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Social Security Disability for Cystic Fibrosis

An inherited medical condition, cystic fibrosis affects children but the condition does not result in disability to the individual is older. With the passage of time, the disease will cause permanent lung damage. It causes a thickening of the pancreas and lungs. There are symptoms, including persistent and chronic lung infections, breathing complications and difficulties, digestive issues, excessive sweating, and poor absorption of nutrients. It can also cause an immune system that is compromised.

Because it is degenerative and chronic nature, cystic fibrosis leads to disability but most of those who suffer from the disease have longer lifespans now thanks to advances in medical technology. While the symptoms cause issues with continued employment, the treatments for the disease can also cause problems in keeping employment. Treatment involves hospitalizations frequently, nutritional support, pulmonary rehab, antibiotics, and a variety of other medications.

Cystic fibrosis is a challenge for anyone who suffers from it and has a major impact on daily life. Flare ups can be sudden, and compromised immune systems can result in sudden and fast illnesses that result in emergency hospital visits and overnight stays. Because of the inability to determine when a lengthy hospital stay may be required, it is virtually impossible for someone with cystic fibrosis to maintain regular employment.

The Cost of Treating Cystic Fibrosis

According to Science Direct, the cost of treating cystic fibrosis varies from $10,151 per year with mild disease to $25,647 per year with moderate disease and to $33,691 with severe disease. The lifetime costs for an individual with cystic fibrosis are expected to be about $306,332.

If you suffer from Cystic Fibrosis, you may qualify for Social Security disability benefits.

As the disease progresses, more intensive treatment is required. A life-shortening disease, about 1 out of every 2,500 live births in the Caucasian race are diagnosed with the disease. The main impacts of an individual faces are problems with respiratory and pancreatic functioning. Of course, the cost of treatment can vary because of additional health issues encountered throughout the progression of the disease.

The SSA Evaluation and Medical Qualifications

The SSA uses strict guidelines to determine whether or not an individual meets the requirements to be deemed disabled and eligible to receive SSDI benefits. Cystic fibrosis has a listing in the SSA medical guide, which is called the Blue Book.

It is listed under Section 3.04, which falls under Section 3.00 that applies to the Adult Respiratory System. The requirements of the listing indicate that in order to qualify for benefits, you must have:

  • An FEV1 equal to or less than the appropriate value that is specified for the individual’s height without shoes.
  • OR

  • Episodes of pneumonia, bronchitis, coughing up blood, or respiratory failure at least once every two months or six times per year. Each inpatient hospitalization lasting longer than 24 hours will count as two episodes, and there will be an evaluation period of at least 12 months.
  • OR

  • Persistent pulmonary infections that are accompanied by symptomatic, superimposed, and recurrent episodes of increased bacterial infection that occurs at least one time every six months and requires nebulization antimicrobial therapy or intravenous therapy.

One of the more common complications of cystic fibrosis is bronchiectasis, which has its own listing under Section 3.07 in the Blue Book. It states that it is an impairment of pulmonary function caused by extensive disease that can be evaluated under the criteria of 3.02 (chronic pulmonary insufficiency) which pertains to FEV1 readings and other tests, or if it culminates in episodes of bronchitis, pneumonia, coughing up blood, or respiratory failure every two months or at least six times a year, requiring intervention by a physician.

If an individual does not meet the requirements set forth in the Blue Book, he or she can still be deemed disabled by using the medical-vocational allowance.

Meeting Disability Criteria with an RFC and Medical - Vocational Guidelines

When using the medical-vocational allowance, Disability Determination Services considered the medical conditions, the symptoms, any limitations, age, education level, work experience, and transferable skills. When you use the medical-vocational allowance, your physician will need to complete a residual functioning capacity (RFC) form, which will clearly state your limitations.

If using this approach, you should provide as much documentation as possible to prove your case. Your medical documentation should provide evidence that:

  • Thoroughly details your symptoms
  • Lists frequency of infections
  • Durations of medical interventions and hospitalizations
  • The kinds of medications taken, the dosage amounts and the length of therapy
  • The severity of any and all symptoms
  • Your prognosis
  • How your physical activity is limited, such as how far you can walk, how long you can stand, and how much you can lift

As an example, the limited pulmonary functioning will make it difficult for an individual with cystic fibrosis to walk significant distances. Because of the difficulty breathing, bending over frequently, lifting items, and even reaching above he head can be extremely limited or virtually impossible to do repeatedly. This should be clearly indicated.

Cystic fibrosis symptoms worsen over time. As this happens, you should be careful to take note of these problems and indicate how your ability to do things has been affected and your physical activities have gotten more limited over time. Indicate how your ability to do your current job has been impacted during the last several years, months, or even weeks.

Applying Specific Medical Tests to Your Case for Disability

There are several tests that can indicate the severity of your breathing issues. One test that is repeatedly mentioned throughout the Blue Book listings for respiratory and pulmonary issues is the FEV1. This test determines your lung functioning and if it is adequate based on your height.

It is not uncommon for the SSA to order a medical evaluation at their expense to determine if your condition is debilitating. This evaluation is just for informational purposes, and not for medical treatment. In some cases, a mental evaluation may be ordered to determine if you are experiencing mental conditions, such as depression or anxiety, resulting from your medical problems that cause you even further difficulty and impact your ability to work.

Getting Help with Your Cystic Fibrosis SSD Application

Whether you meet the SSA’s CF listing or need to prove disability under a medical vocational allowance, you’ll need to work closely with your doctor to ensure your medical records are thorough and that you satisfy all the evidentiary requirements of the SSA. Working with a Social Security attorney or advocate in putting together your application can also increase your chances of being approved for SSD benefits without delays.