How to Win Disability Benefits for COPD

Chronic Obstructive Pulmonary Disease, or COPD, can qualify you for disability benefits if your condition prevents you from working. However, obtaining disability benefits for COPD can be a challenge due to a lack of documentation or proof that you cannot work.

For a start, the American Lung Association states that COPD can often be treated to improve symptoms and quality of life.

If treatment helps you function and live better, that’s encouraging news. However, it could also drive a denial of benefits. This example illustrates how the details of your condition and how you build your case with evidence can significantly impact the outcome of your disability claim.

An experienced disability lawyer will consider relevant aspects of your situation beyond your medical records to help you prove your case. Learn how we can help.

Call or text (800) 562-9830 or complete a Free Case Evaluation form

Where Can I Get Disability Benefits for COPD?

Claims for chronic lung diseases like COPD are generally eligible for disability benefits from the following sources:

Social Security Administration (SSA) ‒ SSA recognizes COPD as one of several respiratory-related disorders. If you meet SSA’s work history requirements, you can receive Social Security Disability Insurance benefits for COPD if SSA finds that you are totally disabled from working.
Long-Term Disability (LTD) Insurance ‒ LTD is long-term disability insurance coverage available through a private insurance policy you have purchased or a group disability plan offered by your employer. The purpose of LTD insurance is to help replace part of your income if you become sick or injured and cannot work for an extended period.
Veterans’ Disability Compensation ‒ As a veteran with a service-connected disability, you can apply to the U.S. Department of Veterans Affairs for disability benefits for COPD. Sadly, not all veterans are aware of VA disability compensation, and many don’t apply for benefits they qualify for. Additionally, some veterans aren’t aware they can receive both Social Security disability and veterans’ disability benefits. If you have enough Social Security work credits, you can apply for and receive both.

For a free legal consultation, call (800) 562-9830

How Does COPD Cause Disability?

Chronic obstructive pulmonary disease is a progressive, obstructive lung disease. It is caused when irritants progressively damage the lung’s airways and air sacs. This damage causes inflammation and other harm, blocking airflow and destroying lung tissue. This limited airflow is called obstruction.

When your body doesn’t get enough oxygen, you might become easily winded, whether you’re active or not. Difficulty breathing makes each day feel like a grueling challenge. Simple activities like walking can become exhausting, leading to shortness of breath, wheezing, coughing, and fatigue.

The American Lung Institute reports that millions of Americans suffer from COPD, making it a significant cause of disability.

According to the U.S. Centers for Disease Control and Prevention (CDC):

COPD is one of the top 10 causes of death in the U.S.
Nearly 16 million U.S. adults have COPD, and many more don’t realize they have it
There is no cure for COPD, but it can be managed and treated

COPD is primarily caused by long-term exposure to lung irritants, including:

Smoking: Cigarette smoking is the most common cause of COPD.
Air pollution: Outdoor air pollution, such as vehicle exhaust and industrial emissions.
Indoor air pollution: Secondhand smoke, dust, and fumes from cooking or heating.
Occupational exposures: Certain chemicals and dusts found in some workplaces.
Chronic lung infections: Repeated lung infections, such as pneumonia and bronchitis.
Genetic factors: A rare condition called alpha-1 antitrypsin deficiency can increase the risk of developing COPD.

Two common types of COPD are chronic bronchitis and emphysema, often occurring together.

Can COPD Be Misdiagnosed?

Yes, COPD can be misdiagnosed or go undetected for several reasons:

It is similar to other lung conditions. COPD symptoms — such as shortness of breath, coughing, wheezing, fatigue, and chest pain — can resemble those of other respiratory disorders like asthma, bronchiectasis, lung cancer, or heart failure. Likewise, other conditions can be mistaken for COPD. Additionally, COPD symptoms may not be noticeable in the early stages.
Diagnostic criteria vary, as doctors use different methods to diagnose COPD and assess lung damage. Uncertainty about your COPD diagnosis or description can make the evaluation process confusing. If the disability claims examiner or VA rater perceives your condition as less severe than it actually is because your medical records are unclear or mixed up, your claim might be denied.
Sometimes, medical records and notes from different doctors may not match. Inconsistencies or conflicts in your records can alert the claims examiner, causing them to doubt the credibility of your claim.

Getting Social Security Disability Benefits for COPD

Social Security Disability Insurance (SSDI) offers benefits for total disability only; SSDI does not cover partial or short-term disabilities.

