Residual Functional Capacity Assessment for Diabetes
What Is RFC?
If your diabetes is not severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process, the Social Security Administration will need to determine your residual functional capacity (RFC) to decide whether you are disabled at Step 4 and Step 5 of the Sequential Evaluation Process. RFC is a claimant’s ability to perform work-related activities. In other words, it is what you can still do despite your limitations. An RFC for physical impairments is expressed in terms of whether the Social Security Administration believes you can do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.
Some people can have diabetes for many years with no significant symptoms or functional limitations. While serious organ damage—such as to the kidneys or eyes—may appear as soon as 10 years after diagnosis, some Type 1 diabetics are highly functional after more than 30 years of insulin dependency.
If you have brittle diabetes you will likely be limited to light work and work that does not expose you to environmental extremes of heat and cold. If your blood glucose is already unstable, and you have numerous fluctuating symptoms, medium and heavy work would probably be unsustainable.
Diabetic Neuropathic Foot Ulcers and RFC
Neuropathic foot ulcers that develop in about 15% of patients with diabetes are a frequent cause of hospitalization and account for 85% of the reasons for amputation. They are also expensive to treat—a single foot ulcer costs about $28,000.00 over a period of two years.
If you have a foot ulcer as a result of your diabetes that has not required amputation, the Social Security Administration will need to assess your RFC. Foot ulcers are extremely debilitating in their effect on the ability to stand and walk for prolonged periods. Pain is not necessarily an issue—pain may be minimal as a result of neuropathy (nerve damage). But standing will put pressure on an ulcer and make it worse. If you have an unhealed ulcer on the bottom of your foot, you should be precluded from even sedentary work, and be eligible for disability benefits provided that the ulcer has lasted or is expected to last at least 12 months.
If you have a history of recurrent diabetic foot ulcers anywhere else on the foot, there is a good chance that the Social Security Administration will find that your RFC is limited to sedentary work, even if you have no current ulceration. It is well-established that healing cannot take place without protecting an ulcer from mechanical pressure. Various methods have been used to relieve pressure from ulcers, such as casts, boots, special shoes, and foam padding. It is doubtful that any of these measures could be effective in the healing of a current ulcer with prolonged standing and walking 6 to 8 hours daily, or in the prevention of recurrent ulceration in a susceptible foot with a history of easy recurrence with prolonged standing and walking.