (pallor, diaphoresis, tachycardia, hypotension, postural hypotension, or syncope) and required hospitalization for transfusion of at least 2 units of blood.

Per 5.00C2a, "consider under a disability for 1 year" in 5.05A is not the onset date. It's the date SSA must reevaluate. Onset comes from the facts of your case, usually the bleed itself or earlier if you had qualifying liver dysfunction documented before the bleed.

What this means in practice: a single qualifying bleed with a 2-unit transfusion gives you 12 months of disability automatically. After that, your impairment is reevaluated. If your CLD is still active and you meet a different 5.05 path or have a low SSA CLD score, the case continues. If you've been transplanted or your liver function has normalized, SSA performs a CDR. We covered the medical-improvement standard in our CDR deep-dive.

5.05B: ascites or hydrothorax with two evaluations

Per 5.05B, you qualify if you have ascites (peritoneal fluid) or hydrothorax (pleural fluid) not attributable to other causes, present on two evaluations within a 12-month period, at least 60 days apart, and each evaluation documents the fluid by paracentesis, thoracentesis, or imaging or physical examination plus a lab finding.

The lab finding alternatives under 5.05B3 are:

• Serum albumin of 3.0 g/dL or less, or
• INR of at least 1.5.

Per 5.00C2b, SSA evaluates other causes of ascites (congestive heart failure, malignancy) under the listings for those body systems, not 5.05B. So your records need to show that the ascites is from portal hypertension and CLD, not from listing 4.02 chronic heart failure or from cancer.

How the two-evaluation rule actually plays out

Most claimants have multiple paracentesis dates in their records. Pick the earliest one and find the next one that's at least 60 days later but still within 12 months of the first. Both need a documented lab value at or under the threshold. If you have paracentesis on March 1 (albumin 2.8) and again on May 12 (albumin 2.7), you meet 5.05B because the dates are 72 days apart and both albumin values are at or under 3.0 g/dL.

5.05C: spontaneous bacterial peritonitis (one event)

Per 5.05C, SBP is met by peritoneal fluid analysis (from paracentesis) showing a neutrophil count of at least 250 cells/mm3. Per 5.00C2c, one documented event is enough. No 60-day rule. No second evaluation.

This is one of the easiest 5.05 paths to meet on paper because SBP is a discrete inpatient event with documented labs. The challenge is that SBP often kills patients within months, so SSA cases on this path tend to be either probate-trail TERI cases or claims for surviving spouses or dependents. The TERI expedited processing we covered for terminal illness applies here when life expectancy is six months or less.

5.05D: hepatorenal syndrome

Per 5.05D, hepatorenal syndrome (HRS) is documented by any one of three findings:

1. Serum creatinine elevation of at least 2.0 mg/dL,
2. Oliguria with 24-hour urine output less than 500 mL, or
3. Sodium retention with urine sodium less than 10 mEq per liter.

One occurrence at any of these thresholds satisfies the path. Per 5.00C2d, renal failure with known underlying kidney pathology (glomerulonephritis, tubular necrosis, infections) is evaluated under the 6.00 series instead. So your records need to show the renal failure is from CLD and portal hypertension, not from a primary kidney problem. If you have both, we covered the kidney side in our listings 6.03, 6.04, and 6.05 deep-dive.

5.05E: hepatopulmonary syndrome

Per 5.05E, hepatopulmonary syndrome (HPS) is met by either an ABG threshold or documented intrapulmonary shunting.

5.05E1: ABG path

The PaO2 thresholds vary by altitude:

• Less than 3,000 feet above sea level: PaO2 60 mmHg or less.
• 3,000 through 6,000 feet: PaO2 55 mmHg or less.
• Over 6,000 feet: PaO2 50 mmHg or less.

The ABG must be drawn while you are at rest, breathing room air (no supplemental oxygen), and the report must include the PaO2 value, your name, the date, and either the altitude or both the city and state. This altitude tier matches the one used in listing 3.02 respiratory disorders.

