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 spinal cord nerves. As a result, SCD can compromise your ability to stand, balance, and walk effectively. If you have symptoms of pernicious anemia or SCD that keep you from working full-time for at least one year, you may be eligible for Social Security disability benefits. Before you apply, it’s a smart move to learn some basics of the disability determination process and what evidence you’ll need to qualify.

When Is Pernicious Anemia or SCD Considered a Disability?

Social Security can award you disability benefits when symptoms of pernicious anemia or SCD keep you from earning at or above the level of substantial gainful activity for twelve months or longer. Simply having a diagnosis of the disorder isn’t enough to be considered disabled. You’ll need to show that these symptoms result in functional limitations that either meet the requirements of a listed impairment or are so severe that they rule out all kinds of jobs.

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 may include:

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

Because pernicious anemia and SCD result from a vitamin deficiency, treatment (which commonly involves a vitamin B12 shot or pill) is usually effective at eliminating symptoms. If supplemental vitamins work well in managing your disorder, it’s unlikely that you’ll have a strong disability claim. But if you have significant functional limitations from your symptoms, you’ll have a better chance at being awarded benefits.

Meeting a Disability Listing for Pernicious Anemia or SCD

Pernicious anemia and SCD don’t have their own listings in Social Security’s Blue Book of medical impairments that can be automatically disabling, but the agency can evaluate these conditions under related listings for hematological (blood) or musculoskeletal (bone) 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, Social Security 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 1.15, Disorders of the Skeletal Spine With Nerve Root Compromise

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 1.15. 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 agency 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).

Showing That You Can’t Work Because of Pernicious Anemia or SCD

You may still be able to qualify for disability benefits without meeting or equaling a listing if pernicious anemia or SCD interferes 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 agency assigns you a set of restrictions about what you can and can’t do at work, a process called assessing your residual functional capacity (RFC).

Your RFC is a short statement about what you can and can’t do in a work environment. Social Security looks at your medical records and your activities of daily living questionnaire to determine which activities you can safely perform and which activities you should avoid. Restrictions can be physical (such as limiting how much weight you can lift and how long you can sit, stand, or walk) and mental (such as limiting the skill level of tasks you can do).

Most people have a combination of physical and mental limitations in their RFC. The more restrictions you have in your RFC, the less likely there will be any jobs available that you can perform in the national economy. 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 younger than 50 will need to show that they can’t do even the easiest, sit-down jobs in order to get approved for disability, while people 50 years of age and older may qualify for benefits under the medical-vocational grid rules.

How Much Will I Get in Disability If I Win?

The amount of money you’ll get in disability benefits doesn’t depend on the type of medical condition you have. Instead, Social Security will calculate your benefits based on your eligibility for one of the two disability programs the agency administers. 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. You can learn more about these programs—and estimate your benefit amount— in our article on SSDI and SSI monthly check amounts.

Filing for Disability Benefits

Applying for SSDI or SSI is a fairly straightforward process. You can choose from one of the methods below to begin your claim.

• One easy way is to file online. You don’t have to complete the application in one sitting, and you’ll get a tracking number so you can check the status of your claim.
• You can also apply over the phone by calling Social Security at 800-772-1213 (TTY 800-325-0778) 8 a.m. to 7 p.m., Monday through Friday.
• If you prefer to file in person, you can schedule an appointment with a representative at your local Social Security field office.

Don’t delay filing because you don’t have all the documents or information you need, as waiting to apply could reduce the amount of disability back pay you can get. Social Security will help you gather whatever you’re missing, including your medical records.

What If My Application is Denied?

Few disability applicants are awarded benefits on their first try, but you can appeal a denial. You’ll need to first request reconsideration of your application before you can ask for a hearing with an administrative law judge. Most people who are awarded disability don’t get approved until after a hearing with a judge, a process that can take about a year (or more, in some cases.)

You aren’t required to get legal assistance during any part of the disability determination process, but it can be a good idea. An experienced lawyer can help you gather the evidence you need to show that you’re disabled and can handle communications with Social Security so that you don’t miss any important appeal deadlines. Disability attorneys work on contingency (meaning they get paid only if you win) and many offer free consultations, so it doesn’t hurt to ask around to find a lawyer you like.