How to Understand Social Security Disability if you have Respiratory Problems like Asthma, Bronchitis and, Emphysema
Social Security Disability claims often include allegations related to respiratory problems. This hub will help you to understand the program in this regard.
The program sees many types of respiratory allegations including emphysema, asthma, chronic bronchitis, lung resection, pulmonary fibrosis, lung infections, cor pulmonale, sleep disorders, lung transplant and, many others.
Your claim will be forwarded to a Disability Determination Office in the state in which you live. Sometimes there is one office in the state and sometimes multiple. Once the adjudicator gets your claim, you will be asked to fill out forms...most commonly medical release forms, a work history form and, an activities of daily living form. The adjudicator will contact your treating sources for medical records.
Findings the program will focus on are wheezing, coughing, rales, rhonchi, etc. Your records will need to include physical exams done by real doctors who listened to your lungs for any breathing anomalies. Chest X rays are often needed or requested.
If the adjudicator cannot obtain enough current-recent medical records a consultative exam will be scheduled at no cost to you. Transportation (taxi service, bus tickets, etc.) can be arranged for you if you have no way to get to your exam.You must cooperate with the process or you will likely be found not disabled due to failure to cooperate or for insufficient evidence.
The most common test the agency likes to see is a pulmonary function test (PFT). This is a laboratory test where you breathe into a tube. It measures the capacity of your lungs. Social Security uses the findings from the test in correlation to your height to see where you fit within their respiratory listings. If your pulmonary function test reveals terrible lung capacity and if all other findings are consistent, you have a good chance of being found disabled. There are a few other tests the agency sometimes asks for, like a DLCO, but far and away, the PFT is the most common.
Frequent asthma attacks despite prescribed treatment and requiring a visit to the hospital can result in a finding of disabled.
If not disabling by itself, your respiratory impairment could still factor into a finding of disability based upon other medical and vocational factors. What this means is that other factors, in addition to your respiratory deficit, can come into play to push you over to an allowance. For example, you may also have a lower back problem and arthritis in your right knee which severely restricts your ability to function. These impairments along with your respiratory impairment can result in your claim being approved.
Age is a VERY important factor in the claims decision process. Ages 50, 55 and 60 are especially important and can tilt you more towards an allowance. A 43 year old can be denied but a 52 year old with the same exact profile can be allowed. Other non medical issues such as educational level, work history and, ability to speak English can come into play.
Once enough evidence is received your claim will be forwarded to a medical consultant. The consultant will determine your residual functional capacity in accordance with Social Security guidelines. The claim will then go back to the adjudicator who will perform additional analysis. It is the adjudicator who will ultimately make and input the decision.
To save money, a few corrupt states mostly bypass the medical consultant and have the adjudicator with a Bachelors Degree assume most of the role of medical consultant. Be very scared! This is called Single Decision Maker and is a twisted perversion of the program. In these states the medical consultant use to be a bonafide, legitimate doctor. Now it is primarily a person who never went to medical school, who has never prescribed medication and, who has never treated a patient. During the claims process you should ask your adjudicator if the state is a single decision maker state. If it is (hopefully they will tell you the truth) you should have little to no confidence in the program and if denied should definitely appeal. The "Single Decision Maker" crime happens mostly in the NW part of the nation i.e. Washington, Oregon, Idaho, Alaska...
Due to this scandal some of these states eliminated the phrase "Single Decision Maker" but still maintain the practice. So, if you ask them if they are a Single Decision Maker state they can say no when really they still are.
If you are denied you have x number of days to file an appeal. Your claim will then be reconsidered. The reversal rate is low. If you are denied again and if you appeal you then go to the third level before a judge.
The program is interpreted differently at this level in a way which is VERY favorable to you. The judges take note of all the objective findings of course but focus more on the subjective at this level than at the prior two levels. Examples of subjective variables are pain, fatigue, down and out stories, etc.
The judges often get lost in historical court case precedents and lots of other legal mumbo jumbo. The judges like to pontificate to prove to everybody how smart they are. Aside from possibly annoying or boring you this does you no harm--be quiet and let them pontificate!
The bad news is it takes well over a year to get before the judge...often much more than a year. Sixty to seventy percent of all claims are reversed to an allowance at the third level. Don't try to make sense out of some of these things or you will lose your mind. You do not need an attorney or an attorney representative at the first and second level but definitely do at the third level.