5.05E2: shunt imaging path

The alternative is documented intrapulmonary arteriovenous shunting shown by contrast-enhanced echocardiography (a "bubble study" with delayed left-heart bubbles) or a macroaggregated albumin (MAA) lung perfusion scan. SSA won't purchase these tests, but if you've had one, your case file should include it.

5.05F: hepatic encephalopathy with two evaluations

Per 5.05F, hepatic encephalopathy is met when you have documentation of abnormal behavior, cognitive dysfunction, changes in mental status, or altered state of consciousness (for example, confusion, delirium, stupor, or coma) on two evaluations within 12 months, at least 60 days apart, plus either of:

1. History of transjugular intrahepatic portosystemic shunt (TIPS) or other surgical portosystemic shunt; or
2. One of the following on at least two evaluations at least 60 days apart within the same 12-month period:
   • Asterixis or other fluctuating physical neurological abnormalities,
   • EEG demonstrating triphasic slow wave activity,
   • Serum albumin of 3.0 g/dL or less, or
   • INR of 1.5 or greater.

Per 5.00C2f, SSA evaluates acute encephalopathy from non-CLD causes (vascular events, cancer) under the listings for those body systems. EEGs are not purchased, but obtained when available.

5.05G: the SSA CLD score

This is the path most claimants with end-stage liver disease meet. Per 5.05G, you qualify if you have two SSA CLD scores of 20 or higher within a 12-month period, at least 60 days apart. Disability is considered from at least the date of the first score.

The SSA CLD score is a modified MELD-Na score using the same labs but with SSA's own coefficients. Per 5.00C3, the formula has two stages.

Stage 1: initial SSA CLD calculation

SSA CLD_i = 9.57 x [ln(creatinine mg/dL)] + 3.78 x [ln(total bilirubin mg/dL)] + 11.2 x [ln(INR)] + 6.43

Round to the nearest whole integer. If the result is 11 or below, that's your final SSA CLD score. If it's greater than 11, move to stage 2.

Stage 2: sodium correction

SSA CLD = SSA CLD_i + 1.32 x (137 minus serum sodium) minus [0.033 x SSA CLD_i x (137 minus serum sodium)]

Round to the nearest whole integer.

The lab rounding rules under 5.00C3b

SSA has very specific lab handling rules:

• All four labs (creatinine, bilirubin, INR, sodium) must be from a continuous 30-day window.
• Values for creatinine, bilirubin, or INR less than 1.0 are rounded up to 1.0.
• Creatinine greater than 4.0 is rounded down to 4.0.
• If multiple values exist within the 30-day window, SSA uses the highest creatinine, bilirubin, and INR, and the lowest sodium.
• If you're in renal failure or on dialysis within a week of any creatinine test, SSA uses 4.0 as the creatinine value.
• If serum sodium is below 125, SSA sets it to 125. If above 137, SSA sets it to 137.
• INR values from anticoagulant treatment are excluded.

The "ln" in the formula is the natural logarithm, not log base 10. Per the SSA example in 5.00C3c, a person with creatinine 1.4, bilirubin 1.3, INR 1.32, sodium 119 ends up with an SSA CLD score of 24.

Why the SSA CLD score is the cleanest 5.05 path

You don't need hospitalizations, ABGs, paracentesis fluid analysis, or imaging beyond a basic abdominal ultrasound for CLD documentation. You need four lab values, twice, 60 days apart, in a 12-month window. Most patients with cirrhosis have these labs drawn quarterly. The path turns documentation into arithmetic.

The CTA on this case file

Worked example 1: California Renata, hepatitis C cirrhosis, 5.05G score path

Worked example 2: Texas Bryant, alcohol-related cirrhosis, 5.05F encephalopathy path

What about liver transplant?

SSA doesn't have a separate transplant grant under 5.05 the way it does for kidney transplant under listing 6.04. If you've had a liver transplant, the post-transplant case is evaluated based on whether the underlying CLD still produces the manifestations listed under 5.05A through 5.05F, or whether you have a qualifying SSA CLD score post-transplant. Most successful transplants drop the patient out of 5.05 eligibility within 6 to 12 months as labs normalize, which triggers a CDR.

