CYSTIC FIBROSIS GUIDE TO SSD BENEFITS
Cystic fibrosis is an inherited genetic disease that affects almost 40,000 adults and children in the United States. It is a defect in a protein that results in the buildup of mucus in organs throughout the body. This can lead to blockages, tissue damage, and infections.
Is there a cure for cystic fibrosis? No. But there are many treatments, which means the impact of the symptoms can vary from person to person.
If you or someone you know has this condition, they may be able to get Social Security Disability (SSD) benefits. Unfortunately, the process of winning SSD benefits is complex and hard to do on your own. You can apply on Social Security’s website. Find out how to apply for SSD benefits.
The good news is that once you understand how to qualify, you can be confident that the SSA will approve your application. The guide below will walk you through the filing process. It also will tell you how an SSD attorney for cystic fibrosis can help you win benefits.
WHAT IS CYSTIC FIBROSIS?
Cystic fibrosis is a disease where mutations in the “cystic fibrosis transmembrane conductant regulator” (CFTR) gene cause dysfunction in a specific protein. Because of the problem with the protein, it moves chloride to the cell surface. This means it cannot attract water. Therefore, this results in the development of thick, sticky mucus in various organs. Specifically, it can affect your lungs.
In the lungs, the mucus can clog airways and is more likely to trap bacteria. This can lead to infections and inflammation. In the pancreas, mucus buildup prevents the organ from releasing digestive enzymes.
Similarly, it can lead to buildup and blockages in the intestinal tract. This can limit your body’s ability to absorb vital vitamins from food.
Cystic fibrosis can also cause other severe health conditions. The good news is that medical treatment has helped people with the disease live longer lives.
CYSTIC FIBROSIS SYMPTOMS
The symptoms of cystic fibrosis vary between people. Also, your symptoms depend on the severity of your condition. For example, some people may not experience symptoms until they become a teenager or until they become an adult. If you are an adult who has just been found to have cystic fibrosis, then chances are goo that you have a mild form of the condition. You symptoms as an adult might include bouts of an inflamed pancreas (pancreatitis), infertility and recurring pneumonia.
People with cystic fibrosis have a higher than normal level of salt in their sweat. Parents often can taste the salt when they kiss their children. Most of the other signs and symptoms of CF affect the respiratory system and digestive system.
RESPIRATORY SYMPTOMS
If you have trouble breathing, then your lungs might have a thick mucus, from cystic fibrosis, in the tubes that carry air in and out of your lungs. Therefore, this mucus problem can cause symptoms such as:
- A cough that produces thick mucus
- Wheezing
- Fatigue on exercise
- Chronic lung infections
- Clogged nasal passages
- Chronic sinusitis
DIGESTIVE SIGNS AND SYMPTOMS
Like the lungs, for instance, the same thick mucus can block the tubes that carry digestive enzymes from your pancreas to your small intestine. This is another serious symptoms of cystic fibrosis. Without these enzymes, your intestines cannot completely absorb the nutrients from your food. If that is the case, then the result is:
- Greasy stools
- Poor weight gain
- Poor growth
- Intestinal blockage, especially in newborn babies
- Chronic constipation
HOW DOES THE DOCTOR DIAGNOSE CYSTIC FIBROSIS?
Cystic fibrosis is a genetic condition, where an affected person has inherited two copies of a defective gene. Many people who do not have cystic fibrosis have a copy of the defective gene. But, they are unaware that they are “carriers.” For symptoms to show, a carrier and another carrier must have a child. That child will have CF symptoms. That is why the condition is so rare. It is often not found until symptoms occur.
Early detection is key to limiting the negative health results of the disease. There are different tests to screen for the presence of the gene mutation. These include genetic tests and specific tests for carriers.
Newborn screening is another method for finding the presence of mutations long before the individual has any symptoms. It has been a good tool for helping in early diagnosis.
WHAT IS THE TREATMENT FOR CYSTIC FIBROSIS?
Treating cystic fibrosis is complex. The treatment depends on your disease symptoms and their progression. Because of that, treatment varies from person to person with the condition.
Medications include those that prevent or control infection in the lungs. Additionally, there are other medications that remove or loosen mucus. Some medications focus on treating intestinal blockages. Others focus on proper diet. Some, for instance, focus on liver health and staving off other linked diseases like diabetes.
Another option for those with lung symptoms from cystic fibrosis is lung transplant. Unfortunately, it is not a cure for CF. Because the lungs that are transplanted do not have cystic fibrosis, that does not mean the DAN of the lung recipient doesn’t have CF. The recipient of the healthy lungs, does not get new DNA. Therefore, the transplant recipient still has CF.
According to the International Society for Heart and Lung Transplantation (ISHLT), cystic fibrosis is the third most common reason for getting a lung transplant. However, even with a lung transplant, the best survival rate is 60% at 5 years.
Fortunately, there also are medications that focus on gene mutations. These have been incredible medical advances for attacking the root causes of the disease.
QUALIFYING FOR SSD BENEFITS WITH CYSTIC FIBROSIS
Cystic fibrosis itself can cause physical limits. However, it also can lead to other medical disorders, like diabetes, that can limit one’s ability to work as well. This is what makes qualifying for SSD so complex.
There are several steps involved in a successful application for SSD benefits. Here are the main ones to consider.
ASSESSING YOUR CONDITION
The Social Security Administration (SSA) considers cystic fibrosis a potentially “disabling medical condition.” But that is only one piece of the puzzle. Having cystic fibrosis does not mean you will automatically win SSD benefits. However, a lung transplant due to cystic fibrosis is an automatic grant of SSD benefits.
The main question is whether the symptoms caused by the disease impedes your ability to work. Specifically, you must meet a listing found in SSA’s “Blue Book.” The listing for cystic fibrosis is 3.04.
The listing includes things like your “forced expiratory volume” and blood oxygen saturation. Another item, for instance, is whether you have complications resulting in three hospitalizations in a year.
Few of these rules under listing 3.04 are easy to understand. That is why it is important to ensure you meet the standards exactly as they are laid out. Below you will find SSA’s listing 3.04 for cystic fibrosis. Listing 3.04 shows you exactly the test results you will need in