How to Win Disability Benefits for Cystic Fibrosis (CF)

After living with cystic fibrosis, your symptoms have deteriorated to the point where you can no longer work. Are any disability benefits available for people with CF?

Yes, it is considered a disabling condition, and making a disability claim can be crucial to one’s well-being. You may be eligible for disability benefits for cystic fibrosis through Social Security Disability Insurance (SSDI), veteran’s disability compensation, or you may be covered under a disability insurance plan:

- Social Security Disability Insurance (SSDI) covers people who meet the SSA’s work and medical requirements. To get Social Security Disability benefits for cystic fibrosis, you must have (1) worked in jobs covered by Social Security, and (2) you must prove your CF is severe enough to keep you from working for at least 12 months.
  
  You can qualify medically by meeting a specific impairment listing in the SSA’s Listing of Impairments for Respiratory Disorders, Section 3.04 for cystic fibrosis.
  If you cannot satisfy the medical listing, your next step is to show the SSA that your combined CF impairments prevent you from doing any substantial work.
- Veterans with cystic fibrosis can obtain disability compensation when the CF was made worse by their service. Cystic fibrosis is listed in the Department of Veterans Affairs (VA) Schedule of Ratings, under the Respiratory System.
  
  Note: A veteran who has paid Social Security taxes (FICA) or self-employment taxes (SECA) can claim both VA and SSDI benefits.

Long-Term Disability (LTD) insurance benefits are different from the above government-funded benefits. LTD insurance benefits are issued either by your employer as a group benefit, or you’re paying premiums on a private disability insurance policy as your personal financial safety net. For both group and private disability claims, the insurance company will focus closely on how cystic fibrosis prevents you from performing your job duties. The burden of proof is on the claimant.

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

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About Cystic Fibrosis Disability

Cystic fibrosis is an inherited disorder that mainly affects the lungs and digestive system. The condition causes thick, sticky mucus to build up in the lungs, pancreas, and other organs, leading to severe respiratory issues and digestive problems.

CF is a progressive disease, meaning it worsens over time, with potentially life-threatening complications. According to the Cystic Fibrosis Foundation, about 40,000 children and adults currently live with CF in the United States.

Many view CF primarily as an obstructive lung condition, since it is widely known to impact the lungs, causing blocked airways and lung damage. The mucus is also an ideal environment for bacteria, where germs get trapped and cause lung infections (recurring pneumonia or bronchitis).

However, the disease is named cystic fibrosis because it also leads to the formation of cysts and scarring (fibrosis) in the pancreas. The fibrosis, along with the thick mucus, obstructs the ducts that release digestive enzymes to the intestines, thus hindering nutrient absorption from the digestive system.

Not all CF problems are necessarily pulmonary or digestive in nature. People with CF are prone to develop other disabling health problems such as diabetes mellitus, liver disease, arthritis, sinusitis, heart failure, fibrosis of the bile ducts, an overactive spleen, and osteoporosis.

While there is no cure yet, treatments can help manage symptoms and improve quality of life. Management of cystic fibrosis encompasses airway clearance techniques, inhaled medications, pancreatic enzyme supplements, specialized diets, and exercise plans.

Today, People with CF Are Living Much Longer.

In the not-so-distant past, few people with cystic fibrosis lived past age 20. However, thanks to remarkable advances in medicine, diagnosis, and treatment, people with CF are now enjoying longer, fuller lives. A 2023 study found that the median age at death for people with CF had more than doubled from age 26 in 2008 to age 66 in 2022.

According to the Cystic Fibrosis Foundation, in 2025:

65% of adults with CF have full-time or part-time jobs.
41% of adults with CF have a college degree.

Getting Social Security Disability Benefits for Cystic Fibrosis

To find out if your cystic fibrosis qualifies as a disability, the SSA first determines if your CF “meets or equals” a listing in the official Listing of Impairments, also referred to as the Blue Book.

You will need to satisfy the SSA’s medical criteria under Listing 3.04 Cystic fibrosis. The listing addresses lung problems caused by CF explicitly and consists of seven parts (A, B, C, D, E, F, and G).

You can qualify medically if you meet any one of the following criteria, summarized below. See 3.04 Cystic Fibrosis for SSA’s full text.

