Getting Disability Benefits for COPD, Asthma, or Other Respiratory Disorders
It can be tough to meet Social Security's disability listings for respiratory problems, but with your doctor's help, you can get benefits.
Updated October 21, 2016
Many Social Security disability applicants suffer from breathing problems that prevent them from meeting the demands of full-time employment. Disability applicants with severe breathing issues are most likely to be approved for benefits when their symptoms are documented by objective medical evidence, usually in the form of breathing tests. In the most serious cases, an individual can automatically qualify for benefits if he or she meets the requirements of a listing in Social Security's Blue Book. Others may be eligible for benefits by proving that they are unable to perform their past work or any other type of job.
Common Respiratory Disorders That May Cause Disability
COPD (chronic obstructive pulmonary disease) is an umbrella term that includes several lung diseases, including emphysema, bronchitis, and sometimes asthma, which cause coughing, wheezing, and shortness of breath. Those with COPD exhibit reduced breathing capacity due to obstructed airflow into and out of the lungs. The most common cause of COPD is smoking, and quitting smoking will usually stabilize symptoms, if not always improve them.
COPD is typically diagnosed through spirometry, a pulmonary function test that measures the amount of air that can be inhaled and exhaled over a certain period. Asthma can be partly diagnosed by a pre-bronchodilator and post-bronchodilator spirometry test, but a doctor must also look at the patient's medical history and physical exam.
Many of those diagnosed with COPD also suffer from sleep apnea, a condition which not only impacts the ability to obtain meaningful rest but can also severely impair daytime functioning. Sleep apnea is diagnosed based on a combination of self-reported symptoms and objective testing, typically a sleep study. The most common therapy is a CPAP machine, which pumps a steady stream of air into a mask to keep the airways unobstructed during sleep.
Another respiratory disorder, cystic fibrosis, is a life-threatening respiratory condition marked by a build-up of thick mucus in the lungs, liver, pancreas, and elsewhere in the body. The symptoms of cystic fibrosis include persistent coughing, pulmonary hypertension, shortness of breath, and frequent lung infections.
Social Security's Listings for Respiratory Disorders
Individuals who fulfill the requirements of a disability listing in Social Security's Blue Book are approved for disability benefits automatically. However, the SSA's listing requirements for respiratory disorders, like those for most other medical impairments, can be very difficult to meet. Here are some of the key listing requirements for respiratory disorders.
Listing 3.02 for Chronic Respiratory Disorders
COPD is evaluated under Listing 3.02 for chronic respiratory disorders. You'll meet the listing if a spirometry test has shown that your FEV1 (volume of air exhaled in one second) is equal or less then a given amount depending on your height. Table I-B in the listing states, for example, that an adult woman who is 5'5" meets the listing with an FEV1 of 1.35 or below.
Those with chronic restrictive ventilatory disease, which is marked by decreased lung volume, can also meet this listing based on the results of a spirometry test. If your FVC (forced vital capacity), the amount of air you can exhale after taking your deepest breath, is less than or equal to the amounts in Table II of the listing, you will meet the requirements of the listing.
The third part of listing 3.02 is for claimants whose lungs cannot properly oxygenate their blood. The important test results here are the DLCO (diffusing capacity of lungs for carbon monoxide), the PO2 (pressure of oxygen in arterial blood), and the PCO2 (pressure of carbon dioxide in arterial blood).
Alternatively, if you have been hospitalized for at least two days three times within a year due to your breathing problems (at least 30 days apart), you will be automatically approved for disability benefits.
Because the tables of lung function results in listing 3.02 are technical, you may wish to ask your doctor, preferably your pulmonary specialist, whether you meet the listing.
Listing 3.03 for Asthma
Persistent asthma attacks, defined as symptomatic episodes requiring hospitalization three times in a year, can meet listing 3.03. The asthma attacks must occur, despite following prescribed treatment, at least 30 days apart and must last at least 48 hours each. (Chronic asthmatic bronchitis may be evaluated under listing 3.02 for COPD, discussed above.)
Listing 3.04 for Cystic Fibrosis
There are several ways to meet the listing 3.04 for cystic fibrosis, including needing frequent hospitalizations or having low FEV1 results or oxygen saturation levels (SpO2).
Medical-Vocational Allowances for Respiratory Conditions
Only the most serious respiratory conditions are likely to come close to meeting one of the above Blue Book listings. Most of those who qualify for disability benefits do so based on a "medical-vocational allowance," which takes into account an applicant's age, education, work experience, and residual functional capacity (RFC) in deciding whether the applicant can perform any full-time work. Your RFC is a description of the physical and mental capabilities you possess in spite of your impairments.
In disability cases based on respiratory conditions, Social Security requires objective medical evidence, especially pulmonary function testing, to prove that the impairment is severe. Getting consistent treatment from an appropriate specialist such as a pulmonologist is also critical.
In addition to submitting relevant medical records, you should provide Social Security with an RFC form completed by your treating doctor. The RFC form should address your ability to walk, stand, lift, and carry. In respiratory cases, your doctor should also indicate if you have any restrictions with regards to dust, fumes, odors, or extreme temperatures. Prescriptions for supplemental oxygen or a CPAP machine should also be noted. Whether your doctor submits an RFC form indicating that your respiratory condition has caused you severe limitations can make or break your case.
Finally, many respiratory conditions, particularly COPD, become worse as one ages. If you're over 50, SSA's grid rules may make it easier for you to show that you're unable to perform full-time work.