When Does Cystic Fibrosis Qualify for Disability Benefits?

Cystic fibrosis (CF) is an inherited disorder that causes the mucus in a patient's lungs and pancreas to become sticky and thick. The thick mucus in the lungs makes it difficult to breathe and increases the chance for lung infections and other respiratory complications. The mucus also affects your digestive tract and prevents your body from absorbing nutrients from food. People with CF also lose large amounts of minerals through their sweat, which leads to numerous health problems. Over time, CF usually leads to permanent lung damage and disability.

Treatment for Cystic Fibrosis

Treatment for CF includes physical therapy to the chest (to help remove the thick mucus), antibiotics to avoid infection, other medications, exercise, nutritional support, and pulmonary rehabilitation. Oftentimes CF patients must be hospitalized while undergoing treatment. As medical advances are made, the prognosis for CF patients continues to improve, but most patients with CF have a shortened life span.

Can I Get Disability for My Cystic Fibrosis?

For most children with CF, the condition doesn't become disabling until sometime in adulthood, when lung disease usually begins to interfere with normal functioning.

The Social Security Administration (SSA) will automatically approve a CF patient for disability benefits if he or she meets the criteria in its disability listing for severe cystic fibrosis. To be eligible for automatic approval under Social Security's cystic fibrosis listing, you must be diagnosed with CF and have one of the following conditions:

• A chronic lung infection with recurring bacterial infections that cause symptoms at least once every 6 months that are severe enough to need antibacterial treatment by I.V. or nebulizer.
• Repeated bouts of pneumonia, hemoptysis (coughing up blood), bronchitis, or respiratory failure that:
  • Require the assistance of a doctor or hospital, and
  • Occur at least once every two months or at least six times a year (note that if you are in the hospital for more than 24 hours, the SSA counts this as two episodes).
• A forced expiatory volume (FEV1) test that qualifies under the cystic fibrosis listing (see the chart below). FEV1 is a measure of how much air you can force out of your lungs in the first second of exhalation.

If your FEV1 test is the same or worse as the above quantities, you will automatically qualify for disability benefits, subject to the standard SSDI and SSI requirements below.

However, with the possible exception of the FEV1 test, you may not know whether your condition meets the above requirements. You should consult your treating physician to see if your CF meets the SSA's CF listing criteria.

Note that the first two qualifying conditions above must be documented over a period of one year so that the SSA can assess how often the repeated infections are occurring.

A frequent complication of CF is bronchiectasis, which has its own disability listing.

What If I Don't Qualify Under the Listing?

If you suffer from CF but don’t meet the above requirements (say your FEV1 test results aren't quite as bad as those in the chart), you still have a good chance of getting approved for benefits. The SSA will look at how your CF is affecting your ability to work. The agency will put together an "RFC," a residual functional capacity assessment, that details any work-related limitations that stem from your CF. For example, CF patients often must undergo lengthy daily treatments to control their CF, such as chest percussion therapy to drain excess fluid from the lungs or nebulizer treatments. If you would need frequent breaks or extended time away from work during the day to undergo treatment for your CF, the SSA would likely find that this limitation precludes full-time work, and would find you disabled. In addition, because the lungs of CF patients are compromised, your RFC should state if you need to avoid temperature extremes, dust, fumes or other environmental restrictions.

After your RFC assessment, the SSA will decide if you can perform any kind of work with your functional limitations. For this reason, it's important to ask your treating physician to provide the SSA with his or her residual functional capacity assessment, detailing your limitations. For more information, see our article on RFC assessments.

Standard Requirements for SSDI or SSI

All applicants for disability must meet several standard conditions: you must not be earning more than $1,040 or more per month through work, and your inability to make more than that amount must be expected to last at least a year.

In addition, for SSDI benefits, you must have worked a certain number of years at a job that paid Social Security taxes; for more information, see our section on SSDI eligibility.

For SSI benefits, you must come under the income and resource limits; for more information, see our section on SSI eligibility.