Breathing is not something you think about until a medical condition prevents your lungs from functioning properly. Difficulty breathing from lung disease takes a toll on your body. Daily activities, including working, that you once accomplished without a problem, become challenges that you now must overcome.
If a respiratory disorder prevents you from working, lung disease disability benefits through programs administered by the Social Security Administration may be available to relieve financial pressures. Proving that you have a condition that meets the high approval standards for the Social Security Disability Insurance or Supplemental Security Income programs can be complicated and overwhelming.
The disability benefits team at the Clauson Law Firm understands and is ready to help you through the stages of the application approval process. Contact us today for a consultation with our chronic lung disease disability attorney.
“Lung disease” refers to several health conditions affecting a person’s lungs and airways, including:
· Asthma
· Chronic obstructive pulmonary disease (COPD)
· Infections, such as pneumonia and tuberculosis
· Lung cancer
· Pulmonary fibrosis
· Bronchiectasis
· Cystic fibrosis
Symptoms commonly associated with lung diseases may include:
· Shortness of breath
· Wheezing
· Coughing
· Fatigue
· Chest pain
Causes of lung disease include smoking, genetics, allergic reactions, inhaling asbestos and other harmful substances, and infections caused by viruses or bacteria.
The Social Security Administration does not pay benefits for short-term or partial disabilities. An application for SSD for lung conditions must meet a specific disability standard to be approved for benefits.
Federal regulations define “disability as a medically determinable physical or mental impairment expected to result in death or that has lasted, or is expected to last, for a continuous period of at least 12 months. The impairment or a combination of impairments must prevent a person from engaging in substantial gainful activity.
“Substantial gainful activity,” for purposes of the disability definition, including chronic lung disease disability, separates work into two components: Substantial and gainful. Substantial means work requiring significant physical or mental activities or a combination of both.
Work activity is gainful when a person does it in return for pay or profit. Activity typically engaged in for pay or profit would be gainful even though the person doing it does not receive payment.
The medical documentation necessary to prove respiratory SSD claims must satisfy the “medically determinable” standard of the disability definition. Medical records supporting an application for SSD for lung conditions may include the following:
· Patient’s medical history.
· Physical examination findings and the physician's notes.
· Lab tests, including blood tests.
· Diagnostic imaging, including X-rays and CT scans of the lungs.
· Pulmonary function tests, such as spirometry.
Doctors may use additional tests and procedures, such as bronchoscopy, to diagnose the cause of a patient's symptoms.
The medical documentation should include a record of prescribed medication and recommended treatment. There should also be a record of the patient complying with the course of treatment prescribed by doctors. The failure to take prescribed medication and follow treatment recommendations could result in a denial of a claim for SSD for lung conditions.
Applications for lung disease disability benefits go through a review process to determine whether they meet non-medical and medical requirements for approval of the claim. The non-medical requirements depend on the program:
· Social Security Disability Insurance: A person applying for benefits through the SSDI program must have a recent and long enough work history to be entitled to benefits through the program. How long and recent depend on the claimant's age. Individuals disabled at a young age generally need shorter work records than those disabled later in life.
· Supplemental Security Income: The SSI program does not have a work requirement. Instead, it imposes limits on the income and resources available to claimants.
Local field offices of the Social Security Administration review applications to determine whether they meet the non-medical requirements for SSDI and SSI. Those that do are sent to the Disability Determination Services, a state agency that reviews them for medical compliance.
Disability examiners at the DDS review an applicant’s medical records to determine if they prove that the person has a disability according to the federal standard. The DDS uses a five-step sequential evaluation process that includes the use of the listing of impairment, or “Blue Book.”
The Blue Book lists physical and mental impairments affecting major body systems that Social Security considers severe enough to be permanent and to prevent a person from doing substantial gainful activity. Each listed condition includes the medical criteria for determining whether an applicant has an impairment that meets or medically equals the listing.
Section 3.00, Respiratory Disorders, includes the following conditions:
· Chronic respiratory disorders
· Asthma
· Cystic fibrosis
· Chronic pulmonary hypertension due to any cause
· Lung transplant
· Respiratory failure
For example, the listing for chronic lung disease disability is section 3.02, chronic respiratory disorders. The listing contains pulmonary function testing results required to meet the listing. A person could meet the listing by being hospitalized three times within a 12-month period, provided the hospitalizations were at least 30 days apart, and each lasted at least 48 hours.
The evaluation process does not stop when a claimant’s medical condition does not meet or equal a listed impairment. The process continues with an assessment of the person’s residual functional capacity (RFC). RFC assesses the limitations imposed by a physical or mental impairment on an applicant's ability to work.
The fourth step of the evaluation process uses a person’s RFC to determine whether the limitations imposed by lung disease prevent them from doing the work they did before the onset of their disability. If a person cannot do past relevant work, the evaluation process moves on to the fifth and final step to determine their ability to adjust to doing other types of work.
The fifth step uses an individual’s RFC, along with their age, education, work history, and acquired vocational skills. If you do not have the ability to adjust to other types of work available in the national economy, you could be approved for disability benefits.
Respiratory SSD claims denied benefits during the initial review may be challenged through an appeals process. A Clauson Law disability attorney will review a denial and discuss the options available to you, including submitting a request to appeal and overturn the denial.
The levels of the appeals process include:
· Reconsideration
· Hearing with an administrative law judge
· Appeals Council review
· Federal court review
The Social Security Administration denies benefits to about two-thirds of the individuals who submit applications. The appeals process provides four opportunities to convert a claim denial into an approval.
The Clauson Law Firm has helped individuals in North Carolina and nationwide to obtain SSD benefits for respiratory conditions for more than two decades. Contact them at Clauson Law today for a free consultation. Take the opportunity to learn how an experienced and skilled disability attorney can make a difference in your life.
