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As an inflammatory lung disease, asthma constricts or narrows a person’s airways, thus impairing breathing capacity. According to the Asthma and Allergy Foundation of America, the United States has more than 25 million Americans with asthma. Since the early 80s, the number of individuals affected by asthma has increased steadily. In recent years, one out of every thirteen Americans has been diagnosed with asthma. In severe cases, a person with asthma may struggle to maintain employment and will need to apply for disability benefits.
Can You Qualify For Long-Term Disability for Asthma?
Yes, you can qualify for long-term disability benefits because of asthma. An example of a severe asthma condition that may qualify for disability benefits is when the patient has persistent asthma attacks, defined as symptomatic episodes lasting at least one day and requiring intensive treatment, or when the patient has asthma attacks that necessitate a doctor’s treatment or hospitalization at least once every two months.
However, millions of people continue to live their everyday lives with asthma. Many people, including the claims representatives hired by your long-term disability insurance company to review your claim, may not think of asthma as a disabling condition. As such, claimants may struggle to obtain disability insurance benefits for asthma.
If you have asthma that significantly affects your ability to work and have been unable to qualify for long-term disability benefits on your own, you should consult an experienced long-term disability attorney at Ortiz Law Firm. For many claimants, hiring a lawyer is the difference between being approved or denied for benefits. Our skilled legal team specializes in long-term disability appeals and lawsuits. We will guide you through the disability appeal process to help you get the disability benefits you deserve.
Get a Free Case ReviewUnderstanding Asthma
When a healthy person takes deep breaths, the airways typically relax. However, asthmatic patients may go into a spasm or find their airways constricted when they take a deep breath. Someone who has asthma may be breathless, wheeze, or even gasp for air when their airways tighten. It is easy to see how these symptoms would interfere with a person’s ability to perform their job duties.
There are acute and chronic classifications for asthmatic episodes. The severity and length of the attacks tend to vary, with some people with asthma reporting attacks that may last for several days.
The two primary stages of asthma include:
- Inflammatory response
- Hyper-reactive response
The immune system triggers the inflammatory response, which causes the airways to produce sticky mucous, fill with fluid, or swell. Due to continuous inflammation, asthmatics tend to be sensitive to common environmental factors, including psychological stressors, ordinary exercise, pollution, dust, or cold air.
If your work environment triggers your asthma, you may be considered for disability benefits for asthma. Be sure to include information about workplace triggers in your application for benefits and include evidence if possible.
Symptoms of Asthma
You need to have a positive diagnosis of asthma in your medical records since several other conditions cause asthma-like symptoms. Though they are typically worse at night, typical asthma symptoms are:
- Coughing
- Trouble breathing
- Chest tightness
- Shortness of breath
- Recurrent wheezing
When trying to prove disability, it is not enough to identify your asthma symptoms. You must also explain why your condition prevents you from doing your job duties. This could include having to regularly take sick days due to poorly controlled chronic asthma or asthma attacks, leading to ineffectiveness in your work. You may also be fatigued due to wheezing and coughing at night. As such, you have distracted days where you cannot concentrate. Shortness of breath may prevent you from performing strenuous tasks, thus forcing you to seek help from a coworker.
You will improve your chances of being approved for disability benefits if you can connect your symptoms to a specific limitation, such as an inability to concentrate. You or your lawyer must ensure your symptoms and resulting limitations are documented in your medical records. Your attorney can also help you document your symptoms and limitations in a sworn statement. Our attorneys typically do so in the form of a notarized affidavit that our office will prepare for you.
Diagnosing Asthma
After noting a patient’s reported symptoms, a physician will conduct a full physical exam and complete a thorough medical history review. A doctor may use several standard lung function tests to diagnose asthma. Lung function tests are various breathing tests the doctor uses to confirm asthma. With these tests, patients can measure their breathing.
Spirometry is easy to use for calculating the maximum amount of air a patient can exhale or inhale. The test also measures the air a patient can exhale in one second. The doctor will take spirometry and give the patient an asthma medication called a bronchodilator, which works by opening the airways. If the patient’s scores improve significantly, an asthma diagnosis is possible. Even if the bronchodilator does not help and there is no improvement in their lung strength, the doctor may also administer additional tests if they still believe a patient may have asthma.
You can also determine how much air you inhale or exhale from your lungs through other tests, such as provocative testing for cold-induced asthma, sputum eosinophils, methacholine challenge, and allergy tests. Other common lung function tests physicians also use to diagnose asthma include:
- Provocation tests: a challenge test whereby the specialist may intend to induce asthmatic symptoms and then test again to see if the patient’s score falls with spirometry;
- FeNO tests: an exhaled nitric oxide test. High levels of nitric oxide may indicate inflamed airways and
- Peak airflow tests: peak flow measurement can show the amount and rate of air that can be forcefully breathed out of the lungs.
