Applying for Social Security Disability Benefits with COPD.

Applying for Social Security Disability Benefits with COPD

Last updated: October 2022

The Social Security Administration is a branch of the United States federal government that provides disability benefits to individuals who cannot work due to long-term disability. Benefits are provided through two programs: Social Security disability insurance (SSDI), which pays benefits to people with disabilities who have worked long enough, and Supplemental Security Income (SSI), which provides benefits based on financial need. Applying to either program requires you to make an initial claim by filing out an application and providing the necessary documentation to prove your medical condition.

How to qualify for social security benefits with COPD

The Social Security Administration maintains a publication called the Blue Book that lists the medical conditions that may qualify an individual for disability benefits. COPD is evaluated in Section 3.02, under the heading “Chronic pulmonary insufficiency.” However, simply being diagnosed with COPD is not sufficient to qualify for benefits. You must also be able to provide specific medical evidence, especially pulmonary function testing, to prove that your particular condition meets the specific criteria listed in the Blue Book.

In addition to proof of an official diagnosis, you will need to undergo a spirometry test. The test will consist of breathing into a mouthpiece attached to a recording device to measure how quickly you can move air out of your lungs. The resulting measurement will be your FEV1 value, or the amount of air you can exhale in one second. Section 3.02(A) of the Blue Book contains a chart that specifies qualifying FEV1 values based on a person’s height, measured without shoes. If your FEV1 value is equal to or less than the value in the chart based on your height, you will automatically qualify. For example, a person who is 62 inches tall without shoes (about 5’ 2”) will need an FEV1 value equal to or less than 1.15.
Section 3.02(B) contains a similar chart for individuals diagnosed with chronic restrictive ventilator disease. This disease is marked by decreased lung volume, and claimants can also meet the listing based on their height and the results of their spirometry test.

Alternatively, if your FEV1 value is too high (i.e. you don’t have a problem getting air in our out of your lungs) you may still be able to qualify for benefits if your lungs have a problem oxygenating your blood. The important test results for this category, listed in Section 3.02(C), are the diffusing capacity of lungs for carbon monoxide (DLCO), the pressure of oxygen in arterial blood (PO2), and the pressure of carbon dioxide in arterial blood (PCO2).

Consider working with your doctor or lawyer

Because the language in the Blue Book is a mixture of legal and highly technical medical terminology, it can be quite difficult to understand. If you have any questions about the exact application of the criteria to your case, be sure to discuss it with your doctor and/or lawyer.

Gain appropriate documentation from your healthcare team

It is very important to work closely with your medical providers, particularly your pulmonary specialist, to obtain the appropriate documentation to support your application. In addition to submitting the relevant medical records, you should also have your treating physician complete an RFC form – or Residual Functional Capacity form. The RFC form should address your ability to walk, stand, lift, and carry. In respiratory cases it should also indicate whether you have any restrictions concerning dust, fumes, odors, or extreme temperatures. Prescriptions for supplemental oxygen or a CPAP machine should also be included.

Additionally, if at all possible, any letter or form completed by your physician in support of your disability claim should refer specifically to the correct section of the Blue Book.
Unfortunately, despite having specifically defined criteria listed in the Blue Book, obtaining disability benefits based on COPD can often be difficult. If the Social Security Administration denies your original application, you may want to pursue a disability appeal. At that point you should also consider retaining the services of a qualified Social Security attorney or disability advocate, who can help you through each stage of the appeals process, including your disability hearing.

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