Hemic and lymphatic disorders refer to all diseases of the blood.  This category would include such disorders as lymphoma or leukemias (cancers of the blood), AIDS and an array of assorted anemias.  Significant blood disorders can cause symptoms of muscular weakness, pain, vertigo, headaches, ringing of the ears, fatigue and irritability.

General Evaluation

     Most blood disorders in and of themselves will not cause symptoms which are serious enough to totally disable a person, although there are exceptions which will be discussed later.  For the most part, blood disorders should be used as an additional impairment to the claimant who is suffering from another significant disorder.

     Most blood diseases are diagnosed by a combination of physical examination and a common blood test.  The most comprehensive and widely used blood test is the CBC.  With the CBC alone, a trained individual can spot several types of anemias and other more common blood cell abnormalities.  

     Disorders of the blood can involve abnormalities in blood cell size, shape, concentration, types, and cellular content.  Each of these abnormalities may cause anything from mild irritability to extreme muscular pain and death.  Since blood disorders are not necessarily specific in how they may affect a person, we will focus our attentions on some of the more serious hemotologic diseases. 

     The following is a list of blood disorders commonly seen by SSA.  We will discuss each disorder briefly, pointing out some of their more unique characteristics.

Anemia
Leukemia
AIDS
Sickle cell
Hemophilia

Anemias:

     Anemias are the most common blood disorders seen by medical professionals.  Anemias are not really a diagnosis as much as they are a symptom of some other underlying problem.  Normally, anemias are not significant and are a reaction to other medical conditions such as loss of blood or infection.  However, there are anemias which are very dangerous and can cause severe symptoms and even death if not properly treated.  

     Examples of some of the more dangerous anemias are thalassemia, aplastic anemia, sickle cell anemia, B12 or folic acid deficiency and autoimmune hemolytic anemia.  It is not necessary for you to understand the physiochemical processes which are behind anemic disorders.  But if you encounter any form of anemia, take the time to note its symptoms and prognosis.  This information alone will tell you if the anemic disorder is worth trying to argue.  Look for symptoms of long standing weakness or low energy levels. These symptoms can have an adverse effect on the claimant's ability to work and may add to your case.

Leukemias:

     Leukemia is a cancerous disorder of the tissues which form white blood cells.  White blood cells are used by the body to fight infections.   A significant increase in the number of these cells can have a serious impact on the human body.  Most individuals suffering from this disorder can be treated successfully with radiation and chemotherapy.  Both the condition and the treatment can cause a significant decrease in a claimant's ability to perform physical activity.

AIDS:  

    This disorder needs no introduction.  From an SSA disability standpoint, the claimant must have a positive serology test (HIV), lowered T-Cell count (less than 400) and an adequate description of the clinical findings associated with the disease in order to receive an allowance determination.  If the claimant is serum negative HIV and shows any of the standard secondary manifestations of this disorder, you may have a fight ahead of you.   In such a situation you must identify and discuss in detail the secondary symptoms and manifestations.  Information on the secondary manifestations of symptomatic HIV infections can be found in the Merck Manual.  

     First identify the secondary manifestations by looking them up in the Merck Manual or any other medical text you choose to use.  Identify and discuss the symptoms and effects of the secondary manifestations on your clients ability to perform work activity.  Point out the high probability of a worsening condition associated with this disorder.

     Identify those symptoms suffered by your claimant and discuss their restrictive aspects on the claimant's ability to work.  Also note and discuss any general symptoms the claimant may have such as recurrent infections and weakness.  Do not hesitate to include and discuss these symptoms in your argument, and show how they interact to reduce the claimant's overall ability to work.

     If the claimant's test is positive with no other symptoms, SSA may also deny the claim.  If this occurs, you will have to document a worsening of the claimant's disorder to get him benefits.   This can be done if the claimant develops any of the common symptoms and is showing a general state of physical decline.  The symptoms do not have to be extreme or permanent to show the physical decline.  If any of  the secondary manifestations erupt after a positive serology, the claimant should be allowed without difficulty.

     In representing AIDS cases in the first situation discussed above, you must be aggressive in your argument.  We are all well aware of the prognosis of this disorder, so don't hesitate to remind SSA of its poor prognosis in your argument.

Sickle cell anemia:

     This disorder is seen most often in people of African and Mediterranean ancestry.  It is a disorder which affects the actual shape of the red blood cell, causing it to be less efficient at carrying blood to the muscle and organ systems.

     This disorder can cause extreme pain which is associated with the decreased blood flow to the affected areas.  This condition often manifests itself in a series of crisis episodes which may completely incapacitate the patient.  If  the claimant suffering from sickle cell anemia has experienced at least two crises in one year, you have a good case.  Usually these crisis situations require a prolonged hospitalization and intense treatment.

     If a crisis situation occurs within a twelve-month period, argue for a significantly reduced RFC.  This disorder very often affects children.  If this is the case, you must formulate an argument showing how the disorder interferes with normal age-related activity.  Generally, these children will have a reduced exercise tolerance and may be in chronic pain.

     RFC reductions in sickle cell anemia should include most areas of physical strength.   This includes standing, walking for extended periods of time and any other activity which requires sustained physical activity.

Hemophilia:

     Hemophilia is a genetic disorder which causes a deficiency or abnormality in the coagulation factors of the blood.  In this disorder, the patient is unable to control bleeding.  If the individual suffering from this disease is injured, he could easily bleed to death without proper treatment. You can imagine that this disorder might prevent the claimant from performing a large number of job types.  Restrict a claimant with this disorder from any job, inside or outside, that might result in an injury.  This could effectively eliminate all physical labor which would limit the claimant to those jobs with higher educational requirements.

     Be sure to check for the possibility of an AIDS infection in these patients as well.  Although blood is now tested, you might be working with one of the unlucky victims of this tragic disorder.