Winning Social Security Disability Benefits for Cystic Fibrosis by Meeting a Listing

To determine whether you are disabled at Step 3 of the Sequential Evaluation Process, the Social Security Administration will consider whether your breathing difficulties are severe enough to meet or equal the cystic fibrosis listing. The Social Security Administration has developed rules called Listing of Impairments for most common impairments. The listing for a particular impairment describes a degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work. If your cystic fibrosis is severe enough to meet or equal the cystic fibrosis listing, you will be considered disabled.

The listing that applies to lung problems from cystic fibrosis is 3.04. It has 3 parts, A, B, and C.

You will meet the listing and qualify for disability benefits if you meet any part.

Digestive system problems are evaluated under the digestive system listings. You may qualify for disability benefits with a combination of pulmonary and digestive impairments even if neither alone is sufficient to meet a listing.

Meeting Social Security Administration Listing 3.04A for Cystic Fibrosis

You will meet part A of listing 3.04 if you have cystic fibrosis with an FEV1 equal to or less than the appropriate value specified in Table IV corresponding to your height without shoes.

Cystic fibrosis Table IV

Part A involves evaluation of the results of spirometric testing. Spirometric testing requires you to exhale into a device called a spirometer, which measures the volume of air you can inhale and exhale. FEV1 means forced expiratory volume in one second. Spirometry is the most important test for evaluating obstructive lung disease. FEV1 decreases in proportion to the severity of the lung disease. In other words, the lower your FEV1, the more severe your lung disease is.

Table IV shows the threshold values for the FEV1 that meet the listing for various heights. In reality, gender and age affect normal values but are not taken into account in part A. Since older women have somewhat lower normal predicted values for a given height than men, failure of the table to make a distinction is to the maximum advantage of older women.

Meeting Social Security Administration Listing 3.04B for Cystic Fibrosis

You will meet part B of listing 3.04 if you have cystic fibrosis and episodes of bronchitis or pneumonia or hemoptysis (coughing up blood--more than bloodstreaked sputum) or respiratory failure, requiring physician intervention, occurring at least once every 2 months or at least 6 times a year. Each inpatient hospitalization for longer than 24 hours for treatment counts as two episodes, and an evaluation period of at least 12 consecutive months must be used to determine the frequency of episodes.

Not every episode counts. Episodes must be prolonged lasting one or more days and requiring intensive treatment, such as intravenous bronchodilator or antibiotic administration or prolonged inhalational bronchodilator therapy in a hospital, emergency room or equivalent setting. Therefore, to meet Listing 3.04B, you must have episodes that require a trip to the ER or treatment by a doctor to control.

Documentation of your medical treatment is the key to winning a disability claim under listing 3.04B. Documentation should include hospital, emergency facility and/or physician records indicating the dates of treatment; clinical and laboratory findings, such as the results of spirometry and arterial blood gas studies (ABGS); the treatment administered; the time period required for treatment; and your response to treatment. The medical evidence must also include information documenting your adherence to a prescribed regimen of treatment as well as a description of physical signs.

Meeting Social Security Administration Listing 3.04C for Cystic Fibrosis

You will meet part C of listing 3.04 if you have cystic fibrosis and persistent pulmonary infection accompanied by superimposed, recurrent, symptomatic episodes of increased bacterial infection occurring at least once every 6 months and requiring intravenous or nebulization antimicrobial therapy.

The purpose of part C is to document severe chronic lung disease resulting from infection. The Social Security Administration determines whether you meet the listing by considering factors such as medical history, clinical findings, symptoms, sputum cultures, imaging studies like chest X rays, or direct visualization of bronchi with bronchoscopy.

Part C requires only that the infection be persistent. It does not require any particular level of severity. Furthermore, it does not require symptoms, such as chest discomfort or malaise, although these would support the diagnosis of continuing infection, as would a persistent low-grade fever. Even mild, persistent infection implies ongoing deterioration in the lungs, although it might be slow. In fact, deteriorating pulmonary function studies, like a worsening FEV1, in the absence of obvious pneumonia support the existence of some type of chronic infection.

Continue to Residual Functional Capacity Assessment for Cystic Fibrosis.
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