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Emphysema and Social Security Disability

Emphysema - Condition and Symptoms

Emphysema is a chronic lung disease in which the tiny sacs that let the lungs transfer oxygen and carbon dioxide into and out of the body (the alveoli) deteriorate, inhibiting a person’s ability to breathe. As the disease progresses, more and more alveoli are destroyed, making breathing increasingly difficult. There is no cure for Emphysema, but its progress can be slowed by avoiding lung irritants, such as smoke and airborne chemicals. Emphysema is usually treated with medication that helps breathing, such as oxygen, steroids, and inhalers. Two surgical procedures that are sometimes tried, albeit with quite limited success, are:

  • Placement of valves in lung passages affected by Emphysema; and
  • Full lung transplant.

The symptoms of Emphysema are very similar to congestive heart failure, sarcoidosis, tuberculosis and other lung diseases. In order to diagnose the condition, your physician will review your medical history and perform a physical exam. Your doctor may be able to hear characteristic sounds in your lungs during your physical exam, and by tapping on your chest he or she may be able to hear the hollow sound of ruptured alveoli and overinflated lungs. In addition, a person suffering from Emphysema will sometimes develop a peculiar rounding of the fingernails.

Your doctor will also order lung function tests, which are highly effective in making a diagnosis, even before you start to show symptoms of the disease. Lung function tests measure how much air you can take in when taking a deep breath. X-rays can also be a useful diagnostic tool in advanced cases, although often nothing out of the ordinary will appear in X-ray images in the early stages of the disease.

Other diagnostic methods may include an arterial blood gases analysis (showing how well your lungs transfer oxygen and carbon dioxide), pulse oximetry (which measures the amount of oxygen in your blood to determine if you need supplemental oxygen), a sputum examination (to provide cells for analysis), and a CT scan (allowing your physician to view your internal organs, to see if the characteristic bullae, or holes, caused by Emphysema are present).

Shortness of breath during physical exertion is one of the first symptoms of Emphysema. As the disease progresses, you may experience difficulty breathing, coughing, wheezing, excess mucus, and a bluish tint to the skin. In addition, low oxygen levels in the blood may produce grumpiness, irritability, and impaired mental ability. High carbon dioxide levels in the blood can lead to headaches and insomnia.

Filing for Social Security Disability with a Emphysema Diagnosis

Unfortunately, there is no specific listing for Emphysema in the Social Security Administration’s (SSA) Blue Book. Instead, it is grouped under Section 3.00, which covers Respiratory System impairments, where it is categorized by the SSA as an “obstructive airway disease.” In general, the SSA bases its assessment of the severity of your condition on your ability to perform daily tasks, walk, and move, as well as on the degree to which your symptoms (including pain) limit you, the extent of your treatment, and how you respond to treatment.

Individuals who have been diagnosed with Emphysema may qualify for disability benefits, provided they can produce documented medical records that meet the criteria listed in the relevant section of the Blue Book. The listing is extensive and complicated, and proving total disability based on an Emphysema diagnosis can be difficult due to the lack of specific impairment criteria for Emphysema itself.

When you apply for disability benefits, you must show that you have been clinically diagnosed with chronic pulmonary disease and that your Emphysema is severe enough to prevent you from engaging in gainful activity. You must provide your full treatment history of continuous medical and clinical records, including a description of treatment and your response to that treatment over time.

Your records must document the severity of your condition and should provide information as to how well (or how poorly) you are able function with medical treatment. Because symptoms are common to many other diseases, a thorough medical history, including physical examination, and chest x-ray or other appropriate imaging techniques will be required to establish proof of chronic pulmonary disease, which you will need in order to be awarded benefits on the basis of Emphysema. Pulmonary function testing will also be required to assess the severity of the respiratory impairment once a diagnosis is made.

Your Emphysema Disability Case

If Emphysema has disabled you to the extent that you are unable to work, you may well be entitled to Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. Although total disability based on Emphysema can be difficult to prove compared to other disabling conditions, working closely with medical professionals and a qualified Social Security disability attorney or advocate to collect and present the appropriate documentation to support your disability claim in front of the Disability Determination Services (DDS) can help to ensure that your Emphysema disability case will have the highest possible chance of success.

Is Emphysema Considered A Disability?

