Pernicious Anemia and SCD: Can I Get Disability Benefits?

Pernicious anemia is an autoimmune disorder that prevents your intestines from properly absorbing vitamin B12. Because your body needs vitamin B12 to produce red blood cells—which deliver oxygen to your brain, tissues, and muscles—the condition results in anemia, a medical term meaning "lack of blood."

A related condition called "subacute combined degeneration of the spinal cord" (SCD) can occur when long-term vitamin B12 deficiency results in damage to the nerves of the spinal cord. As a result, SCD can compromise your ability to stand, balance, and walk effectively.

Disabling Symptoms of Pernicious Anemia and SCD

If you're unable to work full-time for at least one year due to symptoms from pernicious anemia or SCD, you might qualify for disability benefits from the Social Security Administration (SSA). Symptoms of pernicious anemia can vary greatly in severity from person to person, but commonly include:

• diarrhea or constipation
• fatigue
• light-headedness upon standing
• loss of appetite
• heartburn
• swollen, red tongue or bleeding gums
• mild jaundice (a pale yellow tint to the skin)
• difficulty concentrating, and
• shortness of breath.

Symptoms of SCD include:

• stiff, awkward movements or clumsiness
• changes in mental state, such as memory loss or irritability
• decreased vision
• depression
• sleepiness, and
• poor balance.

Keep in mind that not everybody with a diagnosis of pernicious anemia or SCD will be able to get disability benefits. Because the disorders are the result of a vitamin deficiency, treatment (which commonly involves a vitamin B12 shot or pill) is usually effective at eliminating symptoms. But if you have significant functional limitations from your symptoms, you'll have a better chance at being awarded benefits.

Qualifying for Social Security Disability Benefits

Social Security offers two disability benefits for people who are unable to work as a result of the above symptoms. Social Security Disability Insurance (SSDI) is available to people who've worked for several years before becoming disabled. Supplemental Security Income (SSI) is a needs-based program available to disabled people with limited assets and income.

In order to qualify for SSDI or SSI, you'll need to show that you either:

• meet or "equal" a listed impairment, or
• are unable to perform any jobs in the national economy.

A listed impairment is a medical condition that Social Security will consider to be "automatically" disabling, provided that your medical records contain specific evidence. The evidence you need is set out in the agency's "Blue Book" of listed impairments. If your symptoms aren't severe enough to meet or equal a listing, you'll need to show that you're unable to do any full-time work.

Meeting or Equaling a Disability Listing

Pernicious anemia and SCD don't have their own listings in the Blue Book. But the SSA can evaluate pernicious anemia under a related listing for hematological disorders, listing 7.18, and SCD that results in significant functional loss can be evaluated under listing 11.15 for spinal cord disorders.

Listing 7.18, Repeated Complications of Hematological Disorders

In order to meet the requirements of listing 7.18, you'll need documented medical evidence of "repeated complications" (worsening of symptoms) from pernicious anemia. For the purposes of the listing, complications are "repeated" when:

• they occur on average three times per year (or once every four months) and last at least two weeks
• they don't last as long as two weeks, but occur "substantially" more frequently than three times per year, or
• they occur less frequently than three times per year, but last "substantially" longer than two weeks.

You don't need to have the same kind of complication each time to meet the requirements of Listing 7.18. For example, if you have a flare-up of fatigue that keeps you bedridden for most of January, and in April you're hospitalized for two weeks due to joint pain, the SSA will count both complications towards meeting the listing.

Not only must your complications be "repeated" to meet the listing, but the symptoms must be "significant." You'll need to show that your symptoms cause a "marked" limitation in at least one of the following functional areas:

• activities of daily living, such as taking public transportation, paying bills, maintaining hygiene, cooking meals, and paying bills
• maintaining social functioning, such as interacting with people on a daily basis and keeping relationships with friends and family, or
• completing tasks in a timely manner, such as remembering to finish chores that you start.

It can be difficult to show that you meet this listing, since terms like "significant" and "marked" are vague and not well-defined. You can help increase your chances by having your regular doctor write a medical source statement explaining how your pernicious anemia limits your ability to function.

Listing 11.15, Spinal Cord Disorders

If your SCD has progressed to the point that you're unable to perform basic movements, such as standing up from a seated position, balancing while upright, or using your arms and hands, you may meet the requirements of listing 11.15. You can meet this listing by showing all of the following:

• your SCD affects a nerve root in your spine, causing pain, numbness, or fatigue
• you have physical examinations or diagnostic tests showing muscle weakness, nerve root irritation, and decreased sensations or reflexes
• you have medical imaging (such as an MRI or CT scan) showing a nerve root abnormality, and
• you're unable to independently use both upper extremities, both lower extremities, or one upper and one lower extremity.

Make sure that you submit all relevant medical evidence to Social Security when you file your application. Even if you don't meet all the listing criteria, the SSA may ask a medical consultant or medical expert to determine whether you equal a listing (and therefore can qualify for disability automatically the same as if you met the requirements exactly).

Getting Disability Because You Can't Work

You may be able to qualify for disability benefits even though you don't meet or equal a listing if your symptoms from pernicious anemia or SCD interfere with your ability to work full-time. Social Security evaluates your ability to work by looking at the physical and mental limitations in your medical record. Based on these limitations, the SSA assigns you a set of restrictions about what you can and can't do at work, a process the agency calls assessing your residual functional capacity (RFC).

Mild symptoms of pernicious anemia or SCD aren't enough to rule out all jobs. But if you have severe symptoms as a result of permanent damage, many, if not all, types of work can be eliminated for you. For example:

• Loss of balance could affect your ability to perform physical tasks as work, such as lifting or carrying items.
• Tingling in your hands could affect your ability to do physical tasks that involve fine motor skills.
• Depression and confusion could affect your ability to start and complete tasks at work and properly interact with others at work.
• Tingling and numbness in your hands and feet could limit your ability to safely perform jobs that require you to work at heights or around dangerous machinery.

Social Security compares your current RFC with your past work history to determine whether you can do those jobs today. If not, the agency will determine whether any other jobs exist in the national economy that you can do. Most people under the age of 50 will need to show that they can't do even the easiest, sit-down jobs, while people 50 years of age and older may qualify for benefits under the medical-vocational grid rules.

Conditions Related to Pernicious Anemia and SCD

Very few people who apply for disability benefits have just one condition that's affecting their health. Many disorders have symptoms that are comorbid (occur at the same time as) with pernicious anemia, SCD, or other conditions resulting from a vitamin B12 deficiency.

For example, people with the following diseases have a higher chance of developing pernicious anemia:

• Addison's disease
• chronic thyroiditis (Hashimoto's disease)
• Graves' disease
• Crohn's disease
• hypoparathyroidism
• hypopituitarism
• myasthenia gravis
• type 1 diabetes, and
• vitiligo.

The SSA is required to consider the effects of all your medical conditions combined when determining whether you're disabled. If you're not sure whether you meet a listed impairment or if you'd be able to work despite your limitations, consider contacting an experienced disability attorney to discuss your chances.

_{Updated August 2, 2023}