Anemia, characterized by a reduced number of healthy red blood cells or hemoglobin, can significantly impact an individual’s life, causing symptoms like fatigue, weakness, and shortness of breath. A diagnosis of anemia alone does not automatically qualify someone for disability benefits. Instead, the Social Security Administration (SSA) evaluates each case based on the condition’s severity and how it affects an individual’s ability to perform daily activities and engage in gainful employment.
Understanding Disability Criteria
The Social Security Administration assesses disability based on an individual’s inability to engage in Substantial Gainful Activity (SGA) due to a medically determinable impairment. This impairment must be expected to last for at least 12 months or result in death. The evaluation for anemia focuses on the intensity of its symptoms and how they limit a person’s capacity to perform work-related tasks.
Anemia is evaluated under the SSA’s Listing of Impairments, specifically Section 7.00 for Hematological Disorders. While a specific listing for chronic anemia was removed in 2015, the SSA now considers adult blood disorders under Listing 7.18 or may evaluate severe anemia under Listing 7.05 for hemolytic anemias. To meet these criteria, individuals need to demonstrate severe functional limitations, such as frequent hospitalizations, or specific laboratory values like hemoglobin levels of 7.0 grams per deciliter or less, occurring multiple times within a year. The SSA also considers if anemia is a symptom of another condition or leads to other severe complications, such as cardiac issues or organ damage, which might qualify under different listings. Functional limitations, including difficulty with daily living activities, social functioning, or completing tasks due to issues with concentration or pace, are also considered.
Documenting Your Anemia
Providing comprehensive medical evidence is important for a successful disability claim for anemia. This evidence helps the Social Security Administration understand the full scope of your condition and its impact. Medical records should include details of your anemia diagnosis, specifying its type and known cause.
Laboratory results are a key component of this documentation, with tests such as hemoglobin levels, ferritin, and red blood cell indices demonstrating the severity and chronicity of the condition. Include a complete history of all treatments received, including medications, blood transfusions, and hospitalizations, along with details on your response to these interventions.
Physician’s notes should detail your symptoms, the functional limitations you experience, and your prognosis. Statements from treating physicians confirming the impact of anemia on your ability to perform daily activities and work-related tasks can strengthen the claim. Evidence of any related organ damage or complications resulting from your anemia should also be included.
Navigating the Application Process
Applying for disability benefits involves several steps. You can apply online, by phone, or in person at a local SSA office. The application requests personal information, a detailed medical history, and comprehensive work history.
After initial checks by the SSA, your application is sent to the state-level Disability Determination Services (DDS). DDS agencies, funded by the federal government, decide whether your medical condition meets the SSA’s definition of disability. Their staff, including medical and psychological experts, review all submitted medical records and assess your functional limitations to determine if you can perform your past work or any other type of work. If more information is needed, DDS may request additional records or schedule a consultative examination.
Addressing Denials and Appeals
Many initial disability claims are denied, so understanding the available appeal options is important. If your application is denied, you have the right to appeal the decision. There are four levels of appeal within the Social Security Administration:
Reconsideration
Hearing by an Administrative Law Judge (ALJ)
Appeals Council review
Federal Court review
The first level, Reconsideration, involves a complete review of your claim by a different evaluator who was not involved in the initial decision. File this request within 60 days of receiving your denial and submit any new or additional medical evidence.
If reconsideration is denied, you can request a hearing before an Administrative Law Judge, where you can present new evidence and testimony. Should the ALJ also issue an unfavorable decision, the next step is to request a review by the Appeals Council, which examines the ALJ’s decision for errors in law or procedure. The final level is a review by the Federal Court, where a lawsuit can be filed against the SSA. Seeking legal representation for appeals can be beneficial throughout this process.