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How Do I Know If My Lung Impairment Meets the Criteria for Disability Benefits?

Living with a lung impairment can certainly affect your daily activities and quality of life, but when your symptoms begin to interfere with your ability to work, that is when you may look into filing for Social Security Disability. Here is what you need to know about Lung Impairments if you have been unable to work and are thinking of filing for Social Security Disability or appealing a recent denial.

To start, in determining whether or not you meet the criteria for disability benefits, Social Security evaluates all of your impairments, even non-severe impairments. Therefore, it’s critical that when you apply for benefits, you list all of your medical conditions on your application – both physical and mental.

We receive a lot of inquiries from individuals curious to know whether they should file their claim “based on physical or mental.” Again, list all of your conditions. The law even requires Social Security to consider how a non-severe impairment might impact your ability to function in a work-environment.

Next, once Social Security confirms you are not WORKING COMPETITIVELY and that at least one of your impairments is severe, it next considers whether your impairment “meets or equals” the criteria set forth in the “Blue Book,” a compilation of medical disorders and findings that qualify a claimant based on those findings alone (without considering your Residual Functional Capacity [RFC], taking into account other factors such as age, education, and your past work).

The Listings for Lung Impairments are under the category of “Respiratory System” (Listing 3.00 Respiratory System – Adult). The impairments include “Chronic pulmonary insufficiency,” “Asthma,” “Cystic Fibrosis,” and “Lung Transplant.” Each listed condition has specific and technical requirements that SSA must find to conclude you are disabled.

With the exception of the criteria for a lung transplant, in which you would be considered to be disabled for 12 months following the transplant, the other criteria are technical, so your medical records should be carefully analyzed by a qualified Social Security Disability attorney to determine the best strategy for your case.

As the introduction to the Respiratory System listings enumerates, the listings in this section are analyzed based on “symptoms, physical signs, laboratory test abnormalities, and response to a regiment of treatment prescribed by a treating source” (3.00 A). Therefore, your lung impairment must be established by medical evidence.

Next, your medical records must sufficiently describe not only the treatment your doctor has prescribed, but also your response to the treatment that has been prescribed, in addition to information about the nature and severity of your impairment. This is because Social Security requires evidence that your impairment exists despite prescribed treatment. For example, to demonstrate you meet the criteria for the Asthma Listing because you have asthma “attacks,” you must show that you have attacks “in spite of prescribed treatment and requiring physician intervention, occurring at least once every 2 months or at least six times a year” (3.03B).

On the other hand, impairments caused by some chronic disorders of the respiratory system may produce irreversible loss of pulmonary function due to ventilatory impairments, gas exchange abnormalities, or both (3.00A). Social Security will look for evidence of common symptoms attributable to these disorders, like dyspnea on exertion, cough, wheezing, sputum production, hemoptysis, and chest pain (Id).

Finally, the criteria involved in the analysis of obstructive pulmonary disease and restrictive ventilatory disease require you to undergo “Pulmonary Function Testing.” Therefore, it’s critical when you are filing for disability or appealing a decision denying you benefits that you talk to your doctor about a referral for updated pulmonary function testing.

Remember that Social Security is required to evaluate the effects of obesity on your impairment, because obesity is “often associated with disturbance of the respiratory system, and disturbance of this system can be a major cause of disability in individuals with obesity” (3.00 I). Make sure that your doctor is recording your weight at your office appointments and that if he/she provides an opinion about your limitations, that this opinion also addresses the cumulative effects of obesity.

If your lung impairment does not meet the criteria of any of the conditions listed, Social Security will determine your “Residual Functional Capacity,” which is defined as the “most you can still do despite your limitations (20 CFR §404.1545 (a). In evaluating your physical and mental limitations, Social Security considers all of your symptoms, including pain, and it considers all of the evidence in your case record. With this, it must find that you cannot sustain your “past relevant work” or any other work “in the national economy,” considering factors such as your age, your education, and your work experience.

To prove you are disabled under a Medical-Vocational allowance, it’s critical that you see a doctor on a regular basis and that you report your symptoms accurately to your doctor. Many people who call for our help are bewildered that Social Security has denied them, but they acknowledge that they only go to their doctor for the purpose of “refilling their blood pressure medication.” Their doctor “should know” that they are having trouble climbing stairs and that they are having daily coughing fits-but how will your doctor know unless you tell them?

Reporting your symptoms of breathing difficulties to your doctor can also lead to your doctor referring you to a specialist. With specialized treatment for a condition such as Chronic Obstructive Pulmonary Disease, it’s more likely that Social Security will properly understand how severe your symptoms are and in turn more likely that it will review your claim under the appropriate guidelines.

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