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Respiratory Conditions

How Do I Get Social Security Disability Benefits for a Breathing Disorder?Breathing Disorders and Disability?

All breathing disorders can be classified as chronic obstructive pulmonary disease. The three most common chronic obstructive pulmonary diseases the Social Security Administration sees are emphysema, chronic bronchitis, and asthma.

Do you suffer from a breathing disorder? Does your breathing disorder prevent you from being able to work? If you have a breathing disorder, are unable to work and have been denied social security disability benefits, call the experienced Huntington Beach Social Security Disability attorneys at Howard Law and let us fight to get you the benefits you deserve.

Asthma

Asthma is a common obstructive breathing disorder in both adults and children. It is a chronic inflammatory disease of the large and small airways called bronchi. The bronchial tubes have muscles in them which can open the bronchi wider by relaxing or make them smaller by contracting. Those suffering from asthma have an abnormal tendency of their bronchi to contract.

To qualify for Social Security Disability benefits due to Asthma, you must have chronic asthmatic bronchitis or asthma attacks, in spite of prescribed treatment and requiring physician intervention, occurring at least once every 2 months or at least six times a year. Each in-patient hospitalization for longer than 24 hours for control of asthma counts as two attacks, and an evaluation period of at least 12 consecutive months must be used to determine the frequency of attacks.

Chronic Pulmonary Insufficiency

Chronic obstructive pulmonary disease (COPD) is the most common lung disease seen by the Social Security Administration. The most frequent types of COPD are (1) emphysema, (2) chronic bronchitis, (3) asthma.

To meet the listing and therefore qualify for Social Security Disability benefits, you must satisfy either A, B, or C, below.

A. Chronic obstructive pulmonary disease due to any cause, with the FEV1 equal to or less than the values specified in Table I corresponding to the person's height without shoes.

Table I
Height without Shoes (centimeters)Height without Shoes (inches)FEV1 Equal to or less than (L,BTPS)
154 or less60 or less1.05
155-16061-631.15
161-16564-651.25
166-17066-671.35
171-17568-691.45
176-18070-711.55
181 or more72 or more1.65

Or

B. Chronic restrictive ventilatory disease, due to any cause, with the FVC equal to or less than the values specified in Table II corresponding to the person's height without shoes.

Table II
Height without Shoes (centimeters)Height without Shoes (inches)FVC Equal to or less than (L,BTPS)
154 or less60 or less1.25
155-16061-631.35
161-16564-651.45
166-17066-671.55
171-17568-691.65
176-18070-711.75
181 or more72 or more1.85

Or

C. Chronic impairment of gas exchange due to clinically documented pulmonary disease. With:

  1. Single breath DLCO less than 10.5 ml/min/mm Hg or less than 40 percent of the predicted normal value. (Predicted values must either be based on data obtained at the test site or published values from a laboratory using the same technique as the test site. The source of the predicted values should be reported. If they are not published, they should be submitted in the form of a table or monogram); or
  2. Arterial blood gas values of PO2 and simultaneously determined PCO2 measured while at rest (breathing room air, awake and sitting or standing) in a clinically stable condition on at least two occasions, three or more weeks apart within a 6-month period, equal to or, less then the values specified in the applicable Table III-A or III-B or III-C:
Table III-A
(Applicable at test sites less than 3,000 feet above sea level)
Arterial PCO2 (mm Hg) andArterial PO2 Equal to or Less than (mm Hg)
30 or below65
3164
3263
3362
3461
3560
3659
3758
3857
3956
40 or above55

Table III-B
(Applicable at test sites 3,000 through 6,000 feet above sea level)
Arterial PCO2 (mm Hg) andArterial PO2 Equal to or Less than (mm Hg)
30 or below60
3159
3258
3357
3456
3555
3654
3753
3852
3951
40 or above50

Table III-C
(Applicable at test sites over 6,000 feet above sea level)
Arterial PCO2 (mm Hg) andArterial PO2 Equal to or Less than (mm Hg)
30 or below60
3159
3258
3357
3456
3555
3654
3753
3852
3951
40 or above50

Or

3. Arterial blood gas values of PO2 and simultaneously determined PCO2 during steady state exercise breathing room air (level of exercise equivalent to or less than 17.5 ml O2 consumption/kg/min or 5 METs) equal to or less than the values specified in the applicable Table III-A or III-B or III-C above.

Pneumoconiosis

Pneumoconiosis is a broad term for lung diseases caused by breathing small, dust-like particles into the lungs. Pneumoconiosis refers to lung diseases caused by the inhalation of inorganic particle dusts like coal, beryllium, silicon and asbestos.

To meet the listing and therefore qualify for Social Security Disability benefits, you must show an appropriate imaging technique of the lungs showing pneumoconiosis. The severity of the pneumoconiosis is then evaluated by the Social Security Administration.

Cystic Fibrosis

Cystic Fibrosis is in an inherited disease that causes thick, sticky mucous to form in the lungs, pancreas and other organs.

To qualify for Social Security Disability benefits due to Cystic Fibrosis you must satisfy A, B, or C, below.

A. An FEV1 equal to or less than the appropriate value specified in Table IV corresponding to the individual's height without shoes.

