The Social Security Administration defines cystic fibrosis (CF) as a “a genetic disorder that results in abnormal salt and water transport across cell membranes in the lungs, pancreas, and other body organs.” This potentially life threatening condition causes normally thin and slippery body fluids such as sweat, mucus, and digestive juices to become thicker and stickier. These altered fluids then begin to build-up in various organs of the body. One of the most commonly affected organs are the lungs. Breathing difficulties, lung infections, and pulmonary disease are just a few of the serious medical conditions that can arise as a result of the overproduction of mucus in the lungs.
If the symptoms of your cystic fibrosis are so severe that you are unable to work, you may be qualified to receive disability benefits through the Social Security Administration (SSA). Children with CF may also qualify for benefits. SSA disability benefits help those struggling with CF, and their families, meet their living and medical expenses. However, you must meet certain criteria in order to receive these Cystic Fibrosis Social Security disability benefits.
Adult Disability Benefits for Cystic Fibrosis
The Social Security maintains a document called a “Blue Book” lists a number of medical conditions recognized by the SSA, their symptoms, and the medical criteria needed to qualify for disability benefits. You’ll find CF in Section 3.04, under “Respiratory Disorders.”
Many individuals choose to be represented by an experienced disability benefits attorney when they decide to apply for disability benefits through the SSA. This is often a smart move, since the attorney knows what medical criteria must be met in order to qualify for benefits and how to work with your doctor and other caregivers to obtain the necessary medical evidence the SSA will need to make their decision.
In order to qualify for SSA disability benefits, you must meet at least one of the following requirements:
- You have an FEV1 (a measure of the volume of air you are able to push out of your lungs in one second) that is less than or equal to a value specified in the SSA’s tables for your age, gender, and height without shoes.
OR
- Exacerbations or complications requiring three hospitalizations of any length within one year that are at least 30 days apart.
OR
- Spontaneous pneumothorax, secondary to CF, requiring chest tube placement.
OR
- Respiratory failure that requires invasive mechanical ventilation, noninvasive ventilation with BiPAP, or a combination of both treatments for a continuous period of at least 48 hours, or for a continuous period of at least 72 hours, if postoperatively.
OR
- Pulmonary hemorrhaging that requires vascular embolization to control the bleeding.
OR
- Twice within one year (incidents must be at least 30 days apart) you experience peripheral capillary oxygen saturation (SpO2) levels that measure less than or equal to the value set forth in SSA’s table.
OR
You experience at least two of the following exacerbations or complications within a 12-month period:
- Pulmonary exacerbation (requiring 10 consecutive days of intravenous antibiotic treatment).
- Pulmonary hemorrhage (hemoptysis with more than blood-streaked sputum but not requiring vascular embolization) requiring hospitalization of any length.
- Weight loss requiring daily supplemental enteral nutrition via a gastrostomy for at least 90 consecutive days, or parenteral nutrition via a central venous catheter for at least 90 consecutive days.
- CFRD requiring daily insulin therapy for at least 90 consecutive days.
The medical evidence needed by the SSA to document and assess the severity of your adult CF symptoms, will consist of:
- Your complete medical history;
- The results of physical examination;
- The results of imaging (such as X-rays);
- The results of pulmonary function tests (including spirometry, DLCO, ABG, and pulse oximetry);
- Other relevant laboratory tests; and
- Descriptions of any prescribed treatment and your response to it.
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Disability Benefits for Children with CF
The requirements for getting SSA disability benefits for CF are a little different for children than adults. In order for a child to receive SSA disability benefits for CF, their parent or guardian must submit a report signed by a physician showing both A and B:
A. One of the following:
- A positive newborn screen for CF; or
- A history of CF in a sibling; or
- Documentation of at least one specific CF phenotype or clinical criterion.
AND
B. One of the following definitive laboratory tests:
- An elevated sweat chloride concentration equal to or greater than 60 millimoles per L; or
- The identification of two CF gene mutations affecting the CFTR; or
- Characteristic abnormalities in ion transport across the nasal epithelium.
The child must also have experienced any of two exacerbations or complications specified under the Blue Book listing within a 12-month period; this can be two of the same exacerbation or complication or two different ones.
If You Need to Appeal a Denial of Cystic Fibrosis Social Security Disability Benefits
In addition to the respiratory system, CF can also affect other body systems as well, such as digestive or endocrine. If the symptoms of your CF does not meet the requirements listed for qualifying as a respiratory disorder, the SSA may evaluate your other CF-related impairments under the listings for that affected body system.
The Social Security disability attorneys at the law firm of Marc Whitehead & Associates have helped individuals all over the U.S. suffering from the debilitating effects of the CF obtain the disability benefits they deserve, even in cases where the SSA had denied their original claim for benefits. Many people have their initial disability benefits claims for cystic fibrosis and other medical conditions rejected by the SSA. In our experience, it turns out that a lot of these have been rejected not because they don’t deserve benefits, but simply because the applicant failed to provide the SSA with the information it needed to make a decision in their case.
If you need to appeal a denial of SSA disability benefits for CF, contact the law offices of Marc Whitehead & Associates without delay to schedule a free, no-obligation consultation to discuss your claim with one of our experienced disability benefits attorneys.
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