Residual Functional Capacity Assessment for Asthma
What Is RFC?
If your asthma 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. 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. The lower your RFC, the less the Social Security Administration believes you can do.
The Social Security Administration should carefully assess your RFC assessment because the severity of asthma may fluctuate depending on how effective treatment has been. Consequently, your RFC should not be based as strongly on the results spirometric testing (testing of how much air a person can inhale and exhale) as it is for other types of chronic obstructive pulmonary disease (COPD). See Meeting Social Security Administration Listing 3.03A for Asthma for more on spirometry.
Your own reports of your symptoms can be especially important. See how Keeping a Symptom Diary and Record of PEF Can Help You Win Social Security Disability Benefits.
Exercise-induced asthma, also known as exercise-induced bronchoconstriction (EIB), is particularly difficult for the Social Security Administration to evaluate since the severity will not necessarily be revealed by spirometry (testing of how much air you can inhale and exhale) which is obtained while you are at rest and not exercising. See Meeting Social Security Administration Listing 3.03A for Asthma for more on spirometry. However, if you have this type of asthma, your doctor’s medical records that document the details and severity of your attacks have considerable credibility with Social Security Administration—especially if those records document a problem over a long period before you applied for benefits. See also how Keeping a Symptom Diary and Record of PEF Can Help You Win Social Security Disability Benefits.
In determining your RFC, Social Security Administration must consider whether your condition is aggravated by environmental factors and whether you must avoid jobs that would expose you to those factors. Avoiding exposure to dust, gases, pollution, and inadequate ventilation may be especially important to a person with asthma.
Sometimes a person’s asthma attacks are precipitated by substances inhaled in the workplace (allergens). If your symptoms get better over the weekend and worsen during the week when you go back to work, something at your job may be causing your attacks. If so, it is important that problems related to workplace exposure be documented in your medical records. Make sure you report them to you doctor. Exposure to even small doses of the problem substance can precipitate worsening of asthma or even be lethal. Animal studies have demonstrated life-threatening reactions (e.g., fall in blood pressure) in as little as a millionth of a gram (microgram) of allergen delivered to the bronchial tree of susceptible dogs.
In determining whether you can do past relevant work at Step 4 of the Sequential Evaluation Process and whether you can do any other work at Step 5 of the Sequential Evaluation Process, the Social Security Administration should not find that you can do work that would bring you into contact with a substance that is known to precipitate your asthma.
Occupational hazards for asthma sufferers are not limited to the above examples; several hundred work-related allergens have been identified. Industrial workers can be exposed to various enzymes, chemical fumes, metallic dusts, plastics, or other particulate chemicals that are potential sources of asthma.
In addition to limitations from exposure to specific allergens to which you may be exquisitely sensitive, the Social Security Administration should not find that you can do any jobs involving exposure to excessive dust or fumes of any kind as the irritating effect on the bronchial mucosa could worsen your symptoms.
Keeping a Symptom Diary and Record of PEF Can Help You Win Social Security Disability Benefits for Asthma
If you have asthma, you should keep a diary of your symptoms and also a record of your peak expiratory flow (PEF). The symptom diary should relate your symptoms to your activities. Documentation of worsening air flow under different conditions, like exercise in cold air, not only helps your treating physician give the most appropriate therapy but also helps the Social Security Administration understand how severe your asthma is.
You can measure PEF with a small, hand-held device known as a peak flow meter. PEF is useful in monitoring fluctuations in your condition. All that is required is blowing into the peak flow meter, but proper effort and technique must be used. Your treating physician should be able to train you to use the meter properly.
In evaluating how severe your asthma is, the Social Security Administration considers two issues:
- How well is your asthma controlled in regard to normal lung function, and
- How stable is the control?
Without knowing the answer to both of these questions, it is difficult for the Social Security Administration to assess severity of your condition. A person who has normal PEF values may still be impaired, because control might fluctuate. Similarly, a person might have good control but the baseline chronic lung disease is so severe that marked limitation is present.
The Social Security Administration will look at the FEV1, as measured by formal spirometry (a test that measures how much air you can inhale and exhale), to determine the severity of the chronic and unchanging component of your lung disease. See Meeting Social Security Administration Listing 3.03A for Asthma for more on spirometry. But spirometry testing doesn’t provide information about severity of your asthma that may fluctuate day to day. PEF values and a symptom diary can provide that information.
If your case is a borderline case that nearly meets a listing, a detailed symptom diary and PEF information could make the difference. They may provide the Social Security Administration with sufficient information to find that your disability is equivalent to a listing and that you are entitled to disability benefits. And even if you do not qualify for disability benefits under a listing, a diary and PEF information could have a considerable impact on the Social Security Administration’s determination of your RFC. See Residual Functional Capacity Assessment for Asthma.
Even if you don’t measure PEF with a meter, keep a symptom diary. A diary of symptoms without PEF measurements is better than no information about symptoms, or just general comments about shortness of breath. But a diary in combination with PEF measurements is best. Even if you keep a dairy, you may not notice deterioration in your condition. PEF measurements allow earlier awareness of air flow deterioration, and may provide additional useful objective information regarding functional limitations.