Lung Disease

Can I Get Social Security Disability Benefits for Lung Disease?

How Does the Social Security Administration Decide if I Qualify for Disability Benefits for Lung Disease?

If you have lung disease, Social Security disability benefits may be available. To determine whether you are disabled by your breathing problems, the Social Security Administration first considers whether your lung disease is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. If you meet or equal a listing because of lung disease, you are considered disabled. If your breathing problems are not severe enough to equal or meet a listing, Social Security Administration must assess your residual functional capacity (RFC) (the work you can still do, despite your lung disease), to determine whether you qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process.

About Lung Disease and Disability

How Respiration Occurs

Red blood cells must be brought as closely as possible to the air we breathe, so that hemoglobin in the cells can give up waste carbon dioxide from cellular metabolism and take on oxygen. To accomplish this, the lungs have millions of tiny air sacs (alveoli) with very thin walls (alveolar membranes) containing microscopic blood vessels (capillaries) (see Figure 1 below). This anatomy of the lungs allows exposure of a large surface area of the blood to the air. Oxygen (O2) and carbon dioxide (CO2) gases diffuse (move) across the one cell thick alveolar membrane in opposite directions with the oxygen entering the blood and the carbon dioxide leaving it. This process is known as gas exchange.

Figure 1: Bronchi and lungs.

The gas exchange part of the lungs is known as the lung parenchyma (see Figure 2 below). Air is delivered to the parenchyma of the lungs through the bronchial tree – a repetitively branching tubular system for air conduction. It consists of the trachea, from which arises a right and left main (primary) bronchus to the right and left lungs. Smaller bronchi branch from the main bronchus of the right or left lung, then to smaller bronchi to the various lobes of the lungs, then to even smaller bronchi (bronchioles) that eventually reach the alveoli.

Figure 2: Mechanism of gas exchange.

How Respiration Is Impaired

Many diseases can affect breathing. The most useful classification of respiratory disorders is based on the manner in which the ability of air to come into contact with the hemoglobin in red blood cells (RBCs) is disrupted.

There are only two ways in which respiration can be impaired, regardless of the exact nature of the disorder:

1. Disease that prevents adequate amounts of air from reaching the gas-exchange level of the lungs (obstructive lung disease).

2. Disease of the lung tissue itself that reduces gas exchange (restrictive lung disease).

Thus, physicians have found it broadly useful to classify respiratory disorders as obstructive or restrictive, or a combination or the two.

Chronic Obstructive Lung Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is the most common type of lung disease seen by the Social Security Administration. “Obstruction” refers to the fact that air flow in and out of the lungs is impeded. The three most frequent types of COPD in adults are:

1. Emphysema.

2. Chronic bronchitis.

3. Asthma.

In emphysema, lung tissue itself is destroyed. Damaged lung tissue forms non-functional spaces that trap air, and the lungs expand. The effect of these abnormalities is to obstruct air flow to and from the lungs. Emphysema and chronic bronchitis often occur together usually in people with a history of cigarette smoking.

Chronic bronchitis can also occur from long exposure to chemical fumes associated with a particular occupation. Inflammation of the inner surface of bronchi results from exposure to irritating substances. This inflammation, along with excessive secretion of bronchial mucous glands results in bronchial narrowing. Thus, bronchial tree resistance to air flow increases; there is obstruction of air flow.

Other less common causes of COPD include cystic fibrosis and bronchopulmonary dysplasia (BPD). These disorders, as well as asthma, have separate specific listings.

Restrictive Lung Disease

The hallmark of restrictive lung disease is loss of usable lung volume, either due to:

1. Disease of the gas exchange part of the lungs (lung parenchyma), or

2. Some disorder outside of the lungs (extrapulmonary) that prevents air from adequately ventilating normal lung parenchyma.

Examples of Parenchymal Restrictive Lung Diseases

  • Infections (bacterial, fungal, viral, parasitic). Chronic infections that damage lung tissue, such as severe bronchiectasis or advanced pulmonary TB, could result in some degree of restrictive impairment.
  • Radiation, such as used for treatment of cancer, can damage lungs. Radiation lung damage is less of a problem than in the past, because modern equipment can direct therapeutic radiation in beams precisely delivered to the tumor. To the extent that this is impossible because of the size or location of the tumor, it is possible to have fibrotic lung damage caused by radiation.
  • Inhalation of damaging substances into the lung. Pneumoconiosis is a non-specific term that refers to lung damage from inhaling small particles of some kind. Examples of pneumoconiosis include that caused by asbestos (asbestosis) (see Figure 3 below), coal dust (anthracosis), beryllium (berylliosis) silicon dust (silicosis), aluminum, iron, tin (stannosis) and talc. Inhalation of toxic chemicals, such as acidic fumes, can also damage lung tissue.