It’s estimated that three million Americans suffer from anemia. That number is expected to increase as the population continues to age—almost 10% of people over sixty-five have some form of the disease.
Red blood cells are rich in a substance called hemoglobin, a protein that carries oxygen molecules to all other cells. In adults, hemoglobin-rich red blood cells comprise 35%-52% of a person’s blood; this percentage is known as the hematocrit level. Normal variations in the hematocrit level depend largely on factors such as gender and physical fitness. Anemia occurs when a person’s hematocrit levels drop too low, indicating that the red blood cells are not properly transporting oxygen to other parts of the body.
The American Society of Hematology traces anemia to two basic causes: anemia resulting from a too low amount of red blood cells and anemia resulting from red blood cells that do not function properly. Social Security has a section (Hematological Disorders, Section 7.00) that addresses both forms.
For anemia caused by low hematocrit levels, the key factors considered are “chronicity” and impairment. Chronicity is shown with evidence that the condition has persisted for at least three months. Such evidence can be shown by multiple (at least two) medically acceptable tests over a three month period—persistently 30% or less. Impairment is shown by proof that this low red blood cell count is actually affecting the proper functionality of other body systems. As the SSA website says, “a gradual reduction in red cell mass, even to very low values, is often well tolerated in individuals with a healthy cardiovascular system.” Impairment can be shown by either by an appropriate evaluation by a medical professional or documentation that the applicant needs blood transfusions on average of at least once every two months.
Sickle cell anemia falls into the second anemia category – anemia caused by malfunctioning red blood cells. Red blood cells are shaped like flexible discs, which allow them to travel through all blood vessels, including capillaries that are only one cell thick. Sickle cell anemia occurs when the red blood cell form more rigid C or “sickle shapes.” These abnormally shaped cells become stuck in the smaller blood vessels, blocking proper blood flow and causing immense pain. Sickle cell is an inherited trait with certain groups, such as African Americans, more likely to be carriers than others.
The sickle cell disease listing describes the evidence that must be shown to qualify for disability. The applicant must either show:
A. Documented painful (thrombotic) crises occurring at least three times during the 5 months prior to adjudication; or
B. Requiring extended hospitalization (beyond emergency care) at least three times during the 12 months prior to adjudication; or
C. Chronic, severe anemia with persistence of hematocrit of 26 percent or less; or
D. Evaluate the resulting impairment under the criteria for the affected body system.
Like with chronic anemia resulting from a persistently low hematocrit, the applicant must have documentation that this condition has recurred multiple times in a prescribed period.
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