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# Crohn's Disease Listing 5.06D: Fistula Complications Under the Two Hospitalizations Prong

9/2/2026

Question Listing 5.06D: For a claimant with Crohn's disease and recurrent perianal fistulas requiring two inpatient surgical drainages within a 12-month period, do complications of fistula disease—rather than bowel obstruction—satisfy the "two hospitalizations" prong, and how have circuit courts construed the term "complications" under this listing?

Answer

#### Direct answer

The provided source for Listing 5.06 [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06) contains **only subsection A** and does not include a subsection D. Subsection A's "two hospitalizations" prong is expressly limited to **obstruction of stenotic areas** requiring hospitalization "for intestinal decompression or for surgery" [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06). The text of Listing 5.06 as supplied states that the listing is "demonstrated by A, B, or C"—no subsection D appears in the provided source [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06). Accordingly, the provided sources do not contain the operative text of a "5.06D" prong addressing fistula complications, and they contain **no circuit court case law** construing the term "complications" under Listing 5.06. What follows is an analysis based solely on the regulatory text that was provided.

#### Analysis

#### What the provided Listing 5.06 text covers

Listing 5.06, as provided, requires IBD "documented by endoscopy, biopsy, imaging, or operative findings, and demonstrated by A, B, or C" [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06). The only subsection supplied is:

> **A. Obstruction of stenotic areas (not adhesions) in the small intestine or colon with proximal dilatation, confirmed by imaging or in surgery, requiring two hospitalizations for intestinal decompression or for surgery, within a consecutive 12-month period and at least 60 days apart.** [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06)

This prong is narrow on its face. It requires:

1. **Obstruction** of stenotic areas—not adhesions—in the small intestine or colon [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06).
2. **Proximal dilatation** confirmed by imaging or in surgery [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06).
3. **Two hospitalizations** for "intestinal decompression or for surgery" within a consecutive 12-month period, at least 60 days apart [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06).

The phrase "intestinal decompression or for surgery" ties the hospitalization requirement to the obstructive pathology itself. Recurrent perianal fistulas requiring drainage are a distinct disease process—perineal fistulizing Crohn's disease—not an "obstruction of stenotic areas" with "proximal dilatation." On the text of subsection A alone, fistula drainages would not satisfy this prong because they are not hospitalizations for intestinal decompression of an obstructed stenotic segment [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06).

#### The "complications" concept across other listings

Although the provided sources do not include Listing 5.06D, several other supplied listings use the term "complications" in a hospitalization-count framework, which may inform how SSA structures such prongs:

- **Listing 6.09**—"Complications of chronic kidney disease … requiring at least three hospitalizations within a consecutive 12-month period and occurring at least 30 days apart," with each hospitalization lasting at least 48 hours [\[2\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/6.00-genitourinary-disorders#6.09).
- **Listing 7.05B**—"Complications of hemolytic anemia requiring at least three hospitalizations within a 12-month period and occurring at least 30 days apart," each lasting at least 48 hours [\[4\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.05).
- **Listing 7.08**—Disorders of thrombosis and hemostasis "with complications requiring at least three hospitalizations within a 12-month period and occurring at least 30 days apart" [\[29\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.08).
- **Listing 7.10A**—"Complications of bone marrow failure requiring at least three hospitalizations" [\[33\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.10).
- **Listing 14.11H**—"Complication(s) of HIV infection requiring at least three hospitalizations within a 12-month period and at least 30 days apart" [\[3\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/14.00-immune-system-disorders#14.11).
- **Listing 3.04B**—"Exacerbations or complications … requiring three hospitalizations of any length within a 12-month period and at least 30 days apart" [\[9\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/3.00-respiratory-disorders#3.04).

These listings demonstrate a consistent SSA drafting pattern: a "complications" prong typically requires a minimum number of hospitalizations within a 12-month window, spaced at least 30 days apart, often with a 48-hour minimum length of stay [\[2\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/6.00-genitourinary-disorders#6.09), [\[3\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/14.00-immune-system-disorders#14.11), [\[4\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.05), [\[9\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/3.00-respiratory-disorders#3.04), [\[29\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.08), [\[33\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.10). By contrast, Listing 5.06A uses a different framework—**two** hospitalizations at least **60 days** apart, tied specifically to obstructive pathology [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06).

