Residual Functional Capacity Assessment for Hepatitis & Chronic Liver Disease
What Is RFC?
If your liver disease 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. The lower your RFC, the less the Social Security Administration believes you can do.
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. An RFC for mental impairments is expressed in terms of whether Social Security Administration believes a claimant can do skilled, semi-skilled, or unskilled work in spite of impairments, or whether the claimant cannot even do unskilled work.
Factors to Consider
Evaluation of liver disorders that do not meet or equal the listing must take into consideration:
- Symptoms and their effect on your activities of daily living;
- The presence or absence of esophageal varices;
- History of esophageal bleeding;
- Severity of anemia (if any);
- You nutritional status;
- Hepatic enzymes, bilirubin, prothrombin time; and
- Whether your liver is massively enlarged.
Bleeding Esophageal Varices
If you have had bleeding esophageal varices, it is probably not reasonable to assess a RFC for more than light exertional capacity—especially if you have had prior massive esophageal bleeding. No-one has ever done a medical study to determine the risk of bleeding from varices as a function of weight lifted. But is not unreasonable to think that there could be at least a transient increase in esophageal vein pressure with lifting.
Variceal bleeding is extremely dangerous. It is reasonable for the Social Security Administration not to cite jobs that are likely to be life-threatening to a degree significantly disproportionate to the normal risks associated with a particular type of work. If the prothrombin time is prolonged, blood coagulation ability will be decreased and that further increases the danger of bleeding.
Bleeding is common in alcoholic cirrhosis of the liver, with studies reporting rates of bleeding in the range of 24% to 70% of cases. About 75% of individuals with alcoholic cirrhosis have anemia. Since this issue is not addressed by the listing, it is likely to be overlooked by the Social Security Administration adjudicator when determining the RFC. From the perspective of anemia alone, a hematocrit of 35% could hardly justify a RFC for higher than medium work. If you have cirrhosis, you may also have symptoms of fatigue and malnutrition that would restrict you to light or sedentary work.
When considering RFC, the Social Security Administration should take care not to disregard malnutrition. If you have ascites, your weight may be normal, yet you can still be very under-nourished. For example, you might have a large abdomen that is tense with ascitic fluid, but have wasted muscles in your arms and legs that greatly limit exertional capacity.
Important possible symptoms in any kind of significant liver disease are fatigue, weakness, nausea, and loss of appetite. Fatigue is subjective and perhaps particularly susceptible to being under-rated by Social Security Administration adjudicators. The Social Security Adjudicator is likely to unduly rely on liver function tests. Fatigue is known to be associated with liver disease and the Social Security Administration certainly has no evidence to the contrary.
An enlarged liver should be accompanied by appropriate exertional restrictions. Normally, the liver does not extend below the lower edge of the right rib cage. But when the liver is greatly enlarged, it is susceptible to rupture with blows to the abdomen and also is a source of discomfort, particularly when repeated bending is required.
Continue to Getting Your Doctor's Medical Opinion About What You Can Still Do or Chronic Liver Disease Data Sheet.
Go back to How to Get Disability Benefits for Hepatitis & Liver Disease by Meeting a Listing..