What are the requirements to be approved for disability with COPD?

Social Security impairment listing 3.02, addresses Chronic respiratory disorders, including A. COPD, or chronic obstructive pulmonary disease, B. Chronic restrictive ventilatory disease, C. Chronic impairment of gas exchange due to clinically documented pulmonary disease, and D. Exacerbations or complications requiring three hospitalizations within a 12-month period and at least 30 days apart.

You can satisfy the requirements for listing 3.02, Chronic respiratory disorders, by meeting the A, B, C, or D criteria.

To qualify for disability with COPD based on the listing (and keep in mind that listings are not the only way to be approved for SSD or SSI), you need a diagnosis of COPD from any cause, except cystic fibrosis, and the following information which is obtained from spirometry, i.e. a pulmonary function breathing test:

A FEV1 score (which is defined as a "one second forced expiratory volume") test result that is equal to or less than the values below that correspond to a height without shoes:

FVC critera for 3.02A

Note: The following information regarding DLCO criteria applies to Chronic impairment of gas exchange due to clinically documented pulmonary disease.

ABG criteria for 3.02C2, table 4a

SPO2 criteria for 3.02C2

Qualifying for disability with COPD based on medical records and work history

If you are not approved for disability through the listing mentioned in the preceding paragraphs, then whether or not you are approved will depend entirely on the information obtained from your medical records.

This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.

In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.

Getting approved for COPD after a review of your medical records and work history

The second route allows a person to be approved for disability benefits even if they do not meet the criteria of listing 3.02 which is referred to by disability examiners who work on claims as "medical vocational allowances".

In the medical vocational decison process, Social Security uses a sequential evaluation process to determine if an individual is disabled.

Step 1- Are you currently working or have you been working at since you allege you became disabled? If so, is that work SGA? If your work is currently SGA, your disability claim will be denied. This is true without regard to your specific disabling conditions. If the work you are doing is not SGA or you have stopped working, we move to step 2.

Step-2 ' If you meet the work requirements do you have a severe medical (physical or mental) impairment that is medically determinable that has prevented the performance of SGA?

Step- 3 Does the Severity of your disabling condition meet or equal the criteria of an impairment listing? If it does you may be approved for disability.

If you do not meet the criteria of the listing, Social Security Disability examiners can consider whether your chronic pulmonary disease is medically equivalent to any other impairment listed. Disability examiners must consider steps 4 and 5 of the sequential evaluation process. Individuals who do not meet or equal the criteria of the listings may or may not have a residual functional capacity that allows the to engage in SGA.

Step-4 Are you able to perform any of your past work of the past 15 years, when your limitations are considered? If you are able to perform a past job your disability claim will be denied. If your COPD prevents your from working and performing SGA, the disability examiner must move onto the next step.

Step-5 Are you able to perform any other kind of work? In order to make this determination disability examiners consider your age, your education, transferability of your job skills, and your residual functional capacity (what you are able to do in spite of limitations caused by your COPD).

This is the last step of the sequential evaluation process and as such it determines if you will be found disabled. If they determine you are able to do other work, your disability claim will be denied. If they find that you are unable to do any other kind of work, you may be approved for disability benefits.

Keep in mind, however, that a very high percentage of claims are routinely denied. More than 70 percent. And more than 80 percent of first appeals are also denied, which is why so many individuals only get their disability after a hearing.

Why are so many disability cases lost at the disability application and reconsideration appeal levels?

There are several reasons but here are just two:

1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.

Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.

2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.

Facts about COPD

1) Chronic obstructive pulmonary disease (COPD) is a combination of chronic bronchitis, which is caused by lung damage and inflammation in the large airways, and emphysema, which is caused by damage of the lung tissue and inflammation of the air sacs. The term was coined in 1965.

2) Nearly 90 percent of all COPD cases in the United States are caused by smoking tobacco. Other risk factors are genetics, air pollution, occupational pollution (coal mining, wielding, etc.), and other risks, such as repeated lung infections.

3) COPD, also known as chronic obstructive lung disease, chronic airflow limitation, chronic obstructive respiratory disease, and chronic obstructive airway disease, is the fourth leading cause of death in the United States.

4) The most common symptoms of COPD are dyspnea (shortness of breath), tachypnea (rapid breathing rate), lack of energy, wheezing, chest tightness, and excessive mucus production.

5) COPD causes the air flow to be greatly reduced when breathing out. Although forcing the breath out can increase the air flow, there is often a limitation in the expiratory flow for those with COPD.

6) COPD is most commonly diagnosed using spirometry, a test that measures the volume of air that can breathed out in the first second of a large breath, and a whole large breath. A chest x-ray and a computed tomography scan can both be used to rule out other lung diseases.

7) In severe cases of COPD, complications such as heart failure, pulmonary hypertension and weight loss can occur.

8) COPD is incurable, though quitting smoking and reducing air pollution, occupational pollution, and secondhand smoke can help prevent and treat the disease. Bronchodilators and corticosteroids are often used to manage the disorder. Severe cases may sometimes require surgery such as lung volume reduction surgery, and lung transplantation.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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