Chronic obstructive pulmonary disease (COPD) is a debilitating lung condition that affects around 16 million people in the United States. While there are many symptoms of COPD, shortness of breath, chest pain, and chronic fatigue are among the most crippling. In the early stages of COPD, these symptoms are mild and sometimes even go unnoticed by the patient. However, as time goes by, these symptoms become progressively worse and become even more of a burden for the victim.
Unfortunately, there is no magic wand that you can wave to reverse the effects of COPD. Treatment for this disease is aimed at slowing the rate that it progresses, reducing the risk of exacerbation, and managing chronic pain. And since every case of COPD is different, you’ll need to rely on information from your doctor and make lifestyle changes accordingly in order to achieve the best results.
But many COPD patients are left to wonder if there are other methods that can be used to ease the physical, emotional, and financial burdens of their disease. In our last post, for example, we took a look at some tips for living in the moment with COPD. Doing so will help you settle your regrets about the past and concerns about the future, instead, focusing them on things that you can change in the here and now.
Another thing you should be doing is applying for disability benefits which will help you out with some of the financial difficulties of managing a chronic disease. In this post, we’ll take a look at everything you need to know about Social Security Disability Insurance (SSDI) and how you can apply if you have COPD. If you have any questions, be sure to leave them in the comment section below so we can get back to you.
What is Social Security Disability Insurance (SSDI)?
SSDI is one service offered by the Social Security Administration (SSA). The SSA is a government-run agency that is responsible for assigning Social Security numbers and administering services related to their various insurance programs as well as the Supplemental Security Income (SSI) program for the aged, blind, and disabled. While most people in the country pay social security taxes, not everyone is eligible to receive benefits from it.
When you apply for social security disability, your condition will be compared to the disability “listing” found in the Social Security “Blue Book.” This book is accessible to anyone online and COPD is found under Section 3.02, under the title “Respiratory Disorders” and the subsection “Chronic Pulmonary Insufficiency.” However, when the claimant first requests disability benefits, it will be examined by local SSA field offices or state agencies who will verify non-medical requirements such as employment status, marital status, and age.
Unfortunately, there’s a lot of gray area when it comes to qualifying for SSDI. While the Blue Book clearly states what conditions you need to meet, there is some interpretation required, so it’s very important to fully understand how the process works before you file a claim. Another reason to be meticulous is that the turnaround time is generally quite long and might be even more backed up considering the COVID-19 pandemic. According to Nolo.com, 62% of people receive an answer within three months of filing an application.
What are the Requirements for COPD Patients to Qualify?
According to the SSA, a disability is defined as an inability to participate in something called “substantial gainful activity.” Essentially, what this means is that you are unable to work or make less money than the monthly income limits set by the SSA. This can either be due to a physical or mental disability that’s expected to last or has lasted 12 months or more.
The first thing you will need to gather to apply for benefits is a complete medical history of your COPD. In other words, you’ll need records of every medical event since you were diagnosed with COPD and even future medical procedures or tests if they apply. This should include things like the progression of your lung disease, symptoms, and any other physical examination that’s relevant. Below is a list of some of the test results you should include:
- Pulse oximetry
- Spirometry results
- Records of hospitalizations
- ABG tests
- Pulse Oximetry Levels
- Arterial Blood Gas
- Pulmonary (Lung) Function Tests
- Supplemental oxygen records (including your flow rate)
- CT scans or chest x-rays
Evidence of Comorbid Conditions
Like with many chronic conditions, COPD doesn’t just affect the lungs. The longer someone has COPD, the more likely they are to experience comorbid conditions such as sleep apnea, heart disease, high blood pressure, and even mental health conditions such as anxiety and depression. It’s important to include documented evidence of comorbid conditions because it will increase your chances of receiving benefits. The following are some examples of things you can include:
- Electrocardiogram (ECG) tests
- Heart stress test results
- Echocardiogram results
- History of heart attack, chest pain, or fainting
- Sleep tests
- Blood pressure tests
Evidence of COPD Treatment
Just like your medical history, it’s important to have full documentation of your COPD treatment history as well. Basically, this will show the SSA that you have been making every effort to improve the quality of your life despite the fact that COPD is an incurable disease. You will have the best chance of receiving disability benefits if you can prove that you still experience severe symptoms despite your treatment plan and you are unable to work as a result. Below are a few of the things you should include in this category:
- All medications that you are currently taking or have used in the past. Some common examples include inhaled steroids or bronchodilators, nebulizer treatments, antibiotics, or supplemental oxygen therapy. Be sure to include how your body reacted to these treatments.
