When you have trouble breathing, when your body cannot get enough oxygen, continuing to do your job and earn a living is very difficult, if not impossible. Simple everyday activities, such as walking, pushing a vacuum cleaner, or maintaining concentration become huge challenges.
Lung disease and breathing disorders come in many forms. Symptoms range from shortness of breath, coughing and wheezing, to severe chest pain, and coughing up sputum or blood.
Yet disability claims for respiratory disorders are routinely challenged by the Social Security Administration (SSA), disability insurance companies, and the Department of Veterans Affairs. It can be frustratingly hard to prove to these agencies that your respiratory impairment actually prevents you from working.
If you have been unfairly denied benefits, we have important information to share with you to help you succeed in getting the benefits you need.
Meeting Social Security’s Criteria for Respiratory Disorders
You may have applied for benefits through the Social Security Disability Insurance (SSDI) program, only to find your initial application was denied. You have been diagnosed with a chronic lung condition. Your doctor said you couldn’t work. What went wrong?
Often, the problem is not that you do not meet SSA’s requirements. It is most likely that your application left out information or failed to show sufficient medical evidence of your disability. When granting or denying benefits, Social Security relies heavily on the medical records provided to them, as well as your treating physician’s statement. These and other documents must completely reflect the difficulties and pain you live with daily.
With the right legal help, SSDI claim denials are often reversed on appeal. Our attorneys can give your claim a fresh look and help you develop a fully-documented appeal.
For respiratory disorders, Social Security awards benefits for impairments resulting in
- obstruction (difficulty moving air out of the lungs) or
- restriction (difficulty moving air into the lungs), or
- disorders that interfere with diffusion (gas exchange) across cell membranes in the lungs.
SSA’s disability evaluation information is found in its “Blue Book” Listing of Impairments, in section 3.00 Respiratory Disorders. If you have any of the following respiratory diseases, or other chronic inflammatory lung or obstructive lung diseases, you may qualify for SSDI:
- Acute Respiratory Disease
- Cystic Fibrosis
- Chronic Pulmonary Hypertension due to any cause (this refers to high blood pressure that affects the lungs’ arteries and the right side of the heart)
- Lung Transplant
- Respiratory failure
Plus, SSA looks at cancers that affect the respiratory system, such as lung cancer. SSA also considers disability benefits regarding the pulmonary effects of neuromuscular and autoimmune disorders under each category’s medical listing.
While countless people may have some form of breathing disorder, Social Security Disability benefits are only available to those whose conditions are truly severe. To qualify, your claim must show the SSA adjudicator that your respiratory impairment:
- Prevents you from working full-time
- Has lasted, or is expected to last, for at least one year
- Is life-threatening (especially when diagnosed with other diseases or disorders)
SSA will evaluate your claim based on your medical history, and a number of medical criteria depending on the impairment. Be prepared to provide complete records of ongoing physical examination findings, imaging test results, pulmonary function tests, evidence of the use of supplemental oxygen, and other relevant lab tests, as well as a history of your prescribed treatment plan and how you have responded to it.
Our attorneys can help you determine whether your respiratory disorder meets or equals a Blue Book listing. However, meeting the SSA’s listing requirements is sometimes difficult.
The good news here is, you may ultimately qualify for SSDI under SSA’s medical-vocational allowance for respiratory conditions. This is done by proving you are unable to do past work, or that you cannot even work in a very light or sedentary job.
As your attorneys, we help you explain the reality of your impairments on a day-to-day basis, by translating your daily life into a legal case in SSA’s terms.
We will also ensure you obtain the most favorable disability onset date so that you recover the maximum benefits possible. When your ALJ hearing comes, we will support you before, during, and after regarding your SSDI benefits. We help you prepare for all the questions the judge may ask, and be with you throughout the hearing.
Proving Your Respiratory Disorder Is Disabling to Your Insurance Provider
Fighting for long term disability insurance benefits can be an exhausting process for anyone, especially for someone struggling with respiratory disease.
If your insurer has denied your claim, stay the course. There is a process of administrative appeals and litigation in place to make sure that valid claims will actually get the benefits they should. But you must be prepared. Our attorneys will help you take up the fight.
For example, LTD insurance claims based on asthma, COPD or bronchiectasis are common targets for denial. Insurers will argue that you can work at a sedentary capacity, or there is no basis for the limitations and restrictions as posed by your treating physician. Other times, your claim may be lacking an essential piece of medical or vocational evidence to prove you are disabled under your policy’s definition.
When the insurance company denies your claim or stops payments unfairly, the results can be devastating. Even so, you may very well have a strong case that can be won on appeal or in litigation. Often the key to prevailing against bad faith insurers is to hire a disability attorney who is ready for these tactics and knows how to beat them.
Since 1992, we have helped clients stand up to insurance companies that wrongfully deny or underpay benefits. The insurance companies we fight know our attorneys are prepared and our appeals are solid. We represent individuals across the USA and welcome your call for a free consultation.
Veterans Disability for Respiratory Disorders
Our accredited veteran’s claims lawyers focus on the unique needs of disabled veterans as they seek to obtain service-connected disability compensation. Servicemen and women suffer from all manner of respiratory disorders, and the severity varies widely. Exposure to airborne chemicals, toxins, smoke, and pollutants often develop into respiratory diseases and breathing problems.
Veterans’ claims based on respiratory disorders are often denied initially or multiple times before being granted the benefits they deserve. Claims are rated under the VA’s Schedule for Rating Disabilities using The Respiratory System listing, which includes:
- Diseases of the Nose and Throat
- Diseases of the Trachea and Bronchi
- Diseases of the Lungs and Pleura – Tuberculosis
- Nontuberculous Diseases
Some of the more common breathing and respiratory diseases afflicting US veterans include asthma, bronchitis, cancer, COPD, emphysema, pulmonary vascular disease, and sleep apnea. Symptoms may not surface until years after the veteran goes home.
To determine a veteran’s ratings, the VA relies a great deal on pulmonary function tests (PFTs). These are non-invasive tests that measure lung volume, capacity, rates of flow, and gas exchange. The dollar amount of benefits is determined by the degree of your disability.
The VA may also evaluate respiratory disorders based on alternative evaluation criteria, such as:
- measures of maximum exercise capacity
- the presence of pulmonary hypertension (documented by echocardiogram or cardiac catheterization)
- cor pulmonale (a.k.a. right-sided heart failure)
- episodes of respiratory failure
- requirement for outpatient oxygen therapy
Presumptive service connection is available for certain respiratory illnesses, including tuberculosis and bronchiectasis. See VA’s list of all diseases eligible for presumptive service connection.
Along with issues regarding diagnosis, you may also run into problems with establishing service connection, or with your C&P exam or military service records. Many times the VA is responsible for errors in processing and deciding claims and appeals.
If you have questions, call us without delay. We represent veterans at all levels within the VA disability system including claims before the VA Regional Office, the Board of Veterans’ Appeals and the U.S. Court of Appeals for Veterans Claims.
Talk to Our Attorneys about Your Claim
No matter what stage of the claims process you’re in, we have proven solutions for you based on the law and experience. We look forward to hearing about your situation and answering your questions in a free legal consultation.