Getting Disability Benefits for Pulmonary Fibrosis

Pulmonary fibrosis (PF) is a disease where the delicate tissue inside your lungs becomes scarred and stiffens. These tissue changes (known as fibrosis) interfere with your lungs' ability to supply oxygen to your body. The symptoms of pulmonary fibrosis are mostly caused by low oxygen and can include:

• shortness of breath or difficulty breathing (dyspnea)
• a dry cough that doesn't go away
• tiredness and weakness
• muscle and joint pain
• clubbing (changes in fingertips and toes), and
• weight loss and lack of appetite.

Common treatments for pulmonary fibrosis include medication and oxygen therapy. But the lung scarring from PF has no cure and generally worsens over time. If your pulmonary fibrosis is advanced, you can qualify for disability benefits.

Pulmonary fibrosis disease is just one type of interstitial lung disease that can qualify for disability.

What Causes Pulmonary Fibrosis?

Some of the known causes of pulmonary fibrosis include:

• medications (including some chemotherapy drugs)
• radiation therapy
• exposure to environmental contaminants such as asbestos, coal dust, tobacco smoke, or bacteria, and
• autoimmune conditions like:
  • Sjögren's syndrome
  • rheumatoid arthritis
  • scleroderma
  • myositis, and
  • antisynthetase syndrome.

Sometimes, the origin of pulmonary fibrosis is unknown. Your doctor might use the term idiopathic pulmonary fibrosis (IPF) to describe your condition if the cause is unclear.

Can I Get Disability Benefits for Pulmonary Fibrosis?

If a doctor has diagnosed you with pulmonary fibrosis and you're unable to work (and you don't think you'll be able to work for at least a year), you should consider applying for disability benefits through the Social Security Administration (SSA).

The best benefit available from the SSA is Social Security Disability Insurance (SSDI). To be eligible for SSDI benefits, you must have worked long enough and recently enough in jobs where you paid Social Security taxes.

If you can't meet the work requirements for SSDI, you might qualify for disability benefits through the Supplemental Security Income (SSI) program. SSI is a needs-based program that provides small monthly benefits for people with disabilities—even those with little to no work history.

Although the technical requirements of SSDI and SSI differ significantly, the medical requirements for disability benefits are the same: you must meet Social Security's definition of disabled.

Medical Requirements for Disability Based on Pulmonary Fibrosis

To qualify medically for SSDI or SSI disability benefits, you'll need to prove your pulmonary fibrosis either:

• meets (or "equals") the requirements of a disability listing, or
• prevents you from working.

How Your Pulmonary Fibrosis Can Meet a Disability Listing

Social Security will first determine whether your medical evidence shows that your condition meets a disability listing in the SSA's listing of impairments.

Pulmonary fibrosis is considered under Section 3.00, Respiratory Disorders. There's no specific listing for PF, but Social Security will consider whether your condition satisfies the requirements of:

• listing 3.02 for chronic respiratory disorders, or
• listing 3.14 for respiratory failure.

Each listing has distinct criteria that require specific medical evidence.

One way to meet the requirements of listing 3.02 (chronic respiratory disorders) is with lung function test results showing you have a severely reduced FEV1 (forced expiratory volume) or FVC (forced vital capacity). To get these values, you'll need to undergo a spirometer test at your pulmonologist's office or during a consultative exam.

To find the FEV or FVC values you need to qualify for disability, see our article on getting disability for chronic pulmonary problems. The article also discusses the requirements of the listing for respiratory failure, which is for disability applicants who have been on a ventilator or BiPAP machine.

Medical Evidence Required to Meet a Listing With IPF

Social Security relies on the medical evidence in your file to decide whether or not you're disabled. Your treating doctors' opinions are critical to your claim, but they'll help you only if they're backed up by appropriate medical evidence.

