If you have a serious COPD condition, you may be able to qualify for Social Security Disability (SSD) benefits or Supplemental Security Income (SSI). SSD benefits are a type of insurance program provided to workers who are unable to continue working due to injury or illness. To qualify for SSD benefits, you must have sufficient work credits from when you were able to work. In contrast, SSI benefits do not require a work history and are intended for those with a qualifying disability who have few resources and little income.
Applying for Social Security benefits can be an extremely technical process and require multiple appeals. But working alongside an experienced Social Security attorney can eliminate much of your anxiety and concerns about the process. Fayetteville, AR disability lawyer Ken Kieklak has guided many Arkansans through the Social Security application and appeals process.
What is Chronic Obstructive Lung Disease (COPD)?
COPD or Chronic Obstructive Lung Disease is not a condition in itself, but rather refers to a class of conditions that make breathing difficult for the affected individual. COPD occurs when a person has difficulty in emptying the air from their lungs due to an obstruction A person with COPD typically has some combination of chronic bronchitis or emphysema, but the exact make-up of the condition varies from person to person.
COPD is typically caused by environmental factors although genetics may also cause or contribute to COPD. Smoking, breathing polluted air, or exposure to chemicals at work may cause COPD. COPD can occur due to both long-term exposure to low levels or irritating particles and short-term exposure to concentrated irritants. These irritants can result in increased mucus production that cause the bronchial walls and tubes to become inflamed. COPD is typically diagnosed by something called spirometry which is the measure of a person’s lung function.
While asthma may mimic many of the symptoms of COPD, it is a different condition. However, many people with COPD also have asthma and other respiratory conditions. Also related to COPD is restrictive lung conditions where the problem is in expanding one’s lungs rather than expelling air due to an obstruction. Our attorneys can help you navigate how to apply for disability benefits in Arkansas for your COPD condition.
Can I Qualify for Benefits with COPD or a Related Condition in Arkansas?
All disability claims submitted to the Social Security Administration are determined through a 5-Step sequential evaluation process for adults to find out if your COPD is a condition that qualifies for disability in Arkansas. At Step 1 of the process, you must satisfy the non-medical program requirement by not exceeding the permitted levels of income and work measured by substantial gainful activity (SGA).
At step 2, the inquiry into your condition begins. At this step, the SSA will determine if your condition is considered to be severe. A severe condition is one that causes significant impairment. A non-severe impairment is one that causes few or no limitations in daily living.
To prove both the existence and severity of your COPD condition you will be required to present medical evidence. This evidence can include a:
- Thorough medical history
- Physical examinations
- Imaging tests like an x-ray
- Pulmonary testing
At Step 3, those with the most severe conditions – those that meet or exceed about 100 listed conditions – will qualify without further examination. For instance, Listing 3.02 discusses how the Administration will evaluate chronic pulmonary insufficiency which includes both COPD and Chronic restrictive ventilator disease (CRVD). The Listing includes a table of spirometry results. Based on height and FEV1 results, the amount of air a person can expel in 1 second, one may meet or equal the listing and qualify for benefits. Other related conditions may include:
- 03 Asthma
- 06 Pneumoconiosis
- 07 Bronchiectasis
- 08 Chronic and persistent lung infections
- 10 Sleep related breathing disorders
If one cannot satisfy step 3, they may still qualify through combined medical and occupational reasons. At Step 4, one’s residual functional capacity (RFC) is calculated. RFC includes the things that you are still able to do despite your serious impairment. If your RFC would permit you to perform previous work, you will not qualify for benefits. However, if you are unable to do past work, you proceed to Step 5.
At Step 5 the Administration will determine — for your particularized impairment, age, education and training– if there is other work available in the national economy. The SSA takes into account the number of jobs of that type available in your region.
What If I Can’t Work While I Have COPD in Arkansas?
You could qualify for SSDI benefits if you are able to demonstrate that your COPD has significantly reduced your breathing capacity to the extent that you are not capable of performing any type of employment or any type of job given your ability to learn, experience, education, and age.
Demonstrating that your condition has severely impacted your ability to work will require evidence. Typically, you will be required to provide a medical opinion from your treating physician that explicitly states the diminishing effect your condition has on your ability to perform work-related activities. For example, your doctor might attest to the fact that you are unable to walk more than 30 minutes at a time, are unable to lift 15 pounds, or cannot be exposed to any dust or fumes. You might also have to provide other documentation, such as proof of hospitalization.