Summary of Section 3.04 – Criteria for Cystic Fibrosis Disability

Low FEV1: A spirometry test showing an abnormally low FEV1. Spirometry measures how well your lungs move air in and out. FEV1 stands for Forced Expiratory Volume in 1 second: the amount of air you can force out of your lungs in the first second.
Complications: Three or more hospitalizations due to worsening conditions within 12 months, each at least 30 days apart. All occurrences must be within the time period connected with your disability claim or a continuing disability claim review.
Spontaneous pneumothorax: “Pneumothorax” is when air gets inside your chest cavity and causes your lung to partially or fully collapse. Chest tube placement is required.
Respiratory Failure: Requires either mechanical ventilation or BiPAP ventilation, or a combination of both, for a continuous period of a minimum of 48 hours, or for a continuous period of at least 72 hours if postoperatively.
Pulmonary hemorrhage: This is bleeding in the lungs, and vascular embolization is necessary to stop bleeding. The technique involves injecting materials into the blood vessels via a catheter to block the bleeding arteries.
Low oxygen readings: SpO2 (Peripheral Oxygen Saturation) measures the percentage of oxygen in your blood. A SpO2 oxygen reading of 89% or lower ꟷ at rest, during, or after a 6-minute walk test ꟷ recorded twice within 12 months and not within 30 days of each other. The 12-month period must take place within the period SSA is deliberating your claim for disability benefits for cystic fibrosis or during a continuing disability review.
Serious complications: Experiencing two of the following four complications within 12 months (this can be two of the same or two different complications). The 12-month period must take place within the period SSA is deliberating your claim or during a continuing disability review:

pulmonary exacerbation requiring 10 days of IV antibiotics
pulmonary hemorrhage requiring hospitalization
chronic weight loss needing enteral tube feeding or parenteral nutrition via a central venous catheter – either condition lasting for a minimum of 90 consecutive days.
CFRD (cystic fibrosis-related diabetes) that requires daily insulin for a minimum of 90 consecutive days.

Digestive system issues from CF are evaluated under section 5.00 Digestive Disorders in the SSA listings.

If you meet or equal a listing due to cystic fibrosis, you are deemed disabled.

If your CF is not severe enough to satisfy the medical criteria, you may still qualify for disability benefits for cystic fibrosis.

The SSA will evaluate your residual functional capacity (RFC). This measures the work you can still perform despite your cystic fibrosis. You may still qualify for SSDI if your functional limitations prevent you from doing any job.

You don’t have to handle your disability claim on your own.

The process of applying for SSDI benefits related to CF can be pretty difficult. Statistics show that most applicants are initially denied benefits, leading to an extended appeals journey. Hiring an experienced Social Security disability lawyer can significantly improve your chances of getting approved.

Marc Whitehead & Associates will help you build a strong case to secure the benefits you are entitled to. Discover how we can assist you with a free, no-obligation consultation.

Getting Long-Term Disability (LTD) Insurance Benefits for Cystic Fibrosis

Cystic fibrosis can qualify you for long-term disability insurance benefits under both group and individual disability policies, provided you can demonstrate how the condition severely limits your ability to work.

It’s essential to get and read your policy’s Summary Plan Description (SPD) and understand the specific terms of your insurance policy to support your claim effectively. The SPD outlines how the plan works, including your rights, eligibility, benefits, exclusions, and obligations. This is one of the first steps our disability attorneys take, along with reviewing your entire insurance policy, when examining your case.

Group vs. Private Disability Insurance for CF

Group Disability Benefits for Cystic Fibrosis

Your employer generally sponsors group disability insurance as part of a benefits package. “ERISA” is the abbreviated title of the law that governs group disability insurance plans. ERISA stands for the Employee Retirement Income Security Act, a strict federal law that often favors insurance companies over disabled claimants.

Eligibility and coverage depend on the specific terms of the employer’s insurance plan, such as the severity of your condition and the plan’s definition of disability. Medical records and documentation must show how cystic fibrosis affects your ability to work.

Individual Disability Insurance (IDI)

Individual disability insurance coverage is bought separately, by you, from an insurance broker. Also known as private disability insurance, IDI offers greater flexibility in the coverage you receive, as it is tailored to your individual needs.

You can enhance your policy by including specific riders (options) like portability, occupation-specific (own-occupation) coverage, or cost-of-living protection. With personalized coverage, IDI policies have higher premiums compared to group plans.

State contract laws regulate IDI policies. Compared to ERISA, the state laws are generally more supportive of the IDI policyholder.

Pre-existing Conditions Clauses in Long-Term Disability Insurance Plans

Insurance companies are out to save costs, and a significant way to achieve that is to limit or totally exclude coverage of pre-existing conditions, such as cystic fibrosis. Pre-existing conditions are a primary reason for long-term disability insurance claim denials.

