Social Security Benefits for Chronic Obstructive Pulmonary Disease (COPD)

If you suffer from chronic bronchitis or emphysema, called COPD (Chronic Obstructive Pulmonary Disease), you may be eligible to receive Social Security Disability benefits if the condition impacts your ability to work.

The Social Security Administration (SSA) oversees the Social Security Disability Insurance (SSDI) program. In order to be eligible to receive SSDI, you must have worked enough to have earned sufficient credits and to have paid in an adequate amount of taxes to the SSA. Your medical condition must also be serious enough that it meets the criteria set forth by the SSA for you to be considered fully and permanently disabled.

Applying for SSDI benefits can be complicated and lengthy, but supplying as much documentation as you can upfront or early in the claims process can help your odds of approval significantly. Medical records, physician notes, and documentation showing how your illness has impacted you are all necessary to prove your case.

COPD is a listing level disease, which means that if your COPD does meet the listing requirements set forth in the SSA medical guide, the SSA will not have to evaluate whether or not your functional capacity is restricted to a specific degree. COPD can be a very serious health condition that impacts your ability to function in daily activities as well as your ability to work.

Social Security Benefits for COPD

The Cost of Treating COPD

The National Center for Biotechnology Information reported that during 2010 the cost of treating COPD in the United States was believed to be around $49.9 billion. Dividing that figure up, $30 billion of those expenses are in direct health care expenditures while the other $20 billion is in indirect costs. Broken down, it is about $4,000 per COPD patient per year. These costs are expected are to continually rise in the future.

The SSA Evaluation and Medical Qualifications

The SSA has a medical guide to determine whether an individual is disabled per the SSA guidelines. This medical guide is known as the Blue Book. To qualify for benefits based on a Blue Book listing, you must have been diagnosed with COPD.

The SSA will hire a consulting doctor to perform a lung functioning test. The test must reveal that you are experiencing limited airflow. The test will include a spirometry test that documents your FEV1 value; this is how much volume you forcefully expel within a second. This test measures the how much air you can exhale by volume in a second.

This amount varies based on your height without shoes. As an example, someone with a height of up to 5 feet should exhale 1.05 liters. People who are 6 feet and taller should exhale 1.65 liters. There is a chart with specific heights and FEV listed.

If you do not have a problem with the air circulating out or in your lungs, COPD could cause you to have a problem with properly oxygenating your blood. If this is the case, you may be eligible for SSDI benefits because of a poor (DLCO) diffusing capacity of the lungs for carbon monoxide. Another way to qualify is by ABG, which is the arterial blood gas values of oxygen and carbon dioxide.

The Blue Book lists the values for these tests that approve an individual for disability benefits based on their COPD under section 3.00 - Respiratory System.

Meeting Disability Criteria with a Reduced Capacity for Work

If you don’t meet the Blue Book guidelines for disability approval, you can still be qualified for benefits by showing your residual functioning capacity (RFC) has been limited. An RFC is a form that details your ability to work or participate in regular daily activities. If you show that your COPD has reduced your breathing capacity to such an extent that there is no work that you are able to do, or at least no jobs that you know how to do based on your age, work experience, health condition, and education levels.

In order to use the RFC approach, you need to prove that your breathing capacity and your ability to exert yourself are at such a low level you are unable to work. You doctor needs to complete the RFC to show his medical opinion of activities that you can and cannot do. As an example, you cannot lift more than 10 pounds, walk no more than an hour at a time, stand no more than two hours at a time, and you cannot be exposed to dust or fumes.

The SSA will then give you a RFC assessment that states the kind of work that you can conduct based on your doctors’ restrictions and your breathing test results. This can range from sedentary work to heavy work. If you have a low FEV1 value, which is near the Blue Book listing, you should be assigned a sedentary RFC, which means you are only suited for desk work. If it is determined your education, age, and experience prevent you from doing desk work, you will be approved for SSDI benefits.

Those who are older or less educated have better chances of receiving benefits when those details are combined with the medical conditions and symptoms. Also, please include information about any other medical conditions that you have and how they impact you. Those can be combined with the COPD diagnosis and be used to help you win your benefits claim.

Applying Specific Medical Tests to Your Case for Disability

As mentioned earlier, COPD is determined by lung functioning tests. The spirometry test and blood work that shows you have poor diffusing levels capacity of the lungs for carbon monoxide (DLCO). You may also be asked to have a test to determine arterial blood gas values of oxygen and carbon dioxide (ABG).

The SSDI application process can be very complicated and time consuming. Provide as much documentation up front to speed up the process. You could face up to two denials on your claim. If you disagree with these decisions, file an appeal and move on to the next level. The last step would be to go for a hearing before an administrative law judge.

To start the application process for SSDI, call 1-800-772-1213 or visit the SSA website. You may also want to talk to your physician to see how he or she could help you with your claim.

Chronic Obstructive Pulmonary Disease and Your Social Security Disability Case

It is not uncommon for a patient suffering from COPD to be denied disability benefits at the initial stage of the Social Security Disability application process. In fact, only 30 percent of applications are approved at this stage of the process. You may want to consider hiring a disability lawyer to represent you in your effort to obtain disability benefits. Your chances of filing a successful Social Security Disability claim are statistically much greater with proper legal representation.