The SSA will review your medical records and perform a residual functional capacity (RFC) assessment to determine what type of work you might be capable of performing. Based on your doctor’s restrictions and your breathing test results, the SSA will determine if you can perform sedentary or light work.
The SSA makes a distinction when considering individuals’ capability to learn new skills between people over and under the age of 50. Because of this, the SSA application evaluators utilize a set of grids to determine with older people with COPD are eligible for benefits.
For example, the medical-vocational grid will include several elements that the evaluator will consider when reviewing an application. The factors listed in the grid could include the applicant’s age, educational level, existing employment skills, and the applicant’s RFC. Therefore, a person of advanced age, which for SSA purposes if over 55, would not qualify for disability benefits if, according to the grid, they possessed transferable skills and limited education if their COPD symptoms did not prohibit them engaging applicable employment.
Reasons Why the SSA Would Deny a COPD Disability Claim
It is essential to understand that the SSA will not attempt to contact your treating physician, surgeon, or another healthcare provider when you apply for benefits. As an applicant, you are expected to include all the necessary and essential medical documentation in your application packet. The SSA also anticipates that all forms will be completed accurately and correctly. When an applicant makes an error or small omission, their claim will likely be denied. When applying for SSDI benefits, you should have our experienced Farmington, AR disability attorneys working on your behalf to avoid mistakes that could jeopardize your benefits.
Disability benefits for COPD are also denied because there is a lack of evidence that the applicant was hospitalized for COPD or experienced complications that were severe enough to require emergency treatment. Simply being diagnosed with COPD is not sufficient to be approved for Social Security disability benefits. To increase your chances of being approved for benefits, you must provide proof that you were hospitalized at least three times over the last year for medical complications associated with COPD. Your complications do not have to involve breathing difficulties and could include issues with your heart, circulatory system, or neurological problems caused by an oxygen deficiency. Our office will help you gather the necessary evidence.
The comprehensiveness of your doctor’s medical statement is also crucial to being approved. It is unlikely that the SSA will accept a medical opinion that claims an applicant is disabled without detailed descriptions of the disability and its impact on your ability to function normally. Our knowledgeable Social Security Disability attorneys will work with your treating physician to ensure their statement includes comprehensive and accurate information regarding the nature and level of your disability. When preparing an application packet, the quality of documentation and thoroughness of your supporting information can substantially increase your chances of success. Additionally, the information could prove vital if you are required to appeal an initial application that was denied by the SSA.
What Happens If My Disability Benefits for COPD are Denied?
If your initial application for Social Security benefits for COPD is denied, you have options. First, you are entitled to request an appeal of the decision within sixty days of receiving the denial letter. This process is called “reconsideration.” An SSA evaluator will conduct a thorough review of your application and the denied claim. The evaluator is a pair of “fresh eyes” and was not a party to the original application process. This review is also not limited to the original application documentation. An applicant requesting an appeal is entitled to provide additional medical documentation and evidence relating to the severity of their COPD.
In the unfortunate event that the reconsideration appeal of your claim is also denied, you are permitted to file an appeal with an administrative law judge. Anyone applying for Social Security disability on medical grounds should have an experienced attorney representing them if you are denied disability benefits in Arkansas. However, when you are preparing an appeal for an administrative law judge, having our seasoned Social Security attorney at your side is a requirement. If your case is denied again, you will not be able to receive any benefits for at least a year. Additionally, any further appeals of your application will involve a federal court.
Contact Our Fayetteville, AR Disability Attorney for COPD Today to Review Your Claim
COPD is a disability. It is a progressive and severe illness that will adversely impact your quality of life and could limit your ability to earn a living. When applying for Social Security disability benefits, you want to ensure that you are not making any unforeseen and preventable errors. The Law Practice of Ken Kieklak is dedicated to helping hard-working Arkansans obtain disability benefits after an injury or illness forced them to stop working. Our office will work with your medical providers, collect the required support documentation, and file your initial application. If required, we will also work on an appeal if your initial claim was denied. For your free and confidential consultation with a Johnson, AR disability lawyer, contact us at (479) 316-0438 or contact us online.