Getting Disability Benefits for Respiratory Disorders

Respiratory disorders are illnesses that affect the lungs' ability to bring in the oxygen it needs to function properly. The main function of the lungs is to provide oxygen to the body, but the lungs also remove carbon dioxide, help regulate body temperature, maintain the pH balance in the body, and make hormones and other chemicals needed to sustain a healthy body. Respiratory disorders caused by lifestyle, genetics, and environmental toxins can interrupt these lung functions, leading to a person's inability to work.

Respiratory disorders include asthma, chronic obstructive pulmonary disease, sarcoidosis, cystic fibrosis, chronic lung infections, and lung cancer. Although each illness has its own specific symptoms and prognosis, the common result is the inability of the patient to breath effectively.

Can I Get Disability for My Respiratory Disorder?

When the Social Security Administration (SSA) first reviews your disability application, it will make several initial determinations:

• Whether you are engaged in substantial gainful activity (known as “SGA”—in 2012, this amount is $1,010 per month).
• Whether your respiratory illness has lasted, or is expected to last, at least 12 months.
• Whether your respiratory illness is “severe,” that is, has a significant impact on your ability to perform basic work activities.

If you meet these initial requirements, the SSA will then determine whether your illness meets or equals one of the qualifying conditions in the respiratory section of the SSA’s Listing of Impairments. If your respiratory disorder is a qualifying condition and meets all the criteria, you will be automatically approved for disability (see below).

What Does the SSA Consider When Reviewing Respiratory Disorder Claims?

The SSA will consider your respiratory disorder symptoms, such as whether you suffer from shortness of breath, whether your lungs function normally, whether you suffer from chest pain, or whether you experience bloody sputum when you cough.

However, symptoms alone will not result in an approval for disability. For example, although shortness of breath is a common condition in patients who suffer from respiratory disorders, it can also be caused by being out of shape or by other medical issues. Also, even if you suffer from shortness of breath, as long as your lung capacity is at least 80%, your lung function is considered normal.

Therefore, it is imperative that you provide the SSA with your longitudinal medical record dating back to when your respiratory disorder first prevented you from working, that details the symptoms of your respiratory disorder and the results of all lung function tests.

The Importance of Respiratory Test Results

The most important information the SSA needs when evaluating your claim for disability based on your respiratory disorder are the results of x-rays and physical exams that show the extent of your lung disease. Without this information, the SSA will likely not accept the results of any other tests performed to prove that your respiratory disorder is disabling.

The SSA also has specific requirements for the medical tests used to evaluate your respiratory disorder. For example, the SSA will not consider outcomes of arterial blood gas tests that were performed while you were acutely ill with diseases like pneumonia. Also, although you may have undergone a spirometry test to evaluate your lung capacity, the SSA will likely send you to a doctor they have hired to re-administer the test. This is because the standards set by the SSA are high when considering the validity of spirometry exams.

It is important that you put forth your best effort when undergoing a spirometry test, because the SSA doctor giving you the test will make a notation if he or she believes you have not. If the SSA orders its own spirometry test, it will take longer to decide your claim.

Respiratory Disorders Listings

Listing 3.0 of the SSA's disability listings discusses the respiratory disorders that may qualify a claim for automatic approval. The respiratory disorders covered in the listings are:

• asthma
• chronic pulmonary insufficiency (caused by any illness, such as chronic obstructive pulmonary disease, or COPD)
• cystic fibrosis
• pneumoconiosis
• bronchiectasis
• chronic bacterial or fungal lung infections (such as tuberculosis or pneumonia)
• cor pulmonale, secondary to chronic pulmonary vascular hypertension disorders
• sleep-related breathing disorders, and
• lung transplants.

Each disorder has its own complicated set of criteria you must meet in order to be automatically approved for disability benefits. Follow the links above for an explanation of the disability qualifications for those illnesses.