Disability Determination for Lung Disease

You can get disability benefits for respiratory disorders if they severely affect your ability to work.

Respiratory disorders are illnesses that affect the lungs' ability to bring in the oxygen they need 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.

Lung diseases 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 Lung Disease?

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 2016, this amount is $1,130 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 Claims for Lung Disease?

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.

What Are Lung Function Tests?

The most important information the SSA needs when evaluating your claim for disability based on your lung disease are the results of x-rays, physical exams, and spirometry tests 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 has specific requirements for the medical tests used to evaluate your respiratory disorder. One lung function test is a spirometry test, which measures your "forced expiratory volume," or the amount of air you can breathe out. 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. Also, the SSA will not consider outcomes of arterial blood gas tests or spirometry tests that were performed while you were acutely ill with diseases like pneumonia. 

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.

Which Lung Diseases Are Included in Social Security's Disability 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. It may be helpful to talk to a disability lawyer about your impairments to get advice on the likelihood of winning disability benefits.

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