Chronic Respiratory Disorders and Social Security Disability

In several of my blog posts I have examined what symptomatology the Social Security Administration (SSA) looks for when reviewing medical records for the purposes of awarding disability benefits.  In today’s blog post I’m going to talk about another common ailment category that I see a lot of in my disability practice, Chronic Respiratory Disorders, and how the SSA determines the severity of their impact on a claimant’s ability to perform their past or any other work.

Chronic Respiratory Disorders and the SSA

Chronic Respiratory Disorders can be found within the SSA’s 3.00 Respiratory Disorders – Adult listings section and are described in the SSA’s 3.02 Chronic respiratory disorders listing. The most common examples of this group of ailments are chronic bronchitis, emphysema, pulmonary fibrosis and pneumoconiosis. A close relative is Asthma, which has a separate listing, 3.03 Asthma, which I will probably cover in a later blog post as it is another pretty common diagnosis I see in my disability practice.

While each of these breathing ailments are distinct conditions, they frequently do share some of the same symptoms, examples of which are frequent coughing and hacking (even to the point of producing blood), shortness of breath and particularly a lack of stamina. There are many outside elements that may exacerbate these symptoms, examples of which are strong odors, perfumes, cigarette smoke and chemical smells to name a few.

Is This Case Difficult to Win?

Winning a SSA disability case that is primarily based on Chronic Respiratory Disorders is particularly difficult if the claimant is a smoker.  I’ve warned new clients at the intake stage that they must try and quit, not only for their health’s sake but also that the SSA may effectively invoke the thinking contained within SSR 13-2p: TITLES II AND XVI: EVALUATING CASES INVOLVING DRUG ADDICTION AND ALCOHOLISM (DAA).

This is a Social Security Ruling that allows for a finding of “not disabled” if, hypothetically, the individual stopped abusing drugs (or in this case tobacco) or alcohol they would no longer meet the criteria for whatever particular listing is being considered. In other words, they would get better. I’ve had this reasoning applied mostly to individuals suffering from emotional issues who abuse substances, but occasionally apparently to smokers as well even though the ruling states that smokers weren’t the target of the agency when it came up with this finding.

How the SSA Reviews Chronic Respiratory Disorder Claims

There are a number of dense tests the SSA looks for whose results will determine in its mind the severity of the chronic respiratory condition.  For those interested in the testing particulars, below is the actual listing the SSA uses in reviewing disability claims based on Chronic Respiratory Disorders.

The abbreviations used within are ABG (arterial blood gas), BiPAP (bi-level positive airway pressure ventilation), BTPS (body temperature and ambient pressure, saturated with water vapor), CF (cystic fibrosis), CFRD (CF-related diabetes), CFTR (CF transmembrane conductance regulator), CO (carbon monoxide), COPD (chronic obstructive pulmonary disease), DLCO (diffusing capacity of the lungs for carbon monoxide), FEV1 (forced expiratory volume in the first second of a forced expiratory maneuver), FVC (forced vital capacity), L (liter), mL CO (STPD)/min/mmHg (milliliters of carbon monoxide at standard temperature and pressure, dry, per minute, per millimeter of mercury), PaO2 (arterial blood partial pressure of oxygen), PaCO2 (arterial blood partial pressure of carbon dioxide), SpO2 (percentage of oxygen saturation of blood hemoglobin measured by pulse oximetry), 6MWT (6-minute walk test) and finally VI (volume of inhaled gas during a DLCO test). Good luck!

3.02 Chronic respiratory disorders due to any cause except CF (for CF, see 3.04) with A, B, C, or D:

A. FEV1 (see 3.00E) less than or equal to the value in Table I-A or I-B for your age, gender, and height without shoes (see 3.00E3a).

Table I: FEV1 Criteria for 3.02A

 

Height
without
shoes
(centimeters)

< means
less than

Height
without
shoes
(inches)

< means
less than

Table I-A

Table I-B

Age 18
to attainment of age 20

Age 20
or older

Females 
FEV1
less than or equal to
(L, BTPS)
Males
FEV1
less than or equal to
(L, BTPS)
Females
FEV1
less than or equal to
(L, BTPS)

Males
FEV1
less than or equal to
(L, BTPS)

<153.0

<60.25
1.20
1.45
1.05
1.20

153.0 to <159.0
60.25 to <62.50
1.30
1.55
1.15

1.35

159.0 to <164.0

62.50 to <64.50
1.40
1.65
1.25
1.40

164.0 to <169.0
64.50 to <66.50
1.45
1.75
1.35

1.50

169.0 to <174.0

66.50 to <68.50
1.55
1.85
1.45
1.60

174.0 to <180.0
68.50 to <70.75
1.65
2.00
1.55

1.75

180.0 to <185.0

70.75 to <72.75
1.75
2.10
1.65
1.85

185.0 or more
72.75 or more
1.80
2.15
1.70

1.90

 

OR

B. FVC (see 3.00E) less than or equal to the value in Table II-A or II-B for your age, gender, and height without shoes (see 3.00E3a).

