Does COPD Qualify Me for Social Security Disability?

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Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), refers to a group of lung conditions that make it difficult to breathe. Chronic bronchitis (mucus-producing cough) and emphysema (destruction of lung tissue) are the two main conditions, which often occur together. The main symptoms of COPD are shortness of breath (dyspnea) and limited airflow, and the main cause of COPD is smoking.

Disability benefits are available for people who have severe cases of COPD. The Social Security Administration (SSA) lists the requirements that you must meet for your case to automatically qualify for benefits, under the official impairment listing for chronic pulmonary insufficient (listing 3.02), but if you don't meet the official listing, you may still be able to prove that your COPD reduces your capacity to work to such an extent that there’s no work you can do.

Requirements for Chronic Pulmonary Insufficiency

If you have been diagnosed with chronic obstructive pulmonary disease, due to any cause, and your FEV1 measurement (forced expiratory volume in one second, meaning the amount of air you can exhale in one second), is equal to or less than the amount on the chart below, you will automatically qualify for benefits.

Height FEV1(liters)
5' or shorter 1.05
5'1"-5'3" 1.15
5'4"-5'5" 1.25
5'6"-5'7" 1.35
5'8"-5'9" 1.45
5'10"-5'11" 1.55
6' or taller 1.65

 

In some cases, such as advanced emphysema, you may also be suffering from an impairment of gas exchange – that is, the lungs’ ability to absorb oxygen and expel carbon dioxide. If the FEV1 test did not establish your level of functional impairment, the SSA will consider the results of DLCO (diffusing capacity of the lung for carbon monoxide) or ABGS (arterial blood gas values of oxygen and carbon dioxide) tests to see if they meet the severity required in listing 3.02. But if your FEV1 tests satisfy the requirements for disability, you won’t need these further tests.

Qualifying for Disability Benefits Due to Reduced Functional Capacity

If your lung function hasn’t deteriorated to the point that you can’t qualify under the above impairment listing – for instance, if you are over 6 feet and your FEV1 value is 1.75 liters rather than the 1.65 liters required for the test – you would be denied under the official Social Security listing. However, you might be able to qualify for disability benefits if your COPD has reduced your functional capacity to such an extent that there is no work you can do, given your age, education, and experience.

The SSA will give you a rating (called your residual functional capacity, or RFC) of the type of work it thinks you can do (sedentary work, light work, medium work, or heavy work) based on your test results and your doctors’ restrictions (such as no lifting and carrying objects weighing more than 25 pounds, no working near fumes or dust). For instance, if you cannot stand or walk for six to eight hours per day, you should receive a sedentary RFC. If your FEV1 value is very close to the listing requirement, above, you should also get a sedentary RFC.

The lower the RFC, the fewer jobs you can do. If the SSA determines there are no jobs you can be expected to do with your RFC, there’s a chance you could qualify for disability benefits under what’s called a medical-vocational allowance, but your chances are low unless you are over 50. For instance, if you have a sedentary RFC, you might be considered disabled if you are over 50, have a high school education, and have limited skills. But if you are younger than 50 and literate, the SSA will presume that there are jobs you can do, and that if you don’t have the skills, you can learn them.

Medical Evidence for COPD

The SSA will request your medical records from your treating doctor. Your records should include your diagnosis (COPD, bronchitis, emphysema, or all of the above), all test results, such as lung function tests, chest x-rays, and the results of a physical examination, and all treatments tried, such as bronchodilators and steroids. Your records should also include how and why your doctor thinks your reduced lung capacity impairs your ability to work.

In addition, your doctor should address whether your condition is likely to improve, stay the same, or get worse, and whether you experience acute exacerbations of symptoms caused by dust, fumes, allergies, or air pollution. To get Social Security disability benefits, your disability must have lasted or be expected to last at least twelve months. The effects of COPD are usually irreversible, and the symptoms often get progressively worse, so it’s likely that the SSA will believes you won’t improve within 12 months.

The SSA will pay for any pulmonary function test it wants you to take. The FEV1 test is the most important test for diagnosing the severity of COPD. Your FEV1 measurement is taken by using a spirometer, and the procedure is repeated three times, using a bronchodilator if needed. The SSA will use the highest reading. If whoever gives you the spirometer test doesn’t think you blew as forcefully as you could, you will have to take the test over.

Applying for Disability Benefits for COPD

Call the SSA at 800-772-1213 to set up an appointment to submit an application through your local SSA office. Once you have submitted all necessary medical and financial information to the SSA, a claims examiner and a medical consultant will consider your claim, send you for lung function tests if needed, and make a decision on your entitlement to SSI or SSDI disability benefits. 

by: , J.D.

This article is provided for informational purposes only. If you need legal advice or representation,
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