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Obtaining Social Security Disability for COPD

Obtaining Social Security Disability for COPD

Chronic obstructive pulmonary disease (COPD) isn’t just one disease but a constellation of lung disorders that include chronic bronchitis and emphysema. No cure for COPD currently exists but oxygen supplementation, bronchodilators and oral steroids can help slow progression of the disease and provide some symptom relief. Early signs of COPD involve coughing that produces mucus, becoming short of breath easily, tightness in the chest area and a whistling or wheezing noise when the person breathes. Individuals with COPD often suffer from recurring respiratory infections that exacerbate symptoms.

Cigarette smoking is the most common cause of COPD globally. In fact, COPD is the fourth leading cause of death in the U.S. COPD is also one of the top health reasons people seek social security disability benefits when they can no longer work or even take care of themselves. Not only does COPD make it difficult to breath, this chronic disease can also reduce functioning of major organs due to low oxygen levels in the bloodstream and compromise of the immune system.

The Social Security System does provide SSD for people with chronic obstructive pulmonary disease and medical conditions arising from complications of COPD. Individuals over 50 years old typically have an easier time being approved because the SSA uses a medical-vocational grid to determine eligibility. Unless younger claimants can prove their COPD symptoms are moderately severe or severe, they may be need to appeal several times before getting approved for SSD benefits.

What is the SSA’s Medical-Vocational Grid?

The Social Security Administration considers the ability for individuals over 50 to perform old skills or learn new skills is limited compared to people under 50. For this reason, SSA application evaluators rely on “grids” to determine SSD eligibility for older people with COPD. Factors included in the medical-vocational grid include:

  • Age
  • Education level (high school/college grad/vocational certifications)
  • Previous employment/skills related to that employment
  • Any new skills learned after leaving previous employment sector
  • Claimant’s residual functional capacity (RFC)

An example of how the SSA determines approval of COPD disability when this grid is used would be rule 201.3. This rules states that a person of “advanced age” (over 55) who is skilled or semi-skilled with transferable skills but limited education is considered “not disabled” if their COPD symptoms are not severe enough to prevent them from working.

Residual Functioning Capacity

The Social Security Administration defines residual functioning capacity as a claimant’s “ability to work full-time on a sustained basis”. The medical documentation provided by applicants is vital to ensuring the SSA gets a clear, objective picture of what the applicant can and cannot do. RFC ratings are given to evaluate a person’s ability to perform sedentary work, light to medium work or heavy work. Being initially approved for disability benefits for COPD means proving that you could not sit and do some kind of work without experiencing symptoms severe enough to dangerously affect your health. If an applicant cannot prove advanced COPD with medical documents and reports, the SSA is likely to deny the request. However, be aware that the older an applicant is, the more likely the SSA will approve your SSD application.

The SSA will only accept RFC documentation from physicians or other licensed medical professional specializing in lung disorders. Details on RFC paperwork should include exactly how much weight an applicant can lift safely, how long they can stand or walk without experiencing health problems and how their inability to breathe properly affects employment potential. This allows the SSA to create an RFC assessment based on doctor reports and results of one or more breathing tests.

Applicants should also ensure physicians include all other health issues on reports regardless if they are associated complications of COPD. Even if you are applying specifically for SSD benefits because of COPD, the Social Security Administration’s board of evalutors will look at all other health problems that could potentially make the difference between being approved or being denied.

What is Pulmonary Function Testing and Why Is It Important for Determining SSD Eligibility for COPD?

Multiple pulmonary function tests (PFTs) are necessary for assessing lung functioning. In addition to chronic obstructive pulmonary disease, PFTs are also given to people with asthma, chronic bronchitis, lung cancer and scleroderma. The most common type of PFT is called a spirometry test. If you are planning to apply for SSD benefits for COPD, you will need detailed documentation regarding the results of multiple PFTs.

Spirometry–calculates how much air a patient can inhale and exhale as well as how quickly lungs can empty themselves of oxygen in one second. You will be asked to exhale as much air as possible into a tube connected to a spirometer machine.