Emphysema is a respiratory disorder that is covered by a listing under Section 3.02 of the Blue Book, which is the medical guide used by the Social Security Administration (SSA). The SSA may evaluate your limitations based on the systems of your body that are affected by your emphysema. Emphysema could affect your heart, so you may be able to qualify using Section 4.00 of the Blue Book covering the Cardiovascular System.

You should talk with your physician about your medical condition. He or she will know if you may qualify for disability benefits based on the severity of your condition. Also, if your physician knows you plan to apply for disability benefits, he or she may provide more detailed notations explaining the severity of your condition and your restrictions and limitations. Documentation is essential to the outcome of your claim, and to have a claim approved, hard medical evidence is a necessity.

The SSA considers emphysema to be an obstructive airway disease. They will consider how it impedes your ability perform routine daily tasks, such as walk, bend, and move in general. They will also consider the degree that your symptoms including shortness of breath and pain, limit your functioning and your treatment and how well you respond to that treatment.

Shortness of breath when physically exerted is one of emphysema’s first symptoms. Progression of the disease will lead to difficulty breathing, wheezing, bluish skin, excess mucus, and coughing. Lowered oxygen level can cause irritability, impaired mental state, and cause grumpiness. Headaches and insomnia can result from higher carbon dioxide levels in the blood.

The condition can be very disabling and keep you from performing routine daily activities as well as working and earning a living. To succeed with your disability claim, you will need to be able to provide supporting documentation that details the severity of your condition and how it keeps you from performing your regular work duties. Detailed medical records is essential to a successful disability claim.

Medical Evidence To Support Your Disability Claim For Emphysema

There are many medical documents that can be used to support your disability claim. Test results – specifically breathing tests – details about treatments you have tried and the response to those treatments, notes from physicians about the severity of your condition and detailing your restrictions and limitations, and the specifics about your emphysema and how it affects you.

You will need to supply detailed records from your physician and/or pulmonologist that detail your symptoms, the progression of the lung condition, and any results from a physical examination. You will need to provide copies of the test results. There are several tests to help confirm a diagnosis and severity of the condition.

You should have these tests and then provide the results – arterial blood gas, pulse oximetry levels, and imaging such as chest x-rays and CT scans with documented supplemental oxygen levels with the flow rate. Some more of the commonly used tests include FEV1, FVC levels, DLCO, ABG tests, pulse oximetry, and records that detail any hospitalizations that were required because of the lung disease.

Qualifying With A Medical Vocational Allowance

If you are unable to meet the criteria of a Blue Book listing, you can still qualify for disability benefits using a medical vocational allowance. A medical vocational allowance involves Disability Determination Services looking at the larger overall picture. Your medical conditions, symptoms and side effects, restrictions and limitations, age, work history, transferrable skills, and educational background are all taken into consideration to determine what kind of work – if there is any – that you can do despite the emphysema. Disability Determination Services (DDS) will review the details of your condition to complete a residual functional capacity (RFC). If you have your physician to complete an RFC, it can be very helpful to your claim.

The RFC is very detailed and explains what you can do. For example, with emphysema, you cannot work around dust or toxins that make breathing even more difficult. You may be easily out of breath, so you may not be able to walk more than 1,000 feet. Because of the shortness of breath, you may not be able to bend, crouch, squat, or lift. You may require frequent rest breaks. Those kinds of specifics can help show how your ability to do things is limited and restricted because of your medical issues.

By getting a full picture of your abilities through an RFC, the SSA can make a better and more accurate determination of your abilities and whether you should be approved for disability benefits. When your treating physician completes an RFC, it is given considerable weight because who would know more about your health and abilities than your regular healthcare provider?

You can also include statements from those who are familiar with your situation and who can confirm the severity of your medical issues and how they affect you. Former supervisors and co-workers can detail how your work performance has changed and how emphysema affected your ability to perform your regular work duties.

A Situation in Which Emphysema Can Keep You From Working

As an example, you are 53 years old and have a high school diploma with no additional training. You work in a furniture factory where you sand the wooden table legs. Because of your emphysema, you have suffered from shortness of breath. The sawdust makes matters worse, and even when you wear a protective mask, you find yourself choking and coughing more.

Sometimes you get dizzy and must sit down because of the lack of oxygen. The coughing causes a pain in your chest and back. You become tired easily, and you find yourself needing frequent work breaks. This is had a negative impact on your productivity, and then the lowered oxygen levels have caused you mental capacity to be affected, leading to moodiness, lack of concentration, and confusion. You are no able longer to perform your work duties.