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
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.
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
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
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
The Judge has the discretion to
decide if a personís 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.