Social Security will want to see your clinical history, including examinations that describe the diagnostic features of your impairment. Your doctor might use any of the following tests to confirm your pulmonary fibrosis diagnosis:

• chest X-rays
• high-resolution computed tomography (HRCT) scans
• spirometry (which measures lung function)
• pulse oximetry (which measures the amount of oxygen in your blood)
• echocardiography (which measures how blood flows through your heart), and
• biopsy reports, where lung tissue is analyzed for scarring.

You'll also need the results from pulmonary function tests (PFTs), including:

• diffusing capacity (DLCO)—how well your lungs transfer air into your bloodstream
• ABGs (arterial blood gas studies)—ratio of oxygen to carbon dioxide in your blood, and
• spirometry—lung capacity (FVC and FEV1).

Qualifying for Disability Based on Your Residual Functional Capacity

If your condition doesn't meet the requirements of a listing (few do), Social Security will assess your residual functional capacity (RFC). Your RFC describes the type of work activities you can and can't perform, given your impairments.

In creating your RFC, Social Security will consider your ability to perform a variety of tasks during an 8-hour workday, such as:

• sitting
• standing and walking
• using your arms
• bending and stooping
• concentrating on tasks, and
• following instructions.

What Your RFC Will Say

Your RFC will say whether you can do:

• sedentary work (mostly sitting, with the ability to lift up to 10 pounds)
• light work (frequent walking and standing and the ability to lift up to 20 pounds)
• medium work (up to 50 pounds), or
• heavy work (up to 100 pounds).

Your RFC will also include any non-exertional restrictions you have, like exposure to cold or dust. When you have severe pulmonary fibrosis, your RFC might mention the following:

• significant fatigue that makes you unable to stand or walk for more than two hours during an 8-hour day
• episodes of severe shortness of breath that might cause you to miss work at least two to three days a month, and
• inability to tolerate irritants or fumes.

How Social Security Will Use Your RFC

To qualify as disabled, your RFC must first show that you can't perform the jobs you held in the last five years. With the above RFC, if your last job wasn't a sit-down job, the SSA will find that you can no longer do it.

So, for example, if you've only ever waited tables for a living, with this RFC, you wouldn't be able to do your past work. Social Security would then determine whether there's any other type of work available in the national economy that you could do, or that you'd be expected to learn to do.

With an RFC like the one above, Social Security is likely to find you're disabled, because no employer would hire someone who has to miss three or more days of work per month. But if your RFC shows instead, for instance, that you have shortness of breath that only requires you to take occasional rest breaks, Social Security might not consider you disabled if you could still do a sit-down job.

Social Security doesn't expect people over 50 or 55 to learn to do a new kind of work as easily as younger workers, so it's easier for older workers to qualify for benefits based on RFC. If you don't have the job skills to do sit-down work and you're 50 or older, you have a good chance of being found disabled under Social Security's special rules (called the "medical-vocational grid rules") for older workers.

How to Apply for Disability Benefits for Pulmonary Fibrosis

You can apply for SSDI benefits for pulmonary fibrosis by:

• filing an online application
• calling Social Security at 800-772-1213 (TTY 800-325-0778), or
• contacting your local SSA office to make an appointment to apply in person.

If you don't meet the work requirements for SSDI, you can apply for SSI by phone or in person (as above). You can also start your SSI application online and Social Security will contact you to complete it.

Learn more about the Social Security disability application process.

What You Can Do to Help Your Disability Case

Pulmonary fibrosis can affect different people differently, so it's essential that you clearly describe to Social Security all of the reasons you're unable to work. Otherwise, in assessing your RFC, Social Security might not include all of your limitations in your RFC. For example, Social Security might include restrictions on your exposure to fumes and chemicals but overlook how severely your IPF affects your ability to stand, walk, lift, and carry. That's why you should submit a letter from your doctor describing:

• all your physical limitations
• what activities cause shortness of breath, and
• whether you've tried medication or other treatments to help control your pulmonary fibrosis.

Learn more about getting your doctor's help with your disability claim.