Blood Disorders And Social Security Disability Claims
By Pitt Dickey
This column will review how the Social Security Administration (SSA) evaluates disability claims from people who are suffering from diseases of the blood. The SSA uses a set of criteria called Listings to decide which claims to approve on the record without the need for a hearing before an Administrative Law Judge.
In order to make the Listings easier to understand, a discussion of how the blood will be useful. The medical term for blood is hemat. The study of blood is called hematology. Blood consists of a liquid called plasma in which the three types of blood cells float and are carried throughout the body. Plasma is made up of water, salts, dissolved protein and other materials. To simplify, the blood cells are white cells, red blood cells and platelets. Each type of blood cell has a particular function to perform for the body.
Red blood cells are also called erythrocytes. Red blood cells carry hemoglobin in them. Hemoglobin is what carries oxygen in the blood cells throughout the body. The mix of hemoglobin and oxygen is what causes blood to appear red. Red blood cells are made in bone marrow. Red blood cells have a useful life of about 120 days before they wear out. The body ultimately destroys the old red blood cells in the liver, bone marrow and spleen. The cycle of generating and destroying red blood cells goes on constantly. The usual number of red blood cells in a healthy body ranges from 4.5 to 6 million per cubit millimeter.
White blood cells are also called leukocytes. There are five different types of white blood cells with specialized functions in the body. The functions include an agent which prevents the clotting of blood, allergic reactions, fighting infection, control of the immune response and destruction of bacteria. White blood cells are very important in the immune system as they attack infection and produce antibodies which attack antigens such as viruses and bacteria. White blood cells are produced in the bone marrow. The usual number of white blood cells in a healthy body ranges from 7000 to 9000 cells per cubic mm.
Platelets are also known as thrombocytes. The purpose of platelets is to help form blood clots which is also called coagulation. Clots are the means the body uses to stop the flow of blood from the body after it suffers a wound. Clots can also be extremely dangerous if they form inside of blood vessels and break off into the blood stream. A clot attached that is attached is called a thrombus and a clot that is floating through the blood stream is called an embolism. A person suffering from a danger of floating blood clots will be given anticoagulants to prevent the formation of an embolism.
Anemia is a deficiency in the number of red blood cells or hemoglobin. There are a number of different types of anemia. The listings use the measurement of hematocrit in the blood to evaluate the level of anemia. Hematocrit is the percentage of red blood cells in a given volume of blood.
Chronic anemia: To be awarded disability benefits under the SSA listing for chronic anemia, a person must have a hematocrit listing persisting at 30% of the normal level due to any cause. In addition the person must have undergone a required blood transfusion on an average of at least once every 2 months; or meet a Listing for the effected body system.
Sickle cell anemia is a condition that is inherited and results in misshapen red blood cells from abnormal hemoglobin. The symptoms are joint pain, sudden abdominal pain and ulcers on the persons extremities. It is a genetic disorder found primarily in black persons. A person meets the SSA Listing for sickle cell anemia if he has:
a. documented painful (thrombotic) crises happening at least three times during the 12 months prior to his claim being decided; or
b. Required extended hospitalization (not just emergency room treatment) at least 3 times in the 12 month period prior to his claim being decided; or
c. Chronic severe anemia with persistent hematocrit of 26% or less; or
d. He meets the SSA listing for the affected body system.
Other types of anemia include: Pernicious anemia results from the lack of development of red blood cells because the body cannot absorb the needed about of vitamin B12 to help red blood cells mature. Hemolytic anemia results when there is a shortage of red blood cells when more red blood cells are destroyed than are replaced. The red blood cells are destroyed in the body through a process called hemolysis. Aplastic anemia is a condition resulting from the failure of the bone marrow called aplasia to produce red blood cells. Bone marrow transplants can be used to treat aplastic anemia.
This is a condition in which the number of platelets repeatedly falls below 40,000 per cubic millimeter. The normal count of platelets is 200,000 to 500,000 per cubit millimeter. In addition, the patient suffers from either:
a. at least one spontaneous hemorrhage requiring a transfusion within 5 months of the disability determination by the SSA; or
b. Intra cranial (inside of the skull) bleeding within 12 months of the disability determination.
Hemophilia is a condition caused by a hereditary condition in which excessive bleeding occurs due to a lack of a substance need to cause the blood to clot. A patient meets the SSA listing for hemophilia or other blood clotting disorders if he has had spontaneous bleeding requiring transfusion at least 3 times prior to the SSA making its disability decision.
It should be kept in mind that a person can still be found to be disabled by an Administrative Law Judge even if he does not meet a particular listing if he has health problems that in combination are the equivalent of a listing. The Judge has the discretion to decide if a person’s health problems are serious enough to warrant an award of disability benefits despite not meeting the technical requirements of one of the SSA listings for disability.