If sickle cell anemia has left you unable to work, you may be eligible to receive Social Security Disability benefits. Social Security Disability Insurance (SSDI) pays benefits to the patient diagnosed with sickle cell anemia and certain dependents in his or her family if he or she has worked enough to earn enough credits to pay in the required amount of taxes to Social Security. In order to receive SSDI, the claimant’s condition must be severe enough to render him or her completely disabled.
Sickle cell anemia is most commonly diagnosed blood disorder in the United States, according to bethematch.org. One out of every 500 African Americans and one out of every 1,000 to 1,400 Hispanic Americans are diagnosed with the disorder, according to the site that seeks donor matches to help treat the disease.
Only those considered permanently disabled, which means unable to work for a year or longer, are eligible for Social Security Disability benefits. During the process of applying for benefits, the Social Security Administration collects an extensive amount of information about the claimant and his or her condition. Medical records must be received so the disability determination staff can determine if the individual does meet the requirements to be declared disabled.
Financial Expenses Involved with Sickle Cell Anemia
According to Reuters Health, the cost of treating sickle cell disease is high in the United States. Sickle cell disease is an inherited blood disorder in which the red blood cells contain an abnormal kind of hemoglobin that can take on a crescent or sickle shape. The defective red blood cells can block the small blood vessels resulting in stroke or tissue damage.
Other problems that can arise include anemia, leg and arm pain, gallstones, jaundice, kidney, spleen or liver damage and more. According to Reuters Health, a doctor at the University of Florida in Gainesville and her colleagues analyzed data for 4,294 sickle cell patients on the Florida Medicaid program.
According to the report, the average cost of health care was $1,946 per month for sickle cell patients, with a variation of substantial amounts across the different age groups. Adults with the blood disorder see the highest costs, reaching as high as about $2,853 monthly for those ages 30 to 39.
Looking at the numbers all together, an average patient diagnosed with sickle cell anemia could spend $953,640 on undiscounted health care costs by the time he or she reaches age 45. The study notes that the additional expenses, including uncompensated care, premature mortality, lost productivity and reduced quality of life are much higher than the financial figures.
The SSA Evaluation and Medical Qualifications
Qualifying for Social Security Disability with a sickle cell anemia diagnosis by the Blue Book, the SSA medical guide for determining what classifies as a full and permanent disability, is very specific.
Sickle cell anemia falls under section 7.0 -- Hematological Disorders. First, there must be medical documentation that you have been confirmed to have a hematological disorder.
- Lab report with a definitive test that establishes that there is a hematological disorder and this report needs to be signed by a physician.
- A lab report with a definitive test that determines you have a hematological disorder that is not signed by a physician, but is accompanied by a report from your physician stating that you do indeed have the disorder.
- When there is not a lab report of a definitive test, a report from a physician that is persuasive in nature that indicates your diagnosis was confirmed by diagnostic methods or appropriate lab tests.
- The Social Security Administration will make every reasonable effort to get the results on the appropriate lab testing. However, costly, complex or invasive tests, such as bone marrow aspirations or clotting-factor proteins will not be purchased.
Looking at the category of impairments for an individual with sickle cell anemia, here are the determining factors that help Social Security decide if you are disabled:
- Painful crises that have been documented requiring either injected or IV narcotics at least 6 times within the last 12 months with at least 30 days between the episodes. OR
- Complications of anemia requiring at least three hospital stays within the last 12 months at least 30 days apart. Each hospitalization should last a minimum of 48 hours and can include time in the ER or comprehensive sickle cell disease center immediately prior to hospitalization. OR
- Hemoglobin measurements of 7.0 grams or less per deciliter at least three times within a 12-month period with 30 days in between the measurements.
If you meet one of the three factors, you may be eligible for Social Security Disability benefits.
Meeting Disability Criteria with an RFC
Just because you do not meet the Blue Book criteria does not mean you are not going to be approved for disability benefits. There are other ways to be approved as well. An RFC can help you gain approval for your disability benefits.
The residual functioning capacity (RFC) assessment is a form completed by doctors that clearly states what a patient can or cannot do. Having this form completed by your doctor can greatly increase your chances of being approved for Social Security Disability benefits. These are very detailed forms, indicating how long you can sit, stand or lie down without having to adjust. It indicates your medications, prognosis and expected duration of the disorder.
The Disability Determination team will consider the severity of your impairment, your age, your work history, your education and any transferable skills that can be used in another job. In the event that you have transferable skills, Disability Determination Services is much more likely to believe that there is another job you can do.
Applying Specific Medical Tests to Your Case
The Social Security Administration will have access to your medical records, but they may still order an examination from a doctor they employee to conduct disability examinations. The SSA will cover the costs of this exam. Sometimes mental evaluations are also ordered because certain conditions can impact stress levels, moods and cause depression as well and those things must also be considered. Any consultative examinations ordered by the SSA are not designed to provide you with medical treatment. Instead, they are designed to determine whether your claims regarding your physical limitations and capabilities and medical conditions are accurate.
The consultative examinations could include laboratory tests such as X-rays or blood work. With this particular health condition, sickle cell anemia, the doctor will be checking to determine that the blood disorder is far enough advanced that it causes you enough problems to keep you from working and doing the activities that you had done before.
You can still be determined as disabled at this advanced stage of the evaluation and determination process. With sickle cell anemia, you may experience pain, blood pressure problems and general health issues that may keep you from standing, walking, lifting or bending as frequently as someone who does not suffer from the disorder.
Getting Help with Your Sickle Cell Anemia SSD Application
Since sickle cell anemia can qualify for SSD benefits in several ways, you must work cooperatively with your doctor to ensure your documentation satisfies one procedural review requirements for eligibility. Doing so will help decrease your wait for a determination on eligibility and could increase your chances of receiving SSD benefits as well.
Additionally, as receiving a quick and favorable decision on your eligibility is your goal, you’ll want to consider the benefits of working with a Social Security advocate or disability attorney to complete your initial application and collect the appropriate documentation for supporting your claim.