Respiratory disorders are medical conditions that affect your lungs' ability to function properly. The main function of your lungs is to provide oxygen to the rest of your body. But your lungs also:
Although each respiratory illness has its own specific symptoms and prognosis, they all affect your ability to breathe. If you can't breathe properly, you might not be able to work. Some lung diseases that can be debilitating include:
Here's what you need to know about getting Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits for your lung disease.
When the Social Security Administration (SSA) first reviews your disability application, the claims examiner will make several initial determinations, including the following:
Once Social Security has determined that you meet the non-medical requirements for SSDI or SSI disability benefits, the agency will assess whether you're medically qualified for benefits. Social Security must next answer the following questions:
If you meet these initial requirements, Social Security will determine whether your illness meets or equals one of the qualifying conditions in the respiratory section of the SSA's Listing of Impairments (also called the Blue Book). If your lung disease is a listed condition and meets all the requirements of the listing, Social Security will automatically approve your disability claim (see which conditions are listed below).
Social Security will need to determine whether your lungs function normally and, if they don't, the extent of their dysfunction. Social Security will consider all your respiratory symptoms, including:
But simply having these symptoms isn't enough to qualify you for disability benefits. For example, shortness of breath is a common condition in patients with respiratory disorders. But other conditions, like being out of shape, can also cause you to be short of breath.
Even if you suffer from shortness of breath, as long as your lung capacity is at least 80%, your lung function is considered normal. To prove your claim, you must provide Social Security with adequate medical records that do all of the following:
The most important information Social Security needs when evaluating your claim for disability based on your lung disease is the test results that show the extent of your lung disease. These should include the following:
Without this information, Social Security won't give much weight to the results of any other tests performed to prove that your respiratory disorder is disabling.
Social Security has specific requirements for the medical tests used to evaluate respiratory disorders. One lung function test Social Security will require is a spirometry test, which measures your "forced expiratory volume," or the amount of air you can breathe out. Although you might have had a spirometry test to evaluate your lung capacity, Social Security will likely send you to a consultative exam (CE)—at their expense—to be retested. That's because Social Security has strict standards when considering the validity of spirometry exams.
Also, the SSA won't consider outcomes of spirometry or arterial blood gas tests that were performed while you were acutely ill with diseases like pneumonia.
It's important that you put forth your best effort when undergoing a spirometry test. If the Social Security doctor giving you the test believes you haven't, that observation will be included in the CE report.
Social Security disability listing 3.0 discusses the respiratory disorders that can qualify for automatic approval. The respiratory disorders covered in the listings include:
Each disorder has its own complicated set of criteria you must meet in order to be automatically approved for disability benefits. But even if you don't meet the requirements of a listing, you might still qualify for Social Security disability benefits, but proving your case to Social Security can be more complicated. It might be helpful to talk to a disability lawyer about your impairments to get advice on how to present your case and the likelihood of winning your disability claim.
You can apply for Social Security disability in several ways. To apply by phone, call the national toll-free number 800-772-1213, and a Social Security representative will make an appointment for you to apply. The hearing-impaired can call the toll-free TTY number: 800-325-0778.
You can also apply in person at your local Social Security field office but contact the office first, as you might need an appointment to speak with a representative. Most offices are open Monday through Friday during normal business hours. You can also apply for SSDI online at your convenience.
Learn more about the Social Security application and appeals processes.