Disability Determination for Chronic Pulmonary Insufficiency
Meeting the disability requirements outlined by Social Security will automatically approve you for benefits.
Updated November 18, 2016
Chronic pulmonary insufficiency occurs when your lungs cannot take in enough oxygen or expel enough carbon dioxide to keep your body healthy. The most common symptoms of chronic pulmonary insufficiency are coughing, chest pain, shortness of breath during exercise, and excessive mucus production. Chronic pulmonary insufficiency has many causes, including emphysema; chronic bronchitis; exposure to smoke, harmful chemicals, and air pollution; birth defects; sleep apnea; lung infection; or injury.
Can I Get Disability for Chronic Pulmonary Insufficiency?
If you meet the requirements for the Social Security Administration’s (SSA) listing for chronic respiratory disorders, your disability claim will be automatically approved. To win automatic approval, you must meet the requirements of one of the following four criteria in the listing for chronic respiratory disorders.
- A spirometry test has shown that your FEV1 (volume of air exhaled in one second) is lower than what is normal for your height, age, and gender. For example, Table I-B in the listing shows that an adult man who is 5'9" meets the listing with an FEV1 of 1.75 or below.
- A spirometry test has shown that your FVC (forced vital capacity, or 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. For instance, an adult woman who is 5'4" meets the listing with an FVC of 1.5 or below. (Those with chronic restrictive ventilatory disease would likely be assessed under this table.)
- A gas exchange test has shown that your lungs' ability to exchange oyxgen and carbon dioxide is seriously impaired, such as a DLCO (diffusing capacity of lungs for carbon monoxide) test, ABG test (which measures PO2, the pressure of oxygen in arterial blood, and PCO2, the pressure of carbon dioxide in arterial blood), or an SpO2 test (which measures oxygen saturation). The listing has several tables that list the required levels to meet this criteria.
- You have been hospitalized for at least two days three times within the past year (or within the year for which you are applying for disability benefits) due to your breathing problems (at least 30 days apart), you will be automatically approved for disability benefits.
If you don’t know whether you qualify for automatic approval from the material above, you should ask your doctor to review the SSA's listing for chronic respiratory disorders.
What If My Pulmonary Insufficiency Doesn’t Meet A Listing?
Even if your pulmonary insufficiency doesn’t meet a listing, you can still win your claim for disability. When an impairment doesn’t meet a listing, the SSA will prepare a residual functional capacity assessment (RFC) that details how your chronic pulmonary insufficiency has impacted your ability to work. For example, your illness may prevent you from working in environments that are dusty, that expose you to harmful chemicals, or that expose you to temperature extremes. You also may need to take time from your workday to self-administer a nebulizer or other breathing treatments. Your chronic pulmonary insufficiency might also limit how far you can walk and how long you can stand. These limitations would make it difficult for you to engage in most full-time work.
To make sure that the SSA considers all of your functional limitations in its RFC assessment, you should have your treating physician fill out an RFC for you so that the SSA can consider your doctor’s opinion when deciding your claim. For more information, see our article What Is Your Residual Functional Capacity?
What Are the Other Requirements for SSI and SSDI?
When you first apply for disability, the SSA will make sure that you meet the basic requirements for disability. You cannot be earning more than $1,170 from work (in 2017), and your disability must be expected to prevent you from working for at least a year.
In addition, SSDI is awarded only to applicants who have worked long enough paying taxes to the SSA. For more information, see our article on the SSDI requirements.
To qualify for SSI, which is need based, you must meet both an income and asset test. For more information, see our overview of the SSI requirements.