Table IV
Height without Shoes (centimeters)Height without Shoes (inches)FVC Equal to or less than (L,BTPS)
154 or less60 or less1.45
155-15961-621.55
160-16463-641.65
165-16965-661.75
170-17467-681.85
175-17969-701.95
181 or more71 or more2.05

Or

B. Episodes of bronchitis or pneumonia or hemoptysis (more than bloodstreaked sputum) or respiratory failure (properly documented), requiring physician intervention, occurring at least once every 2 months or at least six times a year. Each inpatient hospitalization for longer than 24 hours for treatment counts as two episodes, and an evaluation period of at least 12 consecutive months must be used to determine the frequency of episodes;

Or

C. Persistent pulmonary infection accompanied by superimposed, recurrent, symptomatic episodes of increased bacterial infection occurring at least once every 6 months and requiring intravenous or nebulization antimicrobial therapy.

Bronchiectasis

Bronchiectasis refers to chronic bronchial bacterial infection.

To qualify for Social Security Disability benefits due to bronchiectasis, you must satisfy either A or B, below.

  1. The severity of the breathing impairments satisfies the criteria set forth by the Social Security Administration.
  2. Episodes of bronchitis, pneumonia, hemoptysis, or respiratory failure requiring physician intervention, and occurring at least once every two months or at least six times a year. An inpatient hospitalization for longer than 24 hours counts as two attacks. Medical records covering a period of at least 12 consecutive months must be available to the Social Security Administration for evaluation.

For more information on breathing disorders and the Social Security Administration guidelines, visit the Social Security Administration website.

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Listing vs. Residual Functional Capacity (RFC): How Does the Social Security Administration Determine Whether I Qualify for Disability Benefits for a Breathing Disorder?

Social Security disability benefits may be available for people who suffer from a Breathing Disorder. The Social Security Administration must first determine whether your Breathing Disorder is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. The Social Security Administration will conclude that you are disabled and eligible for disability benefits if it determines that you meet or equal a listing because of your Breathing Disorder.

If the Social Security Administration decides that your Breathing Disorder is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

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How Can I Meet a Listing and Win Social Security Disability Benefits for a Breathing Disorder?

The Social Security Administration will determine whether you are disabled at Step 3 of the Sequential Evaluation Process by evaluating whether your Breathing Disorder is severe enough to equal a listing.

The term "listing" refers to a compiled list of common impairments. The Social Security Administration created a set of guidelines called the Listing of Impairments that contains the most common impairments. For each listing of a particular impairment, there is an explanation regarding the degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work.

The Social Security Administration will consider you disabled if your Breathing Disorder is severe enough to meet or equal a listing.

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What is Your Residual Functional Capacity Assessment for Your Breathing Disorder?

If the Social Security Administration decides that your Breathing Disorder is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

The Social Security Administration expressesan RFC for physical impairments in terms of whether the Social Security Administration believes you are able to do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.

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Can Your Doctor's Medical Opinion Help You Qualify for Social Security Disability Benefits for a Breathing Disorder?

The role of the Social Security Administration is to conclusivelyestablish whether you are disabled based on your education, work experience, medical evidence, and your age.

The role of your doctor is to provide the Social Security Administration with informationconcerning the degree of your medical impairment by providing the Social Security Administration medical source statement that describes your capacity for work which is part of your residual functional capacity assessment. Your residual functional capacity is what you can still do despite your limitations.

The Social Security Administration must consider your treating physician's opinion because the Social Security Administration considers it to be controlling when making its decision.

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What is the 5 Step Sequential Evaluation Process?

The Social Security Administration has created a five (5) step sequential process to determine whether an adult claimant is entitled to receive disability benefits. Children have a different test to determine eligibility.

Step 1: Substantial Gainful Activity

The Social Security Administration presumes that if you are working and that you make a certain amount of money that you are engaging in what it determines to be a substantial gainful activity (SGA). The Social Security Administration considers a person to be engaged in a SGA if that person is earning more than a certain amount of money each month (i.e. net of impairment - related work related expenses).

In 2013, the Social Security Administration has determined that a statutorily blind individual is engaged in a SGA if they earn more than $1740.00 per month while a non-blind individual must earn more than $1040.00 per month. Changes in the national average wage index usually affect the aforementioned SGA amounts.

Step 2: Severe Impairment

The Social Security Administration has determined that each claimant must either have a severe impairment or a combination of impairments. The impairment or combination of impairments must drastically limit the claimant's physical or mental ability to do basic work activities without regard to age, work history, or education. For many claimants, the level of proof at this level is minimal; therefore, they usually satisfy the Step 2 requirements and proceed to Step 3.

Step 3: Listing of Impairments

The Listing of Impairments details specific impairments that the Social Security Administration considers severe enough to prevent an adult claimant from engaging in a substantial gainful activity and in the case of a minor, the impairment has to be severe enough to cause functional limitations. There is also a durational requirement. The Social Security Administration has determined that the impairment must last for 12 months or long or result in the death of the claimant. If the claimant fails Step 3 because they do not meet or equal a listing then the case will proceed to Step 4.

Step 4: Past Relevant Work

At Step 4, if your condition is severe enough to meet the requirements of Step 2 (Severe Impairment); however, your severe impairment does not meet or equal a listed impairment that is the subject of Step 3 (Listing of Impairments), then the Social Security Administration must decide whether your severe impairment interferes with your ability to do any of the work you previously performed. The Social Security Administration likes to look at the work you performed over the past 15 years prior to the onset of your disability. If the Social Security Administration determines that your impairment does not interfere with work you previously did then you must proceed to Step 5.

Step 5: Ability to Perform Other Work

A majority of disability claims are decided at this level. If you cannot perform work you did in your past, then a determination must be made as to whether you can adjust to different types of work. The determination at this level takes into consideration your education, age, and prior work and is better known as your residual functional capacity.

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