#### The gap in the provided sources

Two critical pieces are absent from the provided source list:

1. **The text of Listing 5.06D.** The source for Listing 5.06 [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06) provides only subsection A and references "A, B, or C." If a subsection D addressing fistula complications or other complications of IBD exists in the current regulations, its operative text is not in the provided sources, and any analysis of whether recurrent perianal fistula drainages satisfy it would require that text.

1. **Circuit court case law.** The provided sources consist entirely of regulatory listing text and the grid framework [\[23\]](https://lib.superinsight.me/v/2026-08-20/ssa/grids/framework#200.00). No judicial opinions—circuit or otherwise—are included. The question of how circuit courts have construed "complications" under Listing 5.06 therefore cannot be answered from the provided sources.

#### Key points

- Listing 5.06A, as provided, covers only **obstruction of stenotic areas** with proximal dilatation requiring two hospitalizations for "intestinal decompression or for surgery"—not fistula complications [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06).
- Perianal fistula drainages are not "intestinal decompression" of an obstructed stenotic segment; they would not satisfy subsection A on the text provided [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06).
- The provided source for Listing 5.06 references prongs "A, B, or C" and does not include a subsection D [\[1\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06). Any analysis of a "5.06D" prong for fistula complications requires the operative text of that subsection, which is not in the provided sources.
- Across other listings, SSA uses "complications" language tied to a specified number of hospitalizations within 12 months, typically spaced at least 30 days apart with a 48-hour minimum stay [\[2\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/6.00-genitourinary-disorders#6.09), [\[3\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/14.00-immune-system-disorders#14.11), [\[4\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.05), [\[9\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/3.00-respiratory-disorders#3.04), [\[29\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.08), [\[33\]](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.10)—but these are distinct listings and do not govern Listing 5.06.
- No circuit court opinions are included in the provided sources, so judicial construction of "complications" under Listing 5.06 cannot be addressed here.

A follow-up question supplying the full text of Listing 5.06D and relevant circuit court decisions would allow a more complete analysis of whether recurrent perianal fistula drainages satisfy that prong.

This answer draws on the most relevant sources found. Ask a follow-up to dig deeper into any point.

#### Pinned citations

[1] [Listing 5.06 — Inflammatory bowel disease (IBD)](https://lib.superinsight.me/v/2026-08-20/ssa/listings/5.00-digestive-disorders#5.06) 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 5.06 [2] [Listing 6.09 — Complications of chronic kidney disease](https://lib.superinsight.me/v/2026-08-20/ssa/listings/6.00-genitourinary-disorders#6.09) 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 6.09 [3] [Listing 14.11 — Human immunodeficiency virus (HIV) infection](https://lib.superinsight.me/v/2026-08-20/ssa/listings/14.00-immune-system-disorders#14.11) 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 14.11 [4] [Listing 7.05 — Hemolytic anemias, including sickle cell disease, thalassemia, and their variants](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.05) 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 7.05 [9] [Listing 3.04 — Cystic fibrosis (documented as described in 3.00J2) with A, B, C, D, E, F, or G:](https://lib.superinsight.me/v/2026-08-20/ssa/listings/3.00-respiratory-disorders#3.04) 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 3.04 [23] [Grid framework 200.00 — Introduction](https://lib.superinsight.me/v/2026-08-20/ssa/grids/framework#200.00) 20 C.F.R. Pt. 404, Subpt. P, App. 2, § 200.00 [29] [Listing 7.08 — Disorders of thrombosis and hemostasis, including hemophilia and thrombocytopenia](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.08) 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 7.08 [33] [Listing 7.10 — Disorders of bone marrow failure, including myelodysplastic syndromes, aplastic anemia, granulocytopenia, and myelofibrosis (see 7.00E), with:](https://lib.superinsight.me/v/2026-08-20/ssa/listings/7.00-hematological-disorders#7.10) 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 7.10

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