Chronic pulmonary insufficiency (CPI) develops when your lungs lose their ability to sufficiently take in enough oxygen or flush out enough carbon dioxide to breathe normally. There are various conditions that fall under CPI, including chronic bronchitis and emphysema.
If you have been diagnosed with CPI and your condition meets certain criteria, you can pursue disability benefits from the Social Security Administration (SSA). To learn more about getting Social Security disability for chronic pulmonary insufficiency in Pittsburgh, call a disability lawyer at Berger and Green: 412-661-1400.
What are the criteria for disability based on CPI?
The SSA evaluates CPI and other respiratory condition using the guidelines laid out in Section 3.00 of the Blue Book. The SSA has listed chronic respiratory diseases under subsection 3.02. Not all cases of CPI qualify someone as disabled; the condition must meet the SSA’s severity requirements in order for the SSA to consider you disabled.
Note: The requirements are highly detailed and in graph form. It might be a good idea to have your doctor review the listing requirements to see if your condition falls within the parameters.
Regardless of the cause of your CPI, the SSA will likely deem you disabled if you meet one of the of the four following criteria:
- Your FEV1 is less than or equal to the value provided in the SSA’s tables for your age, gender, and height. For instance, if you are an 18-year-old, 5’1” female, your FEV1 must be 1.30 or less. If you are a 60-year-old, 5’11” male, your FEV1 must be 1.85 or less.
- Your FVC is less than or equal to the value in the SSA’s tables for your age, gender, and height. Using the above claimant examples, an 18-year-old, 5’1” female would need a FVC of 1.5; a 60-year-old, 5’11” male would need a 2.30.
- You have chronic impairment of gas exchange, i.e., your body cannot transfer adequate oxygen to and carbon dioxide from the body. To confirm this, the SSA will want to make sure your DLCO measurements, your arterial PaO2 and PaCO2 levels, or your SpO2 fall below a certain threshold.
- You have had “exacerbations or complications requiring three hospitalizations within a 12-month period and at least 30 days apart. Each hospitalization must last at least 48 hours.”
Can I still get benefits if my condition does not match the listing criteria?
If your lung condition does not quite fit the criteria under the listing, you may still be able to qualify for benefits. The SSA will review your medical files and prepare a residual functional capacity assessment or RFC. Your assigned RFC rating indicates how your CPI has impacted your ability to work.
If the SSA determines that your condition completely impairs your ability to work — at your job or at any job — then it may still designate you as disabled.
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What are the other requirements to collect disability benefits?
The criteria for disability benefits based on CPI are fairly straightforward:
- You must either meet the listing criteria for chronic respiratory disease, or your RFC must show that your condition is so severe that you cannot do any type of work.
- Your condition has lasted or is expected to last a year or longer, or result in death.
- You are not engaged in substantial gainful activity (SGA), which is defined as having an income that is over $1,130.
You will also need to meet financial or work history requirements to obtain benefits. These requirements depend on which disability benefit you are applying for. The SSA offers two types of disability benefits:
- SSD: Social Security Disability Insurance (SSD) benefits are for disabled workers who have worked a sufficient amount of time at a job where they paid Social Security taxes. The exact number of work credits you need to qualify for benefits depend on your age.
- SSI: For children and those who have not worked long or recent enough to qualify for SSDI can instead apply for Supplemental Security Income (SSI). To qualify for SSI, your income and the value of your assets must be below a certain amount.
Determining whether you qualify — and for which benefit you qualify — can be quite difficult. Our attorneys can examine your medical and work records to determine your best course of action.
How do I prove my disability to the SSA?
You will need to submit substantial medical evidence to the SSA that supports your claim. Your medical files should include diagnostic test results, physician evaluations, detailed descriptions of your diagnosis and condition, past and current treatments, how effective the treatments have been, and your prognosis.
It is prudent to mention that the SSA pay rate at the initial application level is less than three out of 10. The most common reasons for denials are lack of sufficient medical evidence and administrative errors. To improve your chances of winning your benefits, have a local disability lawyer help you apply.
A lawyer can ensure your application and supportive documents are accurate and thorough, explain your rights and responsibilities, and help you navigate the claims process.
A lawyer can also help you through the many levels of the appeals process.
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Call Berger and Green for a free consult with a CPI disability lawyer in Pittsburgh.
At Berger and Green, we provide free consultations so you can get a clear understanding of disability benefits and the qualifications. We also provide our services on a contingency basis, which means we don’t charge for legal fees unless you win your benefits, so there are not upfront costs or risk associated with enlisting our help.
Contact our office and request a free consult with a CPI disability lawyer in Pittsburgh. For decades, our team has been helping people living with disabilities collect benefits, and we would like to see how we may be of service to you, too. During the consult, we can answer any questions you may have and explain what your next steps are as you pursue SSDI or SSI. Call us today at 412-661-1400.