Facts about Emphysema and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1) Emphysema is primarily caused by smoking tobacco, which delivers over 4,000 chemicals to the body. Other causes may be second-hand smoke, air pollution, allergies, and infection.
2) Emphysema is a chronic obstructive pulmonary disease (COPD) and occurs when the air sacs in the lungs lose elasticity and are gradually destroyed, making it difficult to breathe.
3) It is a long-term, degenerative disease with no cure, although quitting smoking and using inhaled steroids or bronchodilators can help manage symptoms and make it easier to breathe. Antibiotics may help with infections and reducing symptoms.
4) Although some people have no symptoms, symptoms of emphysema can include fatigue, headaches, mucous or blood producing cough, wheezing, chest tightness, shortness of breath, and recurrent respiratory infections.
5) Severe cases of emphysema may call for breathing support or surgery. Parts of the lung may be removed during surgery. A lung transplant may be needed in severe cases.
6) Sometimes non smokers will develop emphysema due to missing the alpha-1 antitrypsin protein. Only about 1-2 percent of those with emphysema have it due to this protein deficiency.
7) Those with emphysema can do a few things to make it easier for themselves to breathe, such as eliminating air pollution like fireplace smoke and chemical irritants, staying away from smokers, and avoiding cold air.
8) There are many things that can increase risk for emphysema, including smoking, being a smoker over 40, being exposed to chemicals and pollution, Being HIV positive and a smoker, and having connective tissue disorders.
9) Many complications can occur due to emphysema, such as pneumonia, irregular heartbeat, pneumothorax, heart failure, heart swelling, and chronic lung disease.
10) Doctors may use many different tests to diagnose emphysema, including arterial blood gas analysis, chest x-ray, sputum examination, spirometry tests, pulmonary function tests, CT scan, and a pulse oximetry.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits 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.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
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.
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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