Does COPD Qualify for Social Security Disability Benefits?

Chronic obstructive pulmonary disease, or COPD, is a general term for several lung diseases, mainly chronic bronchitis and emphysema. These diseases are characterized by obstructed airflow through the airways in and out of the lungs. Both cause excessive inflammation that eventually damages lung structures. Both are progressive conditions that worsen over time.

COPD symptoms include shortness of breath, wheezing, and coughing. COPD also adds to the work of the heart and can cause pulmonary heart disease, or "cor pulmonale."

Treatment for COPD can include oxygen therapy, pulmonary rehabilitation, and various medications. The only known successful cure for emphysema is a lung transplant, but many patients with advanced emphysema aren't healthy enough to survive the surgery. (For those patients who do receive a lung transplant, the Social Security Administration (SSA) automatically grants disability benefits for a period of three years.)

Is COPD a Disability?

Not all cases of COPD cause disability; in fact, many ex-smokers have COPD and don't yet know it. But if your COPD is severe enough to limit your activity, you can qualify for disability benefits through the SSA's disability insurance program (SSDI) or the Supplemental Security Income (SSI) program.

What Causes COPD?

The primary cause of chronic obstructive pulmonary disease is cigarette smoking. But a small percentage of COPD sufferers have alpha-1-antitrypsin (AAT) deficiency, also called familial emphysema. Air pollution and occupational dust can also contribute to COPD, and a recent study showed that adults with asthma are 12 times more likely to develop COPD than those who do not have the condition.

How Does COPD Qualify for Disability Benefits?

Social Security publishes a disability "listing" that lays out the requirements for getting automatically approved for disability for various chronic respiratory disorders, including COPD. If you meet the requirements of this listing, you automatically qualify for benefits.

If your condition isn't severe enough to meet the requirements of the official listing, you may still be able to prove that your moderate COPD reduces your capacity to breathe and exert yourself so much that you can't work at any type of job.

How Severe COPD Meets the Disability Listing

If you've had at least three hospitalizations due to exacerbations or complications of your COPD in the last year, you will automatically meet the COPD listing and qualify for disability benefits—if each hospitalization lasted at least 48 hours (including time in the ER) and occurred at least 30 days apart.

Or, if you've had to be on a ventilator or have noninvasive ventilation with BiPAP twice within the last year, you'll automatically meet the listing for respiratory failure—if each ventilation lasted a continuous period of at least 48 hours and occurred at least 30 days apart.

But most people don't meet a listing because they've been frequently hospitalized or ventilated. Instead, they meet the COPD listing by having lung function tests that show very limited airflow. Specifically, the SSA wants to see results from one of the following tests:

• a spirometry test documenting your FEV₁ value (your forced expiratory volume in one second, meaning the amount of air you can exhale in one second)
• a spirometry test documenting your FVC (your "forced vital capacity" value, or the total volume amount of air you exhale)
• a DLCO, or lung diffusion, a test measuring how much oxygen passes into the blood and how much carbon monoxide is expelled
• an ABG (arterial blood gas) test measuring the oxygen and carbon dioxide levels in your blood, or
• an oxygen saturation test (SpO₂) taken during or after a six-minute walk.

The SSA's listing for respiratory disorders includes several tables based on gender, age, and height. The tables state the lung function value for each test that is necessary to meet the standard of disability. Here are some sample lung function values that meet the standard for disability:

• For the FEV₁ test, Table I-B in the listing states that a man over 20 years old who is 6 feet tall meets the requirements of the listing if he has an FEV₁ of 1.85 or below.
• For the FVC test, Table 11-B states that a woman over 20 who is 5'4" meets the requirements if she has an FVC of 1.5 or below.
• For the gas exchange test, Table III states that a man who is 6 feet tall meets the requirements of the listing if he has a DLCO of 12 or less.
• For the arterial blood gas test, Table IV-A states that anyone with a partial pressure of oxygen (PaO2) of 65 or less meets the requirements (the exact number required depends on the partial pressure of carbon monoxide (PaCO₂) in the blood).
• For the pulse oximetry test, anyone at 3,000 feet above sea level or below who has a SpO₂ of 87% or less qualifies for benefits.

The values used in the SSA's tables represent a severe obstruction in breathing, and thus qualify for benefits.

Does Moderate COPD Qualify for Disability?

If your breathing test results are higher than the above listing requirements, meaning your COPD may be more moderate than severe, you might still be able to qualify for disability benefits. You would need to show that your COPD has reduced your breathing capacity to such an extent that there are no jobs you can do, or at least no jobs that you know how to do or can learn to do, given your age, education, and experience.

To show that your breathing capacity and ability to exert yourself are so low that you can't work, you should ask your doctor to write a medical opinion on what kinds of activities you can and cannot do, such as:

• lifting no more than 20 pounds
• walking no more than one hour at a time, and
• no working with exposure to dust or fumes.

The SSA will use your doctor's opinion and your medical records to give you a "residual functional capacity" (RFC) assessment stating the type of work you can do (sedentary work, light work, medium work, or heavy work) based on your breathing test results and your doctors' restrictions. The SSA will then compare your RFC to your last job to decide if you can still do the work. If not, the SSA will look for other types of jobs that someone with your RFC could do.

Here's an example. If your FEV₁ value is almost as low as what's required for the official disability listing, above, you should be assigned a sedentary RFC, meaning that you can only do a desk job. If you've never done desk work, Social Security won't expect you to go back to your last job. And depending on your age and your job skills, and to a lesser extent your education, Social Security might not expect you to learn a new job.

Social Security actually has a set of medical-vocational grid rules to determine when the agency expects you to learn a new job. Many disability applicants with COPD who are older than 50 or 55 will fall under a grid rule, meaning they don't have to learn a new type of job. If they can't go back to their old work because it's too strenuous, and they don't have to learn a new job, Social Security will end up granting them disability benefits. For more information, see our section on how Social Security decides if you can work.

Having Multiple Medical Problems

The vast majority of patients with COPD have other serious medical problems as well. Many people with COPD suffer from coronary artery disease, high blood pressure, diabetes, and/or obesity, as well as mental issues such as depression. When you have multiple medical conditions that affect your ability to work, you have a better chance of getting benefits. For more information, see our article on combining medical impairments to get disability benefits and how moderate depression or anxiety affects your disability claim.

How Do I Apply for Disability Benefits for COPD?

A convenient way to start your disability application is to file online with the SSA. You don't have to finish the application in one sitting; just make sure that you keep track of the "re-entry number" given to you when you start the application so you can return to your saved application to finish it.

You can also apply for disability benefits by phone by calling 800-772-1213, from 8 a.m. to 5:30 p.m. Monday through Friday. If you are deaf or hard of hearing, you can call the TTY number at 800-325-0778.

Finally, you can apply for disability benefits in person at your local Social Security field office. You can locate your field office here.

If you'd like help with your application, think about working with an expert who can help you with the SSDI requirements for COPD. According to a survey of our readers, applicants who filed an initial application without expert help were denied 80% of the time. Consider getting a free case evaluation from one of our legal professionals to determine if your COPD qualifies for benefits.

_{Updated November 29, 2022}