Many long term disability applicants suffer from breathing problems that prevent them from performing a full-time job. Disability applicants with severe breathing problems are most likely to be approved for LTD benefits when their symptoms are well-documented by objective medical evidence, usually in the form of breathing test results.
Common Respiratory Disorders That May Qualify For Disability
COPD is short for chronic obstructive pulmonary disease. COPD, also referred to as Chronic Pulmonary Insufficiency, is an umbrella term used to describe numerous progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis.
These types of breathing disorders may cause coughing, wheezing, and shortness of breath. Patients with COPD typically suffer reduced breathing capacity due to obstructed airflow into and out of the lungs.
Note: Smoking is the most common cause of COPD. Quitting smoking is important as it will usually stabilize symptoms, even if quitting does not completely resolve one’s symptoms. Quitting is also important as it shows anyone looking at your insurance claim that you are doing everything you can to improve your medical condition, and it shows that you are following your doctor’s recommended treatment.
A physician typically diagnoses COPD through spirometry, a pulmonary function test (a lung breathing test) that measures the amount of air that can be inhaled and exhaled by the lungs over a certain period.
A pre-bronchodilator and post-bronchodilator spirometry test can preliminarily diagnose asthma, but a doctor must also look at the patient’s medical history and results of a physical exam.
Many COPD patients also suffer from sleep apnea. Sleep apnea not only impacts the ability to obtain meaningful rest at night; it can also severely impair daytime functioning. A doctor diagnoses sleep apnea based on a combination of the patient’s self-reported symptoms and objective test results, typically a sleep study. The most common treatment for sleep apnea is a CPAP machine, which pumps a steady flow of air into a mask to keep the patient’s airways unobstructed during sleep.
Cystic fibrosis is another respiratory disorder. It is a life-threatening respiratory condition marked by a build-up of thick mucus in the lungs, liver, pancreas, and elsewhere in the body. Typical symptoms of cystic fibrosis include shortness of breath, persistent coughing, pulmonary hypertension, and frequent lung infections.
Asthma or Chronic Asthmatic Bronchitis
To qualify for Long Term Disability due to having asthma, you must demonstrate that it seriously impairs your activities of daily living and your ability to perform work. An example of a serious asthma condition is when the patient has persistent asthma attacks, defined as symptomatic episodes lasting at least one day and requiring intensive treatment, and/or when the patient has attacks which necessitate a doctor’s treatment or hospitalization at least once every two months.
Patients with emphysema have damaged lung tissue. Most of the time – though not always – emphysema is caused by smoking cigarettes. The most common symptom of emphysema is a chronic cough. As with other breathing disorders, in order to qualify for Long Term Disability with emphysema, you will need to demonstrate that you are limited in your daily activities due to the condition.
Restrictive Lung Disease (“RLD”)
RLD prevents your lungs from properly ventilating and exchanging gases, which causes one’s blood to lack adequate oxygen. Restrictive Lung Disease can have viral or bacterial causes. It is also caused by inhaling harmful substances such as asbestos or by exposure to radiation such as that used to treat many forms of cancer. RLD can also be a side effect of a number of serious diseases. As with most respiratory problems, you will need to prove that your RLD makes it extremely difficult for you to accomplish any meaningful daily or work activities.
Stroke-related Respiratory Problems
Many stroke patients face difficulty breathing during their recovery. In some cases, the respiratory problems alone are severe enough to qualify for Long Term Disability. The insurance company evaluating your claim will rely heavily on lung capacity tests to determine whether your problem is severe enough to qualify for Long Term Disability benefits. To support your claim, you will want to carefully document all instances of shortness of breath and how such instances impact your daily activities, along with any other post-stroke related symptoms.
Other Respiratory Disorders
Other Respiratory Disorders that may qualify for LTD benefits include bronchiectasis, pneumoconiosis, pneumonia, and other lung infections.
The Insurance Company’s Evaluation of an LTD Claim Due to a Respiratory Disorder
In claims involving serious respiratory conditions the insurance adjuster considering the claim will review the claimant’s residual functional capacity (RFC) in deciding whether the applicant can perform full-time work. Your RFC is a description of the physical and mental capabilities you still have even in light of your impairments.
An evaluation of a claimant’s LTD claim due to a respiratory disorder typically involves a review of the claimant’s FEV1 and FVC results, the frequency of respiratory episodes requiring medical intervention, and the frequency of chronic pulmonary infections.
In disability cases based on respiratory conditions, the insurance company typically requires objective medical evidence, especially pulmonary function testing, to prove that the impairment is severe. Getting consistent treatment from a primary care provider and/or an appropriate specialist (such as a pulmonologist) is also critical.
In addition to submitting relevant medical records, you should provide the long term disability insurance company with an attending physician statement (APS), or RFC form, completed by your treating doctor. The APS/RFC form should address your ability to perform activities such as walking, standing, lifting, and carrying. In respiratory cases, your doctor should also indicate whether you have any environmental restrictions with respect to surrounding dust, fumes, odors, or extreme temperatures. Prescriptions for supplemental oxygen or a CPAP machine should also be noted. Whether your doctor fills out an APS/RFC form indicating whether your respiratory condition causes severe limitations can have a major impact on the success of your case.
Many respiratory conditions, especially COPD and emphysema, become worse as one ages. If have a serious breathing problem and are unable to perform full-time work you may qualify for LTD benefits.