- Pulmonary rehabilitation: including the duration and results
- Any medical procedures you’ve received such as endobronchial valve placement, lung volume reduction, or any other type of surgery.
- Include any complications related to these procedures
What Benefits Do COPD Patients Receive?
The amount of compensation that someone receives from SSDI will depend entirely on your lifetime earnings, so it’s very difficult to predict the exact amount that you will receive. According to DisabilitySecrets.com, most people receive between $800 and $1,800 each month with the 2021 average being $1,277. Another thing that will affect your earnings is whether or not you are receiving benefits from any other sources. The condition that you have and its severity will not affect how much compensation you receive.
The Social Security Administration uses a very complex formula to determine what your disability benefits will be, but it is possible to estimate your earnings by using an online social security disability payment calculator. In 2021, your disability benefits are based on the amount of income that you have paid Social Security taxes on. These are called “covered earnings.” Over the course of a year, the average covered earnings are called the average indexed monthly earnings (AIME).
The primary insurance amount (PIA) is calculated by applying a formula to your AIME which is the base figure that the SSA uses. If you want to learn more about how this is calculated, refer to this PDF document from the SSA. Alternatively, you can email or call your local SSA office where you will be connected with a representative who can help you predict the amount of your expected benefits.
Tips for Winning Your Disability Claim
Like we mentioned earlier, the amount that you will earn from Social Security benefits is pretty set in stone, so your focus should be on winning your case rather than earning as much as possible. Unfortunately, the burden of proving that your COPD is severe enough for benefits is largely in your hands. This is why you’ll need to be accurate and concise about the way you apply for benefits. The turnaround time for an SSDI application is several months at best, so you should be prepared to submit a thorough application the first time around rather than having to risk waiting for them to process your application a second time. Follow the tips below to get you started.
Speak With Your Pulmonologist
When it comes time to gather medical documents such as evidence of COPD treatment, procedures, or symptoms, it’s always best to get them from your pulmonologist rather than your primary care physician whenever possible. The reason for this is because the SSA may weigh this information more heavily since it’s coming from someone who specializes in COPD and other respiratory conditions.
Another reason to consult your pulmonologist ahead of time is that he/she may be able to provide you with more specific information about your disease including more thorough notes about the type of COPD you have and its expected prognosis. While pulmonologists are not specialists when it comes to disability benefits, they will help you to make the most convincing argument possible so that you can win your SSDI claim.
Hire an SSDI Attorney or Advocate
While your pulmonologist will provide you with information about your disease, SSDI attorneys and advocates are people who understand how the SSA works and how you can present the best case. While attorneys and advocates will provide you with mostly the same services, there are a number of differences between them that you should be aware of. First and foremost, an attorney is someone who is trained and has a degree in law whereas a non-attorney advocate does not have a law degree.
In order for someone to become an attorney, they need to have a bachelor’s degree, a Juris Doctorate (JD) degree and be admitted to a state bar. Attorneys are bound by professional conduct rules, they have many years of specialized training, and they have the ability to appeal your claim to the federal level if you want to dispute the SSA’s decision. If you decide to hire an attorney to help you with your SSDI claim, you should first ensure that they specialize in disability law.
A disability advocate (also called a legal representative, claimant representative, or disability representative) needs to pass an exam administered by the SSA, a background check, need professional liability insurance, and a bachelor’s degree. While disability advocates are highly educated on disability claims, they are not held to the same professional standards as attorneys are, and as a result, you will have less legal recourse if something doesn’t go as planned. In terms of payment, neither attorneys nor advocates are paid unless you win your case and they are entitled to the same fee which is paid directly by the SSA.
Take Your Time and be Thorough
Ultimately, the best way to win the SSDI benefits that you deserve is to be thorough with the application process. You want to provide an overview of your medical history and make it clear that you are taking the initiative to treat your COPD in the way that your pulmonologist advises. Before submitting your application, be sure to review it with a specialist who can point out any potential pitfalls. If your application is declined, the SSA will store your information in the event that you decide to dispute it.
Applying for benefits with COPD is not always an easy process. You need to be able to prove that your lung condition prevents you from participating in “substantial gainful activity” and you need to meet other requirements as well. Gathering the necessary medical information and knowing the right place to acquire it will give you the best chance of receiving benefits upon submitting your first application. You should also be consulting the Blue Book which outlines the exact requirements for qualifying for disability with COPD.
COPD is one of the most common chronic conditions in the world and it represents a serious financial burden on individuals, especially in the latter stages of the disease. If you have any further questions about SSDI benefits, be sure to speak with your doctor or a disability attorney or advocate. Alternatively, you can leave your questions in the comment section below and we’ll get back to you as soon as possible.