To qualify as “totally disabling,” your COPD:

must prevent you from doing any meaningful work. You must be unable to perform your previous tasks and also cannot adapt to other work because of your medical condition; and
is expected to last at least one year or results in death.

The first step SSA will take to determine your eligibility is assessing whether your condition meets SSA’s medical criteria. Your disability claim must show that your chronic obstructive pulmonary disease is medically severe enough to prevent you from working.

The SSA follows the medical eligibility requirements for COPD listed under Section 3.02 – Chronic Respiratory Disorders of SSA’s Listing of Impairments. The listing includes lung problems “due to any cause” except Cystic Fibrosis.

What Medical Evidence Does Social Security Require to Confirm Disability Because of COPD?

Your evidence should include medical documentation such as lung function test results (FEV1) or (DLCO), a history of your hospitalizations, or a physician’s statement on your residual functional capacity. The SSA provides specific details on the types of evidence you need to submit to claim disability benefits for COPD, including:

FEV (Forced Expiratory Volume, total amount of air a person can forcefully exhale)
FEV₁ (Forced Expiratory Volume in one second), which is a spirometry, or air flow, test
DLCO (Diffusing capacity of the Lungs for Carbon Monoxide) test, which measures the efficiency of the gas exchange between your lungs and the bloodstream
ABG (arterial blood gas) test, which measures the exchange of blood gases, such as oxygen and carbon dioxide, and blood pH
Pulse oximetry to determine the percentage of oxygen in your blood’s hemoglobin
Tests conducted at rest
Tests conducted during exercise (if safe for the patient)
Reports from physical exams
Medical imaging (such as X-rays)
Laboratory tests
A comprehensive summary of your medical history
Descriptions of your treatment and its effectiveness

The specific tests and records required to support each case will differ because each person’s condition is unique.

What If My COPD Does Not Meet the SSA’s Medical Criteria?

Meeting the SSA’s listing requirements for COPD can be challenging, and many COPD claims fail to meet the medical criteria. The good news is that you might qualify for SSDI through the SSA’s medical-vocational allowance for respiratory issues.

To determine whether you can perform your past work or adjust to new work, the SSA must next evaluate your:

Age
Education
Work experience, and
Residual functional capacity (RFC).

This involves demonstrating that you cannot perform your previous job or even switch to a less demanding or sedentary position. As your attorneys, we help the SSA understand the reality of your disability in daily life. Beyond medical records, we collaborate with your doctors to fill out RFC forms detailing all physical and mental limitations and provide a work history report explaining why you cannot return to your past employment.

For SSDI applicants, medical vocational allowances are essential for securing benefits for individuals who are unable to work but do not fulfill SSA’s impairment listings.

We will also ensure you receive the best possible disability onset date to maximize your benefits. When your ALJ hearing occurs, we will be there to support you before, during, and after the SSDI benefits process. We prepare you for the questions the judge might ask and stay with you throughout the hearing.

We take many steps to make a very difficult process as easy as possible for our clients. Understanding which medical records are necessary, gathering them, and submitting them to Social Security are tasks our Social Security Disability attorneys can handle for you. We work closely with your doctors so their input effectively supports your case. Our goal is to remove the worry and stress from your shoulders.

Discuss your options with a trusted SSDI claims attorney today to learn more.

Winning Disability Benefits for COPD from Your Insurance Company

Although your COPD prevents you from working, don’t be surprised if your disability insurance company finds reasons to deny your long-term disability benefits. Because COPD is a chronic illness, insurers might claim that you can still work at a less demanding job.

However, insurance providers are prohibited by state and federal laws from denying benefits for “arbitrary and capricious” reasons. This means they must have valid, supported grounds to deny your claim. Therefore, you should gather proper medical validation, evidence, and credible physician support to strengthen your case.

How Do Disability Insurance Companies Deny or Delay Disability Benefits for COPD?