So be prepared for a pre-existing condition exclusion as part of your group or individual disability policy. Some disability plans will require a waiting period for pre-existing conditions. For example, your plan might not cover your CF unless you have been enrolled for a specified period, such as 12 or 24 months.

The definition of “pre-existing” will differ between policies and insurance carriers. Pre-existing generally refers to any permanent medical condition that existed before you applied for disability insurance coverage. Yet with conditions such as cystic fibrosis, your symptoms may have been well managed for years. How policies are underwritten is up to the insurer, and it may be that your CF is covered, perhaps at a higher premium and/or a waiting period before benefits can start.

Can I Get both Social Security Disability and Long-Term Disability Benefits for Cystic Fibrosis?

Yes, people with cystic fibrosis often receive both SSDI and LTD benefits, which can interact with each other. SSDI is usually the main disability benefit, while LTD acts as a secondary benefit.

This is due to how LTD benefits are set up. Typically, LTD benefits provide around 60% of your previous monthly salary, minus any “offsetable” SSDI benefits. Essentially, SSDI pays first, and then LTD pays the remainder to reach your 60% policy limit.

The processes and regulations of the SSA differ from those of insurance companies. Just because the SSA grants benefits does not guarantee that an insurer will approve your LTD claim. However, the same medical and vocational evidence required to win Social Security disability benefits for cystic fibrosis is equally applicable in building a solid LTD insurance claim or an appeal that will hold up in court.

Marc Whitehead & Associates has extensive experience in both individual disability policies and ERISA group disability claims. Our law firm has earned national distinction in the practice of disability law, handling appeals and litigating long-term disability claims.

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

Our attorneys will review your claim to distinguish between claims under ERISA and individual policies, as the rules for each differ. We are familiar with the specific symptoms and complications of cystic fibrosis that qualify for benefits in these cases.

We have the experience and resources to establish medical and occupational evidence that supports a strong case for the claims examiners and administrative law judges who decide your claim.

Getting Veterans Disability Benefits for Cystic Fibrosis

Since cystic fibrosis is a genetic disorder, the VA considers it to be a pre-existing disease. CF is typically not acknowledged as a service-related condition unless it can be demonstrated that military service aggravated your symptoms.

A pre-existing disease will be considered to have been aggravated by active service where there is an increase in disability – the underlying condition (in this case, CF) is worsened – during service. That is, unless the VA specifically finds that the increase in disability is due to the natural progression of the disease. Temporary flare-ups of CF during service would generally not be sufficient to be considered “aggravation in service.”

For example, your symptoms have always been mild. You felt well at the time you entered military service; however, your exposure during service to asbestos and chemical fumes from welding and paint has activated the disease. In addition, your diabetes mellitus was caused by your cystic fibrosis and should be service-connected on a secondary basis.

It is VA’s policy that the benefit of the doubt goes to the veteran. This means to deny your claim, the VA must have clear and unmistakable evidence that shows that your CF was not made permanently worse during military service.

How Does the VA Rate Cystic Fibrosis?

The VA does not use a specific diagnostic code for cystic fibrosis itself. Instead, VA rates the condition based on your symptoms and the organ systems affected, such as respiratory, digestive, or other body systems. The VA will use analogous (similar) conditions and diagnostic codes under 38 CFR § 4.97, the Schedule of Ratings—Respiratory System.

This means the examiner will apply the most appropriate diagnostic code for your case. For example, your cystic fibrosis may be evaluated based on its impact on lung function and any related complications. This condition may be classified using diagnostic codes such as (6825) Diffuse interstitial fibrosis or (6600) Chronic bronchitis, depending on the specific clinical findings.

The specific rating for disability benefits for cystic fibrosis depends on the severity of symptoms and the results of tests, including

Pulmonary Function Tests (PFTs), including:
- Forced Vital Capacity (FVC)
- Forced Expiratory Volume in one second (FEV-1)
- Diffusion Capacity of the Lung for Carbon Monoxide (DLCO)
- Maximum exercise capacity

You may also qualify for SSDI. As mentioned, these two benefits are entirely separate with different rules. While SSDI is awarded for total disability, VA disability benefits are based on a percentage disability rating.

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

We are accredited veterans’ claim attorneys with the knowledge for obtaining VA disability benefits for cystic fibrosis and related complex respiratory issues.

The Veterans disability claims process has multiple levels of appeal. To succeed against the VA and win your appeal, it is essential to have an attorney with expertise in Veterans’ disability benefits law and a successful history at the Veterans Court. We are ready and able to help you get the maximum benefits you deserve.