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How COPD Is Evaluated When Applying for Social Security Disability Benefits

Chronic Obstructive Pulmonary Disease (COPD) is a common impairment for my clients applying for Social Security Disability and SSI. The term “COPD” can refer to several types of lung disease that cause shortness of breath. As with many conditions considered by the Social Security Administration, the disability determination process is concerned with the severity of COPD. In order to determine the severity of a disability claimant’s COPD, the disability evaluator will look at several factors:

Objective Testing

There are several common tests that can help determine the severity of COPD. Pulmonary function tests (PFTs) determine how much air a person can push out of his or her lungs. Assuming the participant exerts maximum effort, this test can measure the severity of obstructive and restrictive lung diseases. If the results of this test fall below a certain level, a disability claimant may qualify for a finding of presumptive disability based on the Social Security Administration’s Listing of Impairments. Gas diffusion tests determine how much oxygen and carbon dioxide occur in the bloodstream. The Social Security Administration also has a set of criteria for this test – and a score below a certain threshold can potentially qualify a person for presumptive disability. X-rays of the chest can be helpful in determining the severity of lung diseases such as emphysema.

Clinical Observations

Physicians are trained to observe and record abnormalities when physically observing a patient. Observations with regard to the lungs, such as wheezing, rhonchi, crackles, and decreased lung sounds can be recorded in a physician’s treatment notes and may indicate a severe breathing disorder.

Specialist Treatment

Primary care doctors will often refer patients with COPD to pulmonologists (doctors specializing in breathing disorders). Ongoing treatment with a pulmonologist may be an indication that a disability claimant’s COPD is severe. The treatment notes of a pulmonologist will often be more detailed than a primary care doctor’s notes, which can be very helpful in determining the severity of the condition. Pulmonologists are more likely to order objective testing (PFTs, gas diffusion tests, and x-rays) and make detailed clinical observations regarding the severity of a patient’s COPD than a primary care doctor. When considering a disability claimant’s COPD, the Social Security Administration’s adjudicators will pay close attention to the observations and treatment recommendations of the treating pulmonologist.

Emergency Room Visits and Hospitalizations

People with COPD are often prescribed inhalers and nebulizer machines to assist with controlling their breathing-related symptoms. However, sometimes these prescribed treatments fail to control acute exacerbations of COPD (such as a person unable to stop coughing). These exacerbations can result in emergency room visits to get the breathing under control. In more severe cases, the exacerbation can require in-patient hospitalization for treatment and observation. Depending on the frequency of hospitalizations in a given calendar year (12 month period), a disability claimant with COPD may qualify for presumptive disability based on the Social Security Administration’s Listing of Impairments.

COPD and Age

Depending on a disability claimant’s work history and education level, the attainment of age 50 (and again at the attainment of age 55) may make it easier to obtain disability benefits for physical conditions such as COPD based on the Social Security Administration’s grid rules. However, even those under the age of 50 can qualify for disability based on COPD if the condition is severe enough.

If You Suffer from COPD, a Disability Attorney May Be Able to Help You Get the Benefits You Need

Keller & Keller’s team of experienced and dedicated Social Security disability attorneys proudly serve Indianapolis and all of Indiana. If you’re suffering from COPD, contact us today for a free, no-obligation consultation to discuss your potential claim for disability benefits.

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