Insurance companies frequently deny or question disability claims based on COPD for several reasons, including:

COPD is often described as “subjective”: Some symptoms, like coughing and fatigue, are subjective, meaning they can vary in intensity and cannot be directly observed or measured by others. By highlighting the subjectivity of your symptoms, insurers often try to underestimate the severity of your disability at work. This is a common insurance tactic and does not reflect an accurate medical or legal assessment. While some symptoms depend on self-reporting, COPD is a medically diagnosable and objectively confirmed condition.
Minimizing COPD’s Impact: The insurance company may argue that your COPD is manageable through lifestyle changes, medical treatment, and rehabilitation; therefore, they do not see it as a long-term disability. Instead, they claim you can work in a sedentary role or control symptoms with treatment.
Pre-existing Conditions: The definition of “pre-existing” varies between policies and insurance providers. Insurance companies often use the preexisting condition argument, suggesting you had prior health issues or were a smoker, which contributed to the development of COPD. In this way, they challenge your claim’s credibility.
Cost Savings: LTD insurance claims present a major financial risk for insurers. Therefore, they often conduct very strict reviews to verify that claims are legitimate and justified.

As your attorneys, we work closely with you to ensure all necessary medical tests are performed. We gather all important documents, including treatment records, doctors’ statements, missing medical evidence, vocational assessments, and more.

A single error or omission can determine whether your disability claim is approved or denied. If your insurance carrier has denied paying disability benefits for COPD, or if you need to submit the initial application and want to maximize your chances of approval, our LTD benefits lawyers are here to assist you.

Our established approach ensures that our clients have the best chance of getting the benefits they deserve. Our long-term disability lawyers assist with all stages of the claims process and will use their experience and resources in your case.

Note: LTD benefits can often be received jointly with SSDI, and many LTD policies require that you apply for SSDI.

Marc Whitehead & Associates has extensive expertise in both individual disability policies and ERISA group disability claims. Our law firm has gained national recognition in disability law, handling appeals and litigating long-term disability claims in both types of cases.

Let us help you regain financial stability by securing the compensation you deserve.

Are VA Disability Benefits for COPD Available?

Yes, the VA may award service-connected disability benefits for COPD in several scenarios:

Presumptive Service Connection (Toxic Exposure): Under the PACT Act, the VA now acknowledges Chronic Obstructive Pulmonary Disease as a presumptive condition in certain instances. Presumptive service connection makes obtaining disability benefits for COPD easier by eliminating the need to prove direct service connection.

You will need to meet the service requirements related to exposure to burn pits and other toxins, which include military service on or after:

August 2, 1990 in the “Southwest Asia theater of operations” – Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations, or Somalia – or –
September 11, 2001 in Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan, or Yemen.

In the above cases, the VA “presumes” service connection, which means you only need to prove you have the condition and served in a qualifying location/time, without needing to provide a direct medical link.

Direct Service Connection: If your case is not presumptive, you can still establish a direct service connection. You must have

a current diagnosis;
proof of an in-service event or exposure (for example, exposure to hazardous fumes, dust, chemicals, or other irritants during service); and
a medical nexus letter from a doctor linking your COPD to that in-service event.

Secondary Service Connection: You might receive VA disability benefits for COPD as a secondary condition related to a primary service-connected impairment. Examples include respiratory issues like bronchitis and asthma that worsen over time, leading to COPD and other complications. Another example could be if you started smoking cigarettes to cope with your service-connected PTSD, which eventually resulted in chronic obstructive pulmonary disorder.

Aggravation of a Pre-existing Condition: If your military service has caused an existing COPD condition to worsen beyond how it would have naturally progressed, you might qualify for VA disability benefits for the increased severity.

How Does the VA Rate COPD?

The VA assigns a rating for COPD under diagnostic code 6604 in the Schedule of Ratings for “Chronic obstructive pulmonary disease.”

Your service-connected COPD may be rated at 10%, 30%, 60%, or 100%, depending on the severity of your symptoms.

Getting TDIU for COPD

Does your condition substantially affect your ability to work? If so, you might be eligible for a Total Disability Rating Based on Individual Unemployability (TDIU).

TDIU provides benefits at a 100% rate, even if your scheduled rating is below 100%. The progressive nature of COPD and its exhausting restrictions on physical activity often serve as a solid foundation for TDIU claims. Find out more about VA TDIU claims.

At Marc Whitehead & Associates, we are Accredited Veterans Claim Attorneys committed to helping service members get the benefits they deserve. We work hard to ensure the VA recognizes and honors your service to this country.

In these scenarios and more, reach out to Marc Whitehead & Associates.

Our attorneys bring extensive knowledge that can significantly influence your case. Let us apply our understanding of disability laws, insurance companies, and government benefit programs to work in your favor.