Chronic Anemia

Residual Functional Capacity Assessment for Chronic Anemia

What Is RFC?

When your chronic anemia is not severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process, the Social Security Administration will need to determine your residual functional capacity (RFC) to decide whether you are disabled at Step 4 and Step 5 of the Sequential Evaluation Process. RFC is a claimant’s ability to perform work-related activities. In other words, it is what you can still do despite your limitations. An RFC for physical impairments is expressed in terms of whether the Social Security Administration believes you can do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.

Assessing Impairment Caused by Chronic Anemia

From the standpoint of anemia itself, the important questions are (1) How does anemia cause functional limitation?; and (2) How does the degree of functional limitation correlate with the severity of the anemia?

Younger people can adapt to chronic anemia better than older people. The longer an anemia has been present, the better a person can adapt. Generally speaking, when a hematocrits get down into the lower 20% range sedentary work is probably all the individual can do. A young and otherwise healthy person with a hematocrit in the upper 20% and lower 30% range could possibly do light work —under comfortable environmental conditions. Heat and cold will both stress the physiology and drive up the heart rate; what an anemic person can do in temperature extremes will obviously be less.

One cannot refer to a chart or a rule or a study to show that a particular hematocrit means a specific functional limitation. All of the facts must be considered. As far as the anemia itself is concerned, it is difficult to conceive of how the SSA could justify a RFC of “not severe” or heavy work for claimants with hematocrits of 35% or less even when other facts in the case are of minimal functional impact. Ideal information would be an exercise test, because then blood pressure, symptoms, and heart rate can be objectively and directly correlated with exertion. For example, if a claimant reaches their predicted maximum heart rate of, say, 150 beats/min at 6 METs exertion (or equivalent on a bicycle ergometer) in the context of significant anemia, the claimant should not receive a RFC for higher than light work. However, formal testing of exercise capacity, although used in clinical medicine, is not a method the SSA will use to assess RFC and that makes disability determination in anemia claims more subjective.

Claimants with hematocrits below 20% should generally be considered of equivalent severity to the listing, in the absence of information to the contrary. Providing a detailed account of your daily activities, especially in regards to levels of physical exertion and resulting symptoms can be helpful in determining RFC. In any event, temperature environmental limitations affect work capacity in significant anemia and that means the SSA cannot mechanically apply a fixed set of rules to claimants based solely on their hematocrit. Yet the SSA adjudicator will almost invariably not apply environmental temperature considerations to RFCs involving anemia.

Assessing Chronicity

Duration is an issue in RFC, because chronicity cannot be assumed in anemia. Some types of anemia may be highly reversible, such as discontinuation of an offending drug. On the other hand, there are some drugs that can permanently cause anemia (and worse), because of bone marrow damage. Iron supplements can easily be given for iron deficiency, and anemia due to blood loss will correct when the cause of the blood loss is treated.

Chronicity is indicated by persistence of the condition for at least 3 months. The laboratory findings cited must reflect the values reported on more than one examination over that 3-month period. People most likely to have chronic anemia are those with chronic diseases like SLE, and hemoglobinopathies such as sickle cell anemia.

If there is some type of chronic disease causing the anemia, then RFC considerations must consider the total effects of that disorder. In the case of an autoimmune disease such as SLE, there may be a number of problems besides anemia. Similarly, individuals with chronic kidney failure can have their anemia reversed into the 30–35% hematocrit range by injection of erythropoietin several times a week. Yet they will have other problems associated with kidney failure.

Continue to How to Get Disability Benefits for Chronic Anemia by Meeting a Listing.

Go back to About Chronic Anemia and Disability.