Residual Functional Capacity Assessment for Chronic Bronchitis
What Is RFC?
When your chronic bronchitis 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 Bronchitis
If your chronic bronchitis is a result of impairment of pulmonary function due to extensive disease, it is important to remember that the intimate physiological relationship between the cardiovascular and pulmonary systems means an impairment in one of these systems influences the other. Thus, the presence of heart and respiratory impairments in the same claimant can result in much worse functional restriction than either considered alone. If you are restricted to medium work on the basis of cardiovascular disease and medium work because of respiratory disease, you should receive a RFC for no higher than light work. In this regard, it is very common for a claimant with chronic obstructive pulmonary disease (COPD) secondary to cigarette smoking to also have significant cardiac disease or peripheral vascular disease as separate impairments.
Removal of lung tissue can also limit the RFC. The most frequent type of pulmonary resection is a lobectomy associated with surgery for lung cancer; sometimes, a pneumonectomy involving the removal of an entire right or left lung is performed. In otherwise healthy lungs, a lobectomy usually results in an exertional restriction to medium work when the results of spirometry are evaluated. In cases of pneumonectomy, an RFC is always required, and even with a healthy remaining lung is usually no higher than light work. As with other pulmonary impairments, environmental restrictions from exposure to excessive dust and fumes would be indicated on the RFC. The fact that a treating surgeon may say something in his or her medical notes like, “The patient has fully recovered from surgery and has no difficulty breathing,” does not mean that spirometry does not have to be performed. When significant amounts of lung tissue are removed, there will be some degree of pulmonary limitation. Most claimants with pulmonary resection associated with removal of a lung cancer are operated on because they have cancer caused by cigarette smoking. Claimants who have smoked long enough to develop lung cancer always have chronic obstructive pulmonary disease and will have pulmonary deficits worse than would be expected if the remaining lung tissue were normal. This is another reason it would be improper for the SSA to guess about remaining lung function without obtaining spirometry (unless the claim is otherwise allowable). Whether or not a claimant post-resection for lung cancer complains of shortness of breath, the SSA has a responsibility to evaluate the residual breathing impairment.
It is important that claimants with lung diseases producing gas exchange impairment not receive RFC levels of exertion that could cause them to desaturate, so that they become so hypoxemic that they are in danger of a cardiac arrhythmia (and consequent sudden death), or in danger of loss of consciousness. Desaturation can happen so quickly that reliable symptom warning signs are not present. Thus, exercise produces a degree of hypoxemia dependent on the amount of exercise and severity of the underlying disease, as well as environmental factors such as extreme heat and cold. Potentially life-threatening levels of exertion should not be recommended in disability adjudication and this consideration supersedes actual exertional capacity.
All claimants with respiratory disorders severe enough to warrant a RFC should receive limitations from exposure to excessive dust and fumes. Furthermore, work at cold temperatures can increase symptoms of shortness of breath and decrease exercise capacity in individuals with COPD such as asthma, emphysema, and chronic bronchitis.
Additionally, if exertion results in increasing coughing and hemoptysis that should be taken into account on the RFC, even if the spirometry or other respiratory test would suggest less limitation.
Go back to About Chronic Bronchitis and Disability.