Social Security Disability Claims for COPD

Social Security has a disability listing for COPD requiring claimants to take a test showing restricted airflow through the lungs.

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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 inflammatory processes that eventually lead to abnormalities in lung structure and limited airflow. Both are progressive conditions that worsen over time.

The primary cause of COPD is cigarette smoking. A small percentage of COPD sufferers have alpha-1-antitrypsin (AAT) deficiency, also called familial emphysema. Air pollution and occupational dusts may also contribute to COPD, especially if the person exposed to these substances is a smoker. In addition, a recent study shows that adults with asthma are 12 times more likely to develop COPD than those who do not have the condition.

COPD symptoms include shortness of breath, wheezing, and coughing. In addition, COPD 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 very few patients with emphysema are healthy enough to survive the surgery. (For those patients who do receive a lung transplant, Social Security disability benefits are automatically granted for a period of three years.)

Getting Disability Benefits for COPD

The Social Security Administration (SSA) has a disability "listing" laying 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 COPD reduces your capacity to breathe and exert yourself so much that you can't work at any type of job.

Disability Listing for COPD

To qualify for benefits, you must first be diagnosed with chronic obstructive pulmonary disease. In addition, a lung function test performed by a consulting doctor hired by the SSA must 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) or (FVC) forced vital capacity
  • a DLCO test (which measures how much oxygen passes into the blood)
  • an ABG test (which measures the partial pressure of oxygen, PaO2, and carbon dioxide, PaCO2, in the blood), or
  • an oxygen saturation test (SpO2).

The SSA's listing for chronic pulmonary insufficiency includes several tables based on gender, age, and height that state the lung function value for the various tests that's necessary to meet the standard of disability; the values used represent a severe obstruction in breathing. For instance, Table I-A in the listing states that a man under 20 years old who is 6 feet tall meets the requirements of the listing if he has an FEV1 of 2.10 or below. Table 1-B states that a woman over 20 who is 5'4" meets the requirements if she has an FEV1 of 1.25 or below.

Alternatively, if you have had at least three hospitalizations due to exacerbations or complications of your COPD in the last year, each lasting at least 48 hours and occurring at least 30 days apart, you will be approved for disability.

Reduced Capacity for Work

If your breathing test results are higher than the above listing requirements, you might still be able to qualify for disability benefits if you can 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 send the SSA 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 exposure to dust or fumes). The SSA will use 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.

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. But if the SSA determines that you can't do a desk job given your experience, your education, and your age (the older you are, the less likely it is that Social Security expects you to learn a new job), you'll be approved for 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 and how moderate depression or anxiety affects your disability claim.

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