Evaluating respiratory disorders can be a challenging undertaking for some disability advocates.  Physical limitations caused by respiratory disorders are many in number and can cause a variety of symptoms.  Like all other impairments, respiratory disorders should be evaluated based on the physical and/or mental limitations caused by the impairment. 
 

General Evaluation  

When evaluating disorders of the respiratory system, it is important that you note the symptoms of the disorder. This is certainly not difficult because usually the claimant will eagerly provide a list of symptoms for you to evaluate.  Most lung disorders will manifest symptoms like chronic cough, wheezing, hemoptysis (coughing up of blood), sputum production, dyspnea (difficulty breathing) and possibly chest pain.  One or more of these symptoms will be found on physical examination of claimants with acute or chronic respiratory disease.  In respiratory disorders, as with all other impairments, it is important to note symptoms.  Symptoms supported by the evidence are the foundation upon which you'll build your argument. 
 

Acute Respiratory Disease

There are many types of acute and chronic respiratory diseases.  Generally, acute respiratory diseases are short-lived and treatable.  Acute disorders, although potentially serious, usually respond to treatment and subside in less than twelve months.  Pneumonia would be a good example of an acute yet serious respiratory disorder that is not expected to last twelve months.  As you know, if a condition is not expected to last twelve months, it will be denied by Social Security for not meeting the duration requirement.  If on the other hand you have an acute respiratory disease that responds poorly to treatment or causes serious and lasting damage to the respiratory system, you may have a case for disability. 

Chronic Respiratory Disease

Most disability cases in both children and adults will involve chronic lung diseases like asthma, chronic pulmonary insufficiency, cystic fibrosis and even lung cancer.  Most chronic lung diseases will easily meet Social Security's duration requirement and can result in permanent disability.  These chronic conditions can cause obstructive and/or restrictive breathing problems.  The terms obstructive and restrictive are used to define the physiological cause of the underlying disease.  

Obstructive Pulmonary Disease (COPD)

The three most common adult  COPDs evaluated by Social Security are asthma, emphysema and chronic bronchitis.  The most common child COPDs are asthma, cystic fibrosis and bronchopulmonary dysplasia.  In all of the above conditions, the claimant may suffer from fatigue, severe shortness of breath and an inability to properly exchange gases in the lungs.  In severe cases, the claimant may also experience chest pain, light headedness and an inability to concentrate.  All of these types of symptoms of COPD can significantly reduce a claimant's ability to perform work.  Your Social Security Guide provides a nice presentation on COPD under section 18/5.
 

Restrictive Pulmonary Disease

In restrictive pulmonary disease, there is a disease or malfunction in the lung tissue.  Disease in the lung tissue can significantly reduce the amount of usable lung volume.  Restrictive pulmonary disease can also be caused by other factors such as obesity, spinal deformities and paralysis of the breathing muscles.  Like COPD, evaluation of a person with restrictive lung disease involves a determination of the extent of the underlying restriction.  Testing the level of lung restriction is done with breathing tests like spirometry and gas exchange.  Spirometry measures the total breathing capacity of the lungs by measuring the FVC or forced vital capacity.
 

Other Laboratory Findings   

The chest x-ray is also an important tool to use as supporting evidence in a respiratory disorder.  The x-ray may or may not show a severe disorder, but any abnormal finding on an x-ray can be used as strong ammunition for the existence of a serious condition.  Whenever you have an x-ray that shows an abnormal finding, use it as part of your argument to support your restrictions of the claimant's residual functional capacity.  

Blood gases are another commonly used laboratory tool for evaluating the severity of lung disease.  Blood gas results provide the physician with an objective measurement of the claimant's respiratory function.  Blood gases show the arterial concentration of pCO2 and pO2 in the patient's blood.  These two gases are exchanged in the blood via the lungs.  Blood gas results indicate if there is normal gas exchange occurring in the lung at a given atmospheric pressure.  When these values are abnormal, they are indicative of an underlying disease. 

A person with a significant lung disorder can have a reduced oxygen (O2) concentration in the blood and an elevated carbon monoxide (CO) level depending upon what type and severity of disease the patient is suffering from.  The existence of any sustained abnormality of blood gases is an indication of an existing serious respiratory condition. 

Rule of thumb:  If the claimant is placed on home oxygen, that person is probably suffering from a serious pulmonary affecting gas exchange.  Any person on O2 treatment will be compromised and will experience a significant reduction of his residual functional capacity.   Not only that, the presence of lung disease and the need for O2 will also limit the environments that a claimant can function on.  Any environment where there are impurities in the air would be off limits for a patient with serious lung disease.  Also, O2 is a volatile gas that if subjected to a flame could result in massive injuries.  You would not want a claimant to continue smoking or working in an environment where there are sparks or other sources of ignition.
   

Episodic Lung Disease

In many respiratory disorders such as asthma and emphysema, the patient may suffer from acute exacerbation of the disease, which may require emergency treatment.  If the claimant has an ongoing disorder that has required at least two doctor visits, a hospitalization or an emergency room visit for treatment, use this to lower the claimant's residual functional capacity. 

Commonly, patients suffer from lung disorders that are episodic in nature.  Social Security tends to deny benefits to these claimants based on the duration requirement.  You must argue that although a claimant has had only two or three emergency visits in a year, she continually suffers the debilitating effects of the disease and should be restricted to the appropriate allowance level residual functional capacity.
 

Other Common Respiratory Restrictions

In all respiratory impairments you should consider limiting a claimant's working environment.  A claimant with a significant lung disorder should not work around chemical fumes or any other type of lung irritant.  If a claimant is allergic to pollens or polluted air, and this is documented by the medical evidence, work should not be done outside.  Using your common sense, you'll be able to determine many practical restrictions that may help you to create a winning argument.

If you address the issues as set forth in this report concerning claimants with severe respiratory disorders, you'll be able to extract enough supportive evidence to produce at least a fair argument for disability. 

There are several other important considerations when evaluating respiratory disorders that are not discussed here.  For additional information about respiratory disorders and how they are evaluated by Social Security, see Social Security Guide, see full discussion link.