Residual Function Capacity Assessment for Breast Cancer
What Is RFC?
When your breast cancer 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 Breast Cancer
Depending on the drug, dosage, dose schedule, and individual susceptibility, chemotherapy has a variable functional impact for different claimants. Although chemotherapy probably should be given for at least 3 months, no improvement in survival is present by giving such treatment more than 6 months. Therefore, symptoms of toxic side-effects of chemotherapy (such as nausea, vomiting, loss of appetite, and malaise) are likely to fail the basic 12-month duration requirement in most breast cancer cases, even if the claimant is incapacitated by symptoms while undergoing chemotherapy. In the event a claimant were going to receive a year of chemotherapy, that fact would have to be documented from the treating oncologist along with a good description of symptoms induced by chemotherapy. Any permanent damage to internal organs induced by drugs would have to be considered.
If a claimant has a lumpectomy or simple mastectomy, that surgery leaves no residual limitation exertionally or in any other way. However, radical and modified radical mastectomies can reasonably be the basis for a RFC limitation to no more than medium work. In the past, some SSA Federal physicians have insisted that there is no significant residual exertional limitation as a result of removal of chest muscles that is part of these surgeries. However, the chest muscles add significantly to the inward (adductive) force that can be applied with the arms and this capacity is relevant to lifting and carrying. The SSA should always obtain information regarding what the claimant says about resulting functional limitations in their activities of daily living.
Many long-term complications could also be possible, depending on individual circumstances. Reference should be made to the RFC discussion associated with any relevant chronic impairment.
Chemotherapy and Cognitive Decline
There is evidence that at least some types of chemotherapy associated with breast cancer treatment can cause cognitive decline. In one study, twenty-five percent of patients taking high-dose cyclophosphamide, thiotepa, and carboplatin (CTC) had cognitive decline by neuropsychological testing compared to 6.7% of healthy women. Considering the known toxicity these agents have to organs other than the brain, it is particularly surprising that the medical profession had not noticed, or at least suspected during the course of patient treatment, the effects of these drugs on the brain despite their use for decades. It is poorly understood what kinds of specific adverse effects many anti-cancer chemotherapeutic drugs have on the brain. Also, the relationship of adverse brain effects to a drug’s dose and the effect on brain toxicity by the use of multiple drugs is unknown. Additionally, there may be confounding factors that affect brain toxicity created by the presence of co-morbid (associated) conditions apart from cancer itself.
Based on this new information, the percentage of women affected is so high that the possible effects of chemotherapy on the brain should always be taken into consideration during disability adjudication, and there is no reason to think that these agents would only be cerebrally toxic in cases of breast cancer, or only for women. It would be a good idea to ask specific questions to the treating physician about cognitive effects. However, considering the fact that physicians in general have not noticed cognitive problems before, treating physicians could be unreliable as a definitive source about this issue. The claimant should be asked whether they have any problems thinking; spouses are particularly sensitive to mental changes that doctors don’t even notice since spouses are in close and prolonged contact with a patient. If there is any reasonable possibility that neuropsychological testing could result in a favorable decision in a particular case, that information should be obtained. This is an area that SSA adjudicators are likely to overlook.
Go back to About Breast Cancer and Disability.