Depending on the terms of your long-term disability policy, you may be required to provide objective evidence of asthma before you can be eligible for long-term disability. Simply stating that you have been diagnosed with asthma or listing symptoms such as shortness of breath and cognitive impairments may not be sufficient in these circumstances. With results from one or more of the tests described above, you may be eligible to receive disability insurance benefits for your asthma disability claim.
Treatments and Therapies for Asthma
Most asthma treatment plans include creating an emergency action plan for severe attacks, using drug therapies, and identifying and avoiding the triggers for your symptoms. Physicians may also recommend monitoring their asthma with a peak flow meter. As a hand-held device, patients can watch how much air they push through their lungs. Allergists may tell the patient to change their treatment plan if their airflow is low. These changes may include a different asthma medication or additional environmental or behavioral changes. Because each case is different, patients may have very different treatment plans.
Some quick-relief medicines are effective in stopping asthma symptoms. However, they are inefficient in controlling the airway inflammation that causes the symptoms. A patient may not be maintaining their asthma well enough if they discover they are using their quick-relief medicine two or three nights a month or to treat asthma symptoms more than twice a week.
Other Conditions Associated with Asthma That May Contribute to Your Disability
Patients with asthma often have other serious medical problems as well, which can make it easier to get a claim for disability benefits approved. Many cases of chronic asthma are usually connected to conditions like COPD, emphysema, chronic asthmatic bronchitis, or allergies. Some people with asthma experience the most symptoms at night, which can lead to a chronic lack of sleep. Long-term sleep deprivation can affect your cognitive ability and may make it difficult for you to function at work. Asthma may also keep some people from participating in exercise or sports, which increases your risk for:
- Diabetes
- High blood pressure
- Weight gain
- Depression
When multiple medical conditions limit your ability to work, your claim for disability insurance benefits will be more likely to be approved. You or your disability lawyer should inform the insurance company about other health problems contributing to your inability to work.
Getting Long-Term Disability Benefits for Asthma
You may qualify for long-term disability benefits if you can show that your asthma has affected your lung function to such an extent that you cannot hold down a job. However, many cases are denied due to a policy exclusion or because the claimant does not provide sufficient evidence to support their claim. If your medical evidence does not support your claim, the insurance company may refer it for an independent medical examination (IME), but the results of these exams often support a claim denial.
Policy Exclusions
You or your attorney must carefully review any exclusions in your disability insurance policy. In our experience, most disability insurance policies will not pay benefits for a claim for a pre-existing condition. Since asthma is a chronic condition, you have likely been receiving treatment for your condition before the date you filed your claim. Be sure to check your policy for information about what is considered a pre-existing condition, as this information varies between insurance policies.
Evidence to Support a Disability Insurance Claim for Asthma
Medical evidence, such as lung function test results, can help support your claim. To ensure you qualify for long-term disability benefits, you should produce evidence such as a lung function test performed by a consulting doctor to show minimal airflow. For example, a spirometry test documenting your FEV1 value (your forced expiratory volume in one second, meaning the amount of air you can exhale in one second) should show significant limitations.
You should also ask your doctor for an opinion on what activities you can and cannot do (such as lifting more than 10 pounds, walking no more than a half-hour at a time, and not being exposed to dust or fumes). The long-term disability insurance company may give you an Attending Physician’s Statement (APS) for your doctor to complete that asks about your restrictions and limitations and the type of work you can do.
However, the forms provided by the disability insurance company are designed to apply to claimants with any medical condition, whether a musculoskeletal condition or a heart problem. As such, the forms may not address asthma’s specific symptoms and limitations. If you work with an experienced disability lawyer, you may be able to obtain a custom residual functional capacity (RFC) form that is specific to asthma. The Ortiz Law Firm has prepared hundreds of custom RFC forms for past disability insurance claims.
Should I File For Social Security Disability Benefits Too?
If your long-term disability claim is approved, many insurance policies require you to file a disability claim with the Social Security Administration (SSA). This is because most policies allow the insurer to reduce your monthly benefit by the amount of your monthly Social Security Disability (SSD) benefits. The Ortiz Law Firm handles long-term disability and SSD claims.
An Experienced Disability Attorney at Ortiz Law Firm Can Help You Get Disability Benefits for Asthma
Asthma affects many Americans. If you cannot work due to asthma, you should consult a lawyer. An experienced disability lawyer understands the tricks and tactics the insurance company will use to deny your disability claim and will help you fight back against the disability insurance company.
The Ortiz Law Firm specializes in long-term disability appeals and lawsuits. Mr. Ortiz is a highly skilled long-term disability attorney dedicated to helping his clients get the benefits they deserve. We will fight to recover the benefits you deserve so that you can focus on your health. If your insurance company has wrongfully denied your disability claim, call us today at (888) 321-8131 to schedule a free disability case evaluation. We would welcome the opportunity for you to tell us about your case.