The exception is if there are complications: graft failure, recurrent hepatitis C, rejection requiring re-transplant, or chronic immunosuppression complications. Those cases are evaluated on the manifestations as they appear, with cross-references to 14.00 (immune system) for graft-versus-host or recurrent autoimmune disease.

The five-month waiting period and Medicare

SSDI under 5.05 is subject to the standard 5-month waiting period under 42 USC 423(c)(2). Medicare entitlement is the standard 24 months after the SSDI eligibility month, except for ALS and ESRD cases. Liver transplant patients do not qualify for the ESRD Medicare waiver, so they wait the full 24 months unless they've already aged into Medicare.

For low-income claimants in concurrent SSI/SSDI cases, Medicaid often kicks in immediately at the SSI level, covering the 24-month Medicare wait. We covered the cross-program coordination in our dual-eligible SNP guide.

Common ways 5.05 claims get denied

From the cases we see at hearings, the recurring failure modes are:

1. Only one ascites evaluation in the file. 5.05B needs two, 60 days apart. One paracentesis report isn't enough. Send your hepatologist a request for prior records or schedule a follow-up that hits the 60-day window.
2. SSA CLD calculation done with the wrong sodium. Adjudicators sometimes use the highest sodium instead of the lowest. The rule under 5.00C3b(iv) is lowest sodium wins. Make this argument in your representative brief.
3. INR drawn while on warfarin. Excluded from SSA CLD calculation per 5.00C3b(iii). Use an INR from before anticoagulation or a pre-warfarin baseline.
4. Encephalopathy episode documented only in family report, no medical record. 5.05F needs medical documentation. Get a hepatologist or PCP note describing the abnormal behavior and asterixis or other neurologic findings.
5. Variceal bleed treated outpatient with banding, no transfusion. Doesn't meet 5.05A. Look instead at 5.05G (SSA CLD score) or 5.05B (ascites).
6. ABG drawn on supplemental oxygen. Doesn't qualify under 5.05E1. The ABG must be on room air.

Step-by-step: how to build a 5.05 claim that wins

1. Identify which path your records best support. Most claimants will find 5.05G is the cleanest with regular hepatology labs. Check the math first before you commit to a path.
2. Pull all labs from the last 12 months. Look for creatinine, bilirubin, INR, and sodium values within continuous 30-day windows. Run the SSA CLD calculator (or do the formula by hand) for any window with all four labs.
3. If 5.05G doesn't work, check 5.05B for ascites. Two paracentesis dates or two imaging-plus-lab evaluations, 60 days apart, within 12 months, with albumin 3.0 or less or INR 1.5 or higher.
4. Check the file for a 2-unit transfusion hospitalization for variceal bleeding. 5.05A is one-and-done if it's there.
5. Check for SBP, hepatorenal, or hepatopulmonary events. Each is a single-event path with hard lab thresholds.
6. For encephalopathy, count documented mental-status events. Need at least two, 60 days apart, within 12 months.
7. Submit medical source statements addressed to the specific path. A hepatologist letter that says "patient has chronic liver disease" is useless. One that says "patient has cirrhosis with SSA CLD scores of 22 (March 2026) and 26 (June 2026)" wins the case.
8. If alcohol is in the etiology, document sobriety. AA attendance, negative breath alcohol or PEth tests, hepatologist attestation that current liver dysfunction would persist with continued abstinence.

FAQ

Related reading

• Listings 6.03, 6.04, and 6.05 chronic kidney disease (sister body system, hepatorenal overlap)
• Listing 3.02 chronic respiratory disorders (matching altitude tier under 5.05E1)
• Listing 4.02 chronic heart failure (ascites rule-out)
• SSR 13-2p DAA materiality (alcohol-related liver disease)
• CDR medical improvement standard (post-transplant review)
• SSR 18-1p alleged onset date and established onset date
• AOD vs EOD analysis
• TERI and expedited processing for end-stage disease
• California disability claims (Renata's state)
• Texas disability claims (Bryant's state)