Get Social Security Disability & SSI: COPD & Emphysema

Winning Your Case

All that is necessary to win a COPD or emphysema Social Security disability and SSI case is to prove two Social Security criteria:

1. Non-Medical Criteria, and
2. Disability Criteria.

Proving the disability criteria involves –

1. Learning how Social Security assesses COPD or emphysema (covered here)
2. Satisfying the Social Security COPD Listing (also covered here) or you have disabling Functional Limitations (covered on the next page), and
3. You Submit Winning Evidence (covered after functional limitations).

Winning A Disability Case – COPD & Emphysema Medical Evidence

Social Security sees many COPD disability and SSI cases. COPD is airway inflammation of the lungs that can cause significant symptoms, impact activities of daily living, result in a disability, and result in death. It is one of the top five causes of death in America. The two most common types of COPD are emphysema and chronic bronchitis. Emphysema is inflammation of the lungs causing damage to the air sacs (alveoli); it is considered a severe/advanced form of COPD. Chronic bronchitis is inflammation of the lungs causing cough and mucus production. There are four stages of COPD:

1. Stage 1 (mild: 80% of normal airflow),
2. Stage 2 (moderate: 50-80% of normal airflow),
3. Stage 3 (severe: 30-50% of normal airflow) which is emphysema, and
4. Stage 4 (very severe: less than 30% of normal airflow) which is end-stage emphysema.

Social Security will review your case to determine your diagnosis which is made with –

1. Spirometry/pulmonary function test,
2. Pulse oximetry,
3. Arterial blood gas test,
4. Diffusing capacity (DLCO) test,
5. CT scan,
6. x-ray, and
7. Blood tests.

Tip. The spirometry test is the single most important medical test to establish the existence and severity of your COPD, emphysema, and bronchitis. Generally, to win your disability case, you will need listing-level or near listing-level spirometry test results.

COPD symptoms are an important aspect of your case. When Social Security reviews your case, it will also determine disability based on the severity of the symptoms you report. Common symptoms of COPD, emphysema, and bronchitis include –

1. Breathing dysfunction,
2. Fatigue,
3. Chest pain,
4. Dizziness,
5. Coughing,
6. Mucus production,
7. Weight loss, and
8. Infections.

The severity of your condition and the extent of your disability is also determined by your treatment which includes antibiotics, airway therapy/medications (bronchodilators and steroids), and supplemental oxygen (oxygen tank). Surgeries are rare and include removal of damaged lung tissue and a lung transplant.

COPD & Emphysema Social Security & SSI Listings

Adult Listing 3.02 requires an adult to have pulmonary testing and meet any of the following four – significantly diminished 1) FEV, 2) FVC, or 3) gas exchange results; or 4) ongoing problems resulting in medical center visits. Child Listing 103.02 requires the child to meet any of the following five – significantly diminished 1) FEV, or 2) FVC; 3) hypoxemia and ongoing oxygen use; 4) a tracheostomy; or 5) for children under age two, CLD (lung scarring) requiring medical center visits.

TERI: Terminal Disease Case

A COPD, emphysema, or bronchitis disability case can be determined by Social Security to be a TERI case which involves a terminal condition – it is untreatable and expected to cause death. Social Security expedites a TERI case to make a faster decision – Expedited Cases.

A COPD Claim In Action – The Power Of A Doctor Statement

Mr. McMinn lived in Oakland, CA. He filed for both Social Security disability and SSI benefits. He was diagnosed with COPD. He was a life-long smoker who had quit smoking three years prior to his hearing (about one year prior to his disability application). He was also diagnosed with depression, hypertension, and diabetes. His medical records were a challenge to him winning his case. He underwent two spirometry tests (the primary tests to determine lung function). His test scores were low – nearly listing level, but they did not meet or equal Listing 3.02. His depression, hypertension, and diabetes were not disabling.

Mr. McMinn was 47 years old, and to be awarded benefits, he needed to show he could not perform any job in the American economy. Generally, when a COPD claimant does not meet a listing, it is very difficult to win a disability case. To Mr. McMinn’s credit, he had a strong work record, he used daily inhalers, a daily nebulizer, and occasional oxygen. But in any difficult case, a doctor’s statement was needed.

Mr. McMinn was treated by both his primary care provider (PCP) and a pulmonologist. Counsel ordered his medical records form both. Surprisingly, both his PCP and his pulmonologist were willing to give statements about Mr. McMinn’s COPD and his residual functional capacity (RFC). The PCP filled out an RFC form indicating that Mr. McMinn was unable to perform sedentary work. The pulmonologist actually spoke to counsel over the phone and then submitted a declaration. The pulmonologist offered a detailed evaluation of Mr. McMinn’s case, found that his patient would be off-task at least 15% in an average day (usually the minimal amount needed to win a case) due to his need to rest because of oxygen deficiency, and specifically detailed why Mr. McMinn would be off task at least 15% of the time even though his spirometry testing was not quite at listing level. I also obtained a statement from both his mother and father (he was living with his parents) about his breathing difficulties and, more importantly, his need to lie down throughout the day due to fatigue.

The hearing was uneventful. The ALJ was kind, but there was no indication one way or another whether the case would be won or lost. We waited about four months for a decision. Mr. McMinn was awarded benefits; the ALJ specifically referenced both doctor statements. The Social Security payment center took about another two months to pay Mr. McMinn’s benefits, and another two months to pay Mr. McMinn benefits for his dependent children.