Getting Disability for Pneumonia or Other Lung Infections

Those who suffer from lung infections that cause severe, long-term breathing problems may be able to get Social Security disability.

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Lung infections can be caused by viruses, bacteria, or fungi. They can also be related to other medical conditions like cystic fibrosis and bronchiectasis. Symptoms of lung infections vary depending on their cause, but generally include chest-pain, fever, shortness of breath, weight-loss, and fatigue. Treatments and outcomes vary based on the type of infection involved.

Getting Disability for Lung Infections

One of the basic requirements for disability is that your medical condition must prevent you from doing a substantial amount of work for at least 12 consecutive months. (For 2014, a substantial amount of work is considered to be earning $1,070 a month.) Because even severe lung infections can frequently be treated effectively within a few months' time, it can be difficult to meet this one-year requirement.

However, if the Social Security Administration (SSA) concludes that your lung infection meets the one-year requirement (has either lasted that long or is anticipated to last that long), there are a couple of ways that you may be able to win your claim.

Meeting a Disability Listing

Once the SSA has established that you meet the basic eligibility requirements for disability, it will next see if your illness meets the requirements of one of the conditions in its Listing of Impairments (called listings). A listing is an impairment that, if all of its criteria are met, are eligible for automatic approval of benefits.

If you suffer from a mycotic (fungal) lung infection, pneumonia, a mycobacterial lung infection (from a certain type of bacteria, like Mycobacterium tuberculosis), or other chronic lung infection, you may qualify under a respiratory listing. However, you must show that the infection has caused you to suffer from "chronic pulmonary insufficiency." Chronic pulmonary insufficiency means having difficulty breathing and severely limited airflow. It is diagnosed using a spirometry test. A spirometry test measures how much air you inhale and exhale, and at what rate you breathe. Even if you have undergone a spirometry test before, the SSA may have you take another that is administered by a doctor hired by the SSA. This is to make sure that the results are accurate.

The outcome of your spirometry test shows how badly your lungs have been damaged by the infection. The SSA will then use this information to determine whether you meet the listing requirements. For details, you can look at our article on chronic pulmonary insufficiency to determine if your spirometry results meet the requirements of the listing.

Specific conditions. You may also meet a listing if your lung infection is related to an illness like bronchiectasis or cystic fibrosis.

Winning Approval If You Can’t Meet a Listing

Even if you don’t meet a disability listing -- say your spirometry results aren't quite low enough -- you can still win your claim, but it will be harder. To be approved at this point, the SSA must conclude that your lung condition is so poor that it prevents you from doing your old job and all other less demanding jobs.

Strength-Related Limitations and The RFC

To make this determination, the SSA will prepare a detailed report using the medical evidence in your file that discusses how your condition affects your ability to do certain strength-related work activities. Examples of these activities are: sitting, standing, walking, lifting, and carrying. The SSA will use the results of this report to determine your residual functional capacity, or RFC. Your RFC is the most you can do on a regular and sustained basis (full-time). Your RFC includes an opinion that you can do either heavy, medium, light, or sedentary work. If the SSA thinks you still have the RFC to do a sedentary job (such as a desk job) despite your condition, you will be denied.

To make sure the SSA gets the full picture of your physical limitations, it's important that you ask your treating physician to prepare an RFC (called a medical source statement in this case) for you as well.

Other Limitations

When deciding if you can work, the SSA must also consider any other limitations (called non-exertional limitations) caused by your condition. Examples of non-exertional limitations include whether you must avoid certain work environments, whether you need extensive breaks throughout the day to use a nebulizer or other self-administered treatment, or whether you suffer from significant fatigue related to your illness. Here are some examples of how the SSA evaluates non-exertional limitations.

  • The claimant filed for disability due to an ongoing fungal lung infection. His symptoms included fatigue, chest pain, and a chronic cough. Although his condition was severe, it did not meet a listing. The claimant’s past work had been as a painter, which he could no longer do because the paint fumes aggravated his condition, even with the use of a facemask. The claimant had no other medical conditions. Although the SSA determined the claimant had the physical capacity to do a sit-down job, the claimant’s attorney was able to argue that his significant fatigue and chronic pain affected his ability to concentrate to the extent that he could not sustain the work pace needed to adequately perform a full-time job.
  • The claimant filed for disability due to pneumonia. Although the condition was severe, the claimant was able to moderate her symptoms with the use of inhalants and steroid medications. None of the treatments caused significant side effects or significantly interfered with her ability to work an eight-hour day. The claimant was still able to walk short distances. Based on the medical evidence, the SSA concluded the claimant still had the RFC to do at least a sit-down job and the claimant was denied.

For more information, see our article on using a combination of exertional and non-exertional limitations to help win your claim.

Combination of impairments. If you suffer from any other disabling conditions in addition to your lung infection, the SSA must consider the combined effects of your conditions on your ability to work. For more information see our article on how to win a disability claim using a combination of impairments.

Standard Requirements For Disability

In addition to meeting the medical requirements for disability, you must also meet the financial and legal requirements of one of the disability programs administered by Social Security.

SSDI. Social Security Disability insurance (SSDI, or simply SSD) is available to people with qualifying work histories for employers who paid taxes to the SSA. For more information on eligibility requirements, see our section on SSDI eligibility.

SSI. Supplemental Security Income (SSI) is a need-based benefit available to disabled people with little or no work history. You must meet certain income and other asset limits to qualify. For more information, see our section on SSI eligibility.

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