Lung Diffusion Capacity–this test analyzes how quickly a person’s red blood cells can transport oxygen to the lungs. LDCs are important to getting approved for SSD if you have COPD because it also shows the amount of damage done to blood vessels connecting the lungs and heart

Body Plethysmography--by measuring how much air remains in the lungs after exhaling, doctors can tell how badly COPD has damaged lung capacity. Body plethysmographies are also useful for adjusting medications, oxygen supplementation and use of bronchodilators

Cardiopulmonary Stress Test–CSTs involve patients walking on treadmills or riding a stationary bicycle. Doctors record respiration and heart rate to determine severity level of COPD or other progressive respiratory disease. While performing some kind of exercise, patients will breathe into a tube attached to a machine that provides physicians with results. People with moderate to severe COPD may only be able to walk or ride a bicycle for a few seconds before feeling dizzy or weak. This type of medical information is vital to increasing your chances of being approved for disability benefits for COPD 

Fractional Exhaled Nitric Oxide Test–people with COPD and asthma may need to take this test to determine if abnormal levels of nitric oxide exist in their bloodstream. By measuring how much nitric oxide is in exhaled breaths, the FENO test tells physicians if lungs are inflamed and dysfunctional

Pulse Oximetry Test–another test to analyze oxygen levels in red blood cells. Since COPD prevents the lungs from absorbing and dispersing oxygen molecules into the bloodstream, doctors can tell how much oxygen is available for the body to utilize.

Arterial Blood Gas Test--a blood sample is taken from the wrist for this test. Arteries with low oxygen levels and high carbon dioxide levels means lungs are unable to exhale enough carbon dioxide to prevent dangerously high amounts from causing additional health problems

Why Would the SSA Deny a Disability Claim for COPD?

Be aware that the Social Security Administration does not make attempts to contact an applicant’s treating physicians, surgeons or other healthcare professional upon receiving a first SSD request claim. Applicants are expected to include all essential documentation in their application packet. The SSA also expects all forms to be filled out correctly and completely. Finding one or two simple errors on SSD applications could give them reason to deny someone their SSD benefits.

Another reason COPD disability benefits are denied is due to lack of evidence that the person was ever hospitalized for COPD or suffered complications severe enough to warrant emergency treatment. Being diagnosed with COPD is not enough for the SSA to approve disability benefits. To increase their chances of being approved, applicants should be able to show they have been hospitalized at least three times over a 12-month period for symptoms related to COPD. These symptoms are not limited to breathing difficulties and could involve heart, circulatory or neurological issues caused by lack of oxygen.

The Social Security Administration will never accept a physician’s statement asserting their patient is “disabled” without descriptions of the patient’s disability and contextual information indicating the patient’s level of disability. Disability attorneys handling COPD applications for SSA benefits often request attending physicians complete a unique medical source statement form that delineates accurate information. Sometimes called “solid supporting” documents, these attorney-directed forms often make all the difference during an appeals hearing following an initial denial from the SSA.

What Happens If the SSA Denies Your Application for COPD Disability Benefits?

The SSA provides several options for applicants who have had their initial claim denied for COPD disability benefits. The first option is to request an appeal within 60 days of receiving a denial letter in the mail. This first appeal level is called “reconsideration” and involves a comprehensive review of the denied claim by an SSA evaluator was not part of the initial evaluation. In addition, applicants are allowed to submit new medical evidence regarding the severity of their COPD.

If the reconsideration appeal results in another denial, the applicant can file an appeal with an administrative law judge (ALJ). Although anyone filing for disability for any medical reason is strongly recommended to hire an experienced disability attorney to handle their case, a second appeal demands the legal expertise of an SSA attorney. Denial by an ALJ means you are likely not to receive benefits for at least another year or more since another appeal involves the federal court.

COPD is a progressive, serious illness that can reduce quality of life and leave you financially unstable because you can’t work. Don’t delay in receiving SSD benefits can you need by contacting Joel Thrift today. From initial filing of your claim to receiving your approval notice in the mail, disability attorney Joel Thrift will manage your claim successfully using in-depth knowledge of exactly what the SSA expects from disability applications. Call to schedule an appointment.

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