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.
Is COPD a Disability?
COPD is considered a disability by the SSA. The SSA classifies COPD as a chronic respiratory disorder and is located in section 3.02 of the SSA’s Blue Book, which is the list of disabilities that qualifies for Social Security disability benefits.
In order for the SSA to qualify your COPD as a disability, you first need to have earned enough work credits through your work history. You need to have enough work credits because SSDI benefits are for workers who at one point could work, but now cannot anymore because of their disability, like COPD.
How much work credits you need to qualify depends on your age and how long you’ve worked. If it’s determined that you mean the work requirements needed to qualify for disability with COPD, you need to meet the medical criteria outlined by the SSA in section 3.02 of the blue book under chronic respiratory disorders.
That section of the Blue Book will outline exactly what the SSA looks for when evaluating your disability claim for COPD and will let you know what medical evidence and records to have in your claim.
If the SSA finds that you meet both the medical and work history criteria, it will deem your COPD a disability and you will be able to qualify for Social Security disability benefits.
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.
When the Blue Book is consulted, the SSA checks to see if it matches any conditions in their official list. If so, you'd automatically be approved for benefits.
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.
What Stages of COPD Qualify for Disability?
Depending on the stage of COPD that you have, if it is severe enough that you will be unable to work for at least 12 months, then you may be able to qualify for disability.
The four stages of disability are mild, moderate, severe, and very severe. No matter what stage your COPD is in, if you are unable to work full time, you will be able to get disability. You may have a better chance of qualifying for disability with COPD if your COPD is severe or very severe compared if your COPD is moderate or mild.
How Long Does it Take To Get Disability for COPD?
It can take anywhere between 3-5 months to hear your decision on whether you qualify for disability with COPD. After you are approved for disability for COPD, you need to wait five months before you can receive your first disability benefit payment.
Depending on how long it takes to get your medical records in order and organized all factor into the decision time in getting your disability application for COPD back.
The more medical evidence you have of your COPD, you may receive your decision back sooner than if you don’t have a lot of medical evidence to back up your claim.
Once you are approved for disability for COPD, you will get your first disability check the full six months after the SSA determines that your COPD disability began.
For example, if the SSA finds that your COPD disability began in August 2022, you will receive your first disability benefits payment for COPD in February 2023.
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 are denied disability 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 Social Security 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.