COPD, or chronic obstructive pulmonary disease is a series of lung diseases that damages your lungs, blocking airflow and affecting your ability to breathe.
The two most common conditions are chronic bronchitis and emphysema. Heathline estimates that as many as 24 million people in the United States are suffering from COPD, though there are at least 13 million reported cases.
If you or a loved one is unable to work due to advanced COPD, there may be help available. The Social Security Administration (SSA) offers different assistance programs to help those with a disability support themselves.
Medical Costs of COPD
COPD costs the United States $50 billion each year. $30 billion of those expenses are from direct medical costs and $12 billion are spend on mortality costs, Heathline reported. The COPD Foundation explained that COPD, on average, costs patients $6,000 more annually than those without. Because COPD is incurable, patients must undergo treatment for the remainder of their lives, and though most cases occur in those over 45, the COPD Foundation found 70 percent were under 65 years of age.
Much of the costs comes from hospitalizations, because almost half of patients are readmitted to the hospital within 60 days of their discharge. The COPD Foundation found that costs could be reduced as much as 40 percent if proper care is taken and there are no complications or hospitalizations.
The other 8 billion of the $50 billion due to indirect costs, such as missed work days, which are common in COPD. Healthline found over 50 percent of those with the condition found themselves limited at work, and 70 percent said they were limited in physical activity. The COPD Foundation reported that the disease causes the most days of lost productivity than any other chronic condition.
Medical Requirements in the Blue Book
When the SSA receives an application for disability benefits, they evaluate it against a number of requirements. First, they use the their disabling conditions guidelines.
COPD can be found in Section 3.02—Chronic pulmonary insufficiency, under Respiratory Disorders. In order to qualify for benefits, you must meet one of the following requirements:
- COPD, due to any cause, with a forced expiratory volume one (FEV1) that is equal to or lower to the minimum for your height, between 1.05 for those who are five feet and 1.65 or those who are six feet.
- Chronic impairment of gas exchange due to documented COPD, with a gas diffusion capacity (DLCO) of a single breath under 10.5 mil/min/mm Hg or a low amount of oxygen dissolved in the blood either during rest or exercise, as determined a low partial pressure of oxygen (PO2) and high partial pressure of carbon dioxide (PCO2).
It can be even easier to qualify for end-stage COPD.
Qualifying Without Meeting a Medical Listing
If you don't meet the Blue Book listing for COPD, but still feel yours is severe enough to keep you from working, there is another way to be approved for benefits. A medical-vocational allowance looks at the limitations COPD causes you, and the SSA will approve you if they find you're unable to earn their minimum monthly income of $1,260.
In order to do this, the SSA will figure out your Residual Functioning Capacity (RFC) by analyzing your reported limitations, as well as your education and work history. It will first put you in a work ability category (sedentary, light, medium, heavy, and very heavy), and from there try to find jobs you're able to do with your experience with little to no training.
There are many symptoms of COPD which could make working hard, such as:
- Getting easily out of breath during physical activity or at rest
- Chest tightness or discomfort
- dizziness or fainting
- Frequent respiratory infections and/or hospitalizations
- Lack of energy or fatigue
- Unintentional weight loss
- Constant coughing and fever
Because RFCs depend also on the type of work you know how to do and physical activity exacerbates many symptoms, you're more likely to be approved if your work history is in physically demanding jobs, such as construction, landscaping, or labor than if you went to college and received a degree in marketing.
Applying for Social Security Disability
Talk to your doctor before starting the application, because the process is often long and drawn out, so it may not be worth applying if your doctor doesn't think you'll be approved. Few applications are approved in the initial claim stage, and so most are forced to take part in various appeals that can take up to two years before you get a positive an answer and start receiving benefits.
If you have decided to apply, whether with the Blue Book or an RFC, make sure to check the SSA's website for all the medical evidence you'll need. So many eligible applicants are denied because they're missing key information they need to prove their disability to the SSA.
For COPD, important medical evidence will include:
- Spirometry, which measures how much air you can force out in an exhale, or our forced expiratory volume (FVC), which includes your FEV1.
- Imaging tests, such as chest X-rays, CT scans, or MRIs. These can help determine how advanced your COPD, as well as rule out other causes.
- Arterial blood gas analysis, which measures how well your lungs take in oxygen and let out carbon dioxide.
- Other lung function tests, like a lung diffusion capacity, which measures how oxygen passes from your lungs into your blood.
- A detailed statement from your doctor describing your medical history as it relates to COPD and your condition, symptoms, and limitations.
- Summaries of any related surgeries, hospitalizations, and treatments.
For most Social Security applications, you can submit the application online, so you don't have to go through the trouble of making an appointment at an SSA office, but if you prefer to do the application in person, the SSA staff is always available. If you're applying for Supplementary Security Benefits (SSI), then you must apply at your local SSA office, as online applications aren't accepted.
Make sure to double check your application not only medical evidence, but also for any mistakes, missed questions, or other missing information. The claim will also require personal documents and tax information. A full list of required documentation can also be found on the SSA's website. It's crucial that you submit everything, otherwise your application may be delayed or denied, even if you qualify.
If your COPD worsens while you wait for an answer, you are hospitalized, change treatments, or have new tests done, let the SSA know immediately. The more evidence you can provide about the severity of your condition and it's limiting nature, the higher chance you have of being approved.
Once you can show you medically qualify for disability benefits with COPD, you will need to make sure you meet the non-medical requirements. These will vary depending on which disability benefit you are applying for.
For those applying for Supplemental Security Income (SSI), you will need to meet specific income limits. For those that are married, your household income and assets must be under $3,000. The SSA will consider that you have access to a portion of your spouse’s income and assets, so their earnings will impact your eligibility. If you are unmarried, you will need to have less than $2,000 in income and assets.
If you are applying for SSDI, then you will need to have earned enough work credits. These are earned by working and paying into Social Security. The number of work credits needed to qualify for disability benefit with COPD will vary by age. Typically speaking, if you have worked 5 of the last 10 years then you will have enough work credits.
If you meet the medical requirements for COPD but do not meet the non-medical requirements, then you will not qualify for disability benefits. Similarly, if you meet the non-medical requirements but cannot prove that you medically qualify with COPD, you may be denied benefits. This is why proving as much medical evidence as you can is important.
Other Benefits For COPD
If you’re approved for benefits, your spouse and children may also be eligible for benefits. To learn more about the different forms about disability benefits, visit our pages on Social Security Disability Insurance. If you have any specific questions regarding your Social Security COPD case, you can ask in our forum, or review our guide on tips for applying for disability benefits with COPD.