Facts about Lung Disease 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. Pulmonary fibrosis is a medical condition that causes inflammation and scaring of the lungs. Idiopathic pulmonary fibrosis refers to a cause that cannot be identified.
2. The condition is also called usual interstitial pneumonitis. This is the most common of all lung diseases of this type (interstitial) without an apparent cause (idiopathic).
3. The interstitium is the normally thin and flexible tissue that lines and supports the air sacs of the lungs. Fibrosis refers to scaring, and this condition causes the interstitium to stiffen and thicken, making breathing difficult and limiting oxygen absorption into the bloodstream from the lungs.
4. Usually, interstitial pneumonitis does not develop in a unified way, so different areas of the lungs are affected differently. There may be inflammation and scaring in two different areas, while other areas may be normal.
5. More men than women contract idiopathic pulmonary fibrosis, and onset typically occurs after age 50.
6. Noticeable symptoms usually do not occur until the condition is advanced. Shortness of breath and dry cough or wheezing are signs of irreversible damage, and breathing problems tend to keep progressing. Other symptoms may include fatigue, weight loss and aching in muscles and joints.
7. Severity and progression vary. For some people symptoms are moderate and progress slowly, whereas others have severe, sudden symptoms.
8. After diagnosis, life expectancy averages from 2.5 to 3.5 years, but can be as long as 10 years.
9. It may be difficult to distinguish the cause of interstitial lung disease, and therefore difficult to determine if it is idiopathic. Exposure to asbestos and radiation, along with a variety of medical conditions, may increase risk for usual interstitial pneumonitis but it is difficult to determine if one of these factors specifically caused onset of the condition.
10. A pulmonary rehabilitation program can provide treatment and enhance quality of life. These programs combine exercise and breathing techniques with education, support and counseling. They usually include a team of medical professionals, from doctors and nurses to counselors and social workers.
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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