Table II: FVC Criteria for 3.02B

 

Height
without
shoes
(centimeters)

< means
less than

 

Height
without
shoes
(inches)

< means
less than

Table II-A

Table II-B

Age 18
to attainment of age 20

Age 20
or older

Females 
FVC
less than or equal to
(L, BTPS)

Males
FVC
less than or equal to
(L, BTPS)
Females
FVC
less than or equal to
(L, BTPS)

Males
FVC
less than or equal to
(L, BTPS)

<153.0

<60.25
1.35
1.65
1.30
1.50

153.0 to <159.0
60.25 to <62.50
1.50
1.80
1.40

1.65

159.0 to <164.0

62.50 to <64.50
1.60
1.90
1.50
1.75

164.0 to <169.0
64.50 to <66.50
1.70
2.05
1.60

1.90

169.0 to <174.0

66.50 to <68.50
1.80
2.20
1.70
2.00

174.0 to <180.0
68.50 to <70.75
1.90
2.35
1.85

2.20

180.0 to <185.0

70.75 to <72.75
2.05
2.50
1.95
2.30

185.0 or more

72.75 or more
2.10
2.60
2.00
2.40

OR

C. Chronic impairment of gas exchange demonstrated by 1, 2, or 3:

1. Average of two unadjusted, single-breath DLCO measurements (see 3.00F) less than or equal to the value in Table III for your gender and height without shoes (see 3.00F3a); or

Table III: DLCO Criteria for 3.02C1

Height without shoes 
(centimeters)

< means
less than

Height without shoes
(inches)< means
less than
Females
DLCO
Less than or equal to (mL CO (STPD)/min/mmHg)

Males
DLCO
Less than or equal to (mL CO (STPD)/min/mmHg)

<153.0

<60.25
8.0
9.0

153.0 to <159.0
60.25 to <62.50
8.5

9.5

159.0 to <164.0

62.50 to <64.50
9.0
10.0

164.0 to <169.0
64.50 to <66.50
9.5

10.5

169.0 to <174.0

66.50 to <68.50
10.0
11.0

174.0 to <180.0
68.50 to <70.75
10.5

11.5

180.0 to <185.0

70.75 to <72.75
11.0
12.0

185.0 or more
72.75 or more
11.5

12.5

2. Arterial PaO2 and PaCO2 measured concurrently by an ABG test, while at rest or during steady state exercise, breathing room air (see 3.00G3b), less than or equal to the applicable values in Table IV-A, IV-B, or IV-C; or

Tables IV-A, IV-B, and IV-C: ABG Criteria for 3.02C2

Table IV-A

(Applicable at test sites less than 3,000 feet above sea level)

Arterial PaCO2 (mm Hg) and

Arterial PaO2 less than or equal to (mm Hg)

30 or below

65

31

64

32

63

33

62

34

61

35

60

36

59

37

58

38

57

39

56

40 or above

55

 

Table IV-B

(Applicable at test sites from 3,000 through 6,000 feet above sea level)

Arterial PaCO2 (mm Hg) and

Arterial PaO2 less than or equal to (mm Hg)

30 or below

60

31

59

32

58

33

57

34

56

35

55

36

54

37

53

38

52

39

51

40 or above

50

 

Table IV-C

(Applicable at test sites over 6,000 feet above sea level)

Arterial PaCO2 (mm Hg) and

Arterial PaO2 less than or equal to (mm Hg)

30 or below

55

31

54

32

53

33

52

34

51

35

50

36

49

37

48

38

47

39

46

40 or above

45

3. SpO2 measured by pulse oximetry (see 3.00H2) either at rest, during a 6MWT, or after a 6MWT, less than or equal to the value in Table V.

Table V: SpO2 Criteria for 3.02C3

Test site altitude (feet above sea level)

SpO2 less than or equal to

Less than 3,000

87 percent

3,000 through 6,000

85 percent

Over 6,000

83 percent

OR

D. Exacerbations or complications requiring three hospitalizations within a 12-month period and at least 30 days apart (the 12-month period must occur within the period we are considering in connection with your application or continuing disability review). Each hospitalization must last at least 48 hours, including hours in a hospital emergency department immediately before the hospitalization.

 

If you or your child have been denied SSA disability benefits or suffer from a severe impairment that is expected to last for more than twelve months and that prevents you from doing any of your past or other work or is causing developmental delay in your child, please contact our office nearest to you to set up a free consultation appointment to discuss your situation.