If you suffer from emphysema and it is affecting your quality of life and your ability to work, you may be eligible to receive Social Security Disability benefits. Emphysema is a disabling chronic lung disease in which the tiny sacs that transfer carbon dioxide and oxygen in and out of the body to deteriorate, which impacts the individual’s ability to breathe. The damage progresses with more alveoli being destroyed and it becomes much more difficult to breathe.
Emphysema is not curable but progression can be limited by avoiding lung irritants such as airborne chemicals and smoke. The treatment is usually medication to help breathing, including inhalers, steroids and oxygen. There are two surgical procedures that are occasionally tried with minimal success. These involve placing valves in the lung passages that have been impacted by emphysema or a full lung transplant.
In order to qualify for Social Security Disability Insurance benefits (SSDI), you have had to work to earn enough credits and pay into enough Social Security taxes. The Social Security Administration (SSA) has strict guidelines that determine whether an individual is disabled and whether he or she is eligible to receive SSDI benefits. If you are eligible to receive benefits, certain dependents may also be eligible to receive benefits as well.
During the benefit application process for SSDI, the Social Security Administration (SSA) involves the extensive collection of information regarding your medical condition, treatment process, medications, and prognosis. These documents are designed to help the Disability Determination Services make a decision regarding your condition and whether you are eligible to receive benefits or not. There are several steps to the application process.
Further Reading: What Conditions Qualify For Disability?
The Cost of Treating Emphysema
The National Center for Biotechnology Information explains that the treatment of emphysema and other lung diseases is very expensive. In the study, the organization estimated the direct medical expenses related to Chronic Obstructive Pulmonary Disease (COPD) by the kind of disease, such as emphysema or chronic bronchitis. The two disorders together are said to account for $14.5 billion each year in direct costs.
In patient costs are more expensive than outpatient costs, and emphysema, which is more severe has higher costs per case coming in at $1,341 to $816. Hospital stays count for the majority of expense with $1.9 billion spent annually on emphysema and $6 billion for chronic bronchitis. According to the study, the high hospitalization expenses versus the low home care costs because there may be an under use of home care and a shift from acute care to preventive care.
In addition, someone with emphysema can expect regular doctor visits which involve copays and deductibles, as well as prescription copays and the cost of medical supplies such as mouthpieces for nebulizers. Breaking down all the cost, an individual with emphysema can expect to pay out, on average, $100,000 to $200,000 for treating the form of COPD.
The SSA Evaluation and Medical Qualifications
The SSA has strict guidelines involving the disability determination process. The Blue Book is the SSA medical guide that used to evaluate every medical claim.
Although there is no specific listing for emphysema in the SSA Blue Book, it is grouped under Section 3.00 covering Respiratory System Impairments. Since emphysema is categorized as an “obstructive airway disease", you may be able to qualify under the following sections for Social Security Disability benefits:
In general, the SSA assessment of the disease uses it assessment of disease severity on your ability to perform your daily tasks as well as walk, move and the limitations you experience based on the symptoms. The SSA also considers your treatment plan and how you respond to it.
If you have been diagnosed with emphysema you may qualify for SSDI benefits as long as you can provide documented medical records that meet the criteria that are listed in the SSA’s Blue Book. The listing is complicated and extensive, so providing documentation that is evident of total disability based on a diagnosis of emphysema can be challenging because of the lack of specified impairment criteria for emphysema itself.
Meeting Disability Criteria with an RFC
Because of the lack of specified impairment criteria for emphysema, it may be necessary to prove your disability with the help of an RFC, a residual functioning capacity form, which should be completely filled out by a physician familiar with your case. The RFC must show that you have indeed been clinically diagnosed with COPD and that your emphysema is severe enough to keep you from gainful activity engagement. It should indicate your full treatment and how you responded to that treatment throughout time.
The RFC should detail how the condition and its symptoms impact your participation in daily life and your ability to do tasks. As an example, if shortness of breath causes fatigue that limits your ability to walk, that should be indicated. If you have trouble breathing when you bend over or reach, your physician must also note that.
A detailed RFC explains how your ability to work is impacted and to what severity levels so the Disability Determination Services team can determine that you are unable to work because of the medical condition and its impact on your daily life. During the RFC consideration process, staffers also look at your past work history, any work related skills and if they can be transferred, your educational level and your age so they can determine if you can switch into another profession and still earn substantial gainful employment.
Applying Specific Medical Tests to Your Case for Disability Because of Emphysema
There are several medical tests used to diagnose emphysema. Your medical file should contain a chest x-ray, pulmonary functioning testing, imaging to establish the severity of the respiratory impairment and to prove there is chronic pulmonary disease and evidence of treatment options undertaken and their results.
The SSA may also order, at their expense, a medical evaluation at their physician of choice. This exam is just for informational purposes to confirm diagnoses and to help determine the severity of impairments resulting from the medical condition. While this evaluation is not for medical treatment, it can be used to help determine whether or not you are disabled.
On occasion, a mental evaluation may also be ordered to determine if the condition has impacted your mental wellness and rendered you depressed or suffering from anxiety, both of which can also impact your ability to work. In order to make a decision, the SSA will require extensive records and detailed information so they can be assured that they have all of the facts they need to determine that you are unable to work.
If you would like to begin the Social Security Disability application process, gather your information and start the process online at ssa.gov. Remember, the more medical information that you provide the better your odds of being approved for benefits.
Emphysema and Your Social Security Disability Case
If your case of Emphysema is severe enough and there is sufficient medical documentation to prove your inability to work because of it, you have a chance of being at the initial stage of the Social Security Disability application process. Keep in mind, however, that only 30 percent of applicants are approved at this stage of the process. Many of the people who suffer from Emphysema have their initial claim for disability benefits denied and must go on to file an appeal.
It normally takes between 90 to 120 days from the date of your Social Security Disability application to receive a decision from the SSA. If your claim is denied, you will need to appeal the decision within 60 days of receiving the denial notice. It is in your best interests to go on to appeal the decision rather than just applying all over again. Your chances of winning an appeal are greater than your chances of having a second application approved at the initial stage of the Social Security Disability claim process.
If your benefits are denied in the initial stage of the process you may want to consider hiring a disability attorney who is experienced at handling Social Security Disability cases. Hiring a qualified attorney can greatly increase your chances of winning your Social Security Disability appeal.
