Criteria Needed to Qualify for SSD for COPD

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Criteria Needed to Qualify for SSD for COPD

Chronic obstructive pulmonary disease (COPD) is a serious respiratory condition and a leading cause of death around the world. Common symptoms include shortness of breath, tightness in the chest, frequent respiratory infections, low energy, and a chronic cough. Other symptoms may develop, such as swelling in the ankles and unexpected weight loss.

Many people with COPD are able to continue working, but this depends on a variety of factors, such as how severe the condition is and the type of work the person does. If you are no longer able to work due to COPD, Social Security disability (SSD) may be an option. Here’s what you need to know about qualifying for SSD due to COPD. 

Non-Medical Qualifications for SSD

Whether you’re applying for Social Security disability benefits due to COPD or some other medical condition, you’ll have to meet certain criteria before the Social Security Administration (SSA) assesses your medical condition. These include: 

  • Having accrued sufficient work credits to qualify for disability benefits. The number of credits required is typically 40, or the equivalent of 10 years of qualifying work. There is also a “recent work” requirement, which means that you must have accrued 20 credits (the equivalent of five years of work) in the ten years leading up to your disability. Fewer credits are required if you became disabled before the quarter in which you turned 31.
  • Not earning above the substantial gainful activity (SGA) standard. Social Security disability benefits are only available to people the SSA deems unable to engage in substantial gainful activity. If you are already earning above the SGA threshold, then you are not eligible for SSD benefits. However, the fact that your earnings are below the threshold does not necessarily mean you are unable to engage in SGA. The current (2023) SGA threshold is $1,470 for most applicants and $2,460 for blind applicants. 

If you are eligible based on these factors, the SSA will move on to determine whether or not you meet its definition of disability.

Meeting Medical Criteria for COPD

The Social Security Blue Book (formally known as Disability Evaluation Under Social Security) contains a listing of adult impairments in 14 categories and childhood impairments in 15 categories. The listings are accompanied by criteria an applicant must meet to qualify for SSD benefits on the basis of that impairment. 

Not every condition that may qualify a person for Social Security disability benefits is included in the listing, so you shouldn’t be deterred if you don’t find your condition listed. However, COPD is a listed condition, so we have specific standards to meet in applying for SSD for COPD. 

Blue Book Standards for COPD

A diagnosis of COPD is not in itself sufficient to establish a disability for purposes of Social Security disability benefits. Applicants pursuing SSD benefits for chronic obstructive pulmonary disorder are assessed under the criteria for chronic respiratory disorders

There are four ways an applicant may meet the criteria: 

  1. Measured forced expiratory volume (FEV1) at or below the designated level based on your height, age, and sex. 
  2. Measured forced vital capacity (FVC) at or below the designated level for your height, age, and sex.
  3. Chronic impairment of gas exchange as demonstrated by one of the following: 
  1. Lung diffusion testing (DLCO) with the average of two results falling at or below the designated level for your height and sex. 
  2. Arterial oxygen pressure (PaO2) and carbon dioxide pressure (PaCO2) levels are measured simultaneously through arterial blood gas testing at or below levels designated based on the distance above sea level where the measurement took place. 
  3. Blood oxygen levels (Sp02) are measured by pulse oximetry at or below levels designated based on feet above sea level. 

      D.  Exacerbation or complications resulting in hospitalization at least three times during a      12-month period, at least 30 days apart and each for a duration of at least 48 hours. 

In addition to the results of any of these or other relevant tests you have undergone, the SSA will want information from your physician about how your condition has progressed, any treatment attempted, and the limitations you face as a result. Depending on the records available, the SSA may ask you to undergo a physical examination, known as a consultative exam

What if I Don’t Meet the Blue Book Standards for COPD? 

If you don’t meet the listed criteria for COPD, you may still qualify for SSD. That’s because the SSA requires that you “meet or equal” a listed condition. That means that even if you don’t check all the boxes for a specific condition, you may qualify if you are equally debilitated. One way people who suffer from a listed condition but don’t meet the written standards may still be approved for SSD benefits would be if a combination of the listed condition and another medical condition elevated the disability to equal a listed condition. 

The best source of information about whether and how you may qualify if you don’t meet a listed condition is an experienced disability benefits advocate.

Putting Together a Strong SSD Claim for COPD

The requirements for receiving Social Security disability benefits for chronic obstructive pulmonary disease are very specific and require specific medical documentation.  But, there’s much more to your application, including your own report and those of people close to you on your activities of daily life. 

Most initial SSDI applications are denied, and that initial denial can set back your benefits by months, or even a year or two. So, it’s important to put together as strong an application as possible the first time out. The experienced disability benefits advocates at Disability Help Group understand what’s required to assemble the strongest application possible, and what types of supporting documentation are required. They can tell you whether your medical records are likely to be sufficient, or whether you may need to see a specialist or get another type of diagnostic test to supplement your documentation. 

If you’ve already been denied, our advocates can review your denial letter and help you determine what additional materials you should submit on reconsideration, or help you prepare for and represent you at a hearing before an administrative law judge (ALJ). 

To learn more about how we can help you submit the most effective application, reconsideration request, or appeal, call  800-800-3332 or fill out the contact form on this site.

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