Residual Functional Capacity Assessment for Lupus
When your lupus 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 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 SSA believes you can do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the SSA believes you can do.
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.
No case of SLE should be adjudicated without a detailed history and physical examination and all relevant laboratory tests. Your longitudinal medical records should be carefully reviewed to identify exacerbations and improvements in your clinical condition, since manifestations of SLE can both change and fluctuate in severity.
Because lupus may have such a broad range of effects (see Effects of Lupus), a wide spectrum of possible RFC limitations is possible. Some claimants with SLE have no symptoms because they have had a complete remission with treatment. However, the Social Security Administration adjudicator should not overlook alleged easy fatigability just because you have no unusual results from a physical examination in a resting state.
Environmental limitations against exposure to cold, based on your own statements about tolerable temperatures, can be important. You could also have difficulty tolerating work in hot environments—simply because of the debilitating effect of chronic disease and perhaps medication.
The Social Security Administration should carefully consider the possibility of mental manifestations of lupus, especially if your lupus appeared during childhood. Neuropsychiatric abnormalities in SLE such as headache, mood disorder, and cognitive disorder, are common.