Residual Functional Capacity Assessment for Lymphoma
What Is RFC?
When your lymphoma 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 Lymphoma
Each case must be looked at on an individual basis, depending on organ systems affected by the cancer, symptoms, and limitations imposed on activities of daily living. Of particular interest is anemia, which can cause weakness and easy fatigability. See Residual Functional Capacity Assessment for Anemia. Fever, loss of appetite and weight loss may be present. If radiation treatment of lymphoma in the chest has been given, the SSA should consider the possibility of radiation-induced fibrotic lung disease and evaluate pulmonary function, if appropriate. Modern radiology equipment can deliver radiation with such accuracy that non-targeted secondary lung damage is not as common as it was several decades ago. If lymphoma has affected the brain, mental evaluation may be required. Lymphoma can invade other organs, including bone, so there are many possibilities for RFC consideration if duration is satisfied.
It is of significance that persistent long-term fatigue may be present following treatment for Hodgkin’s lymphoma, although all objective evidence of disease is gone, including chemotherapy and radiotherapy toxicity. Although health-related quality of life affects less than 10% of patients 18 months after therapy for Hodgkin’s lymphoma, a significant percentage have persistent fatigue and emotional problems. At 22 months after completion of therapy the following results have been found: general fatigue 51.7%, physical fatigue 41.5%, mental fatigue 34.9%, reduced activity 32.2%, and reduced motivation 26.3%.
Therefore, SSA should not summarily dismiss fatigue complaints as non-credible after treatment is complete, even if there is no evidence of disease. This is particularly true if mentioned in treating physician records as a problem, and it must be presumed that this problem also applies to non-Hodgkin’s lymphoma. While the cause of persistent post-treatment fatigue is not clear, it could limit physical exertional capacity. Such fatigue is more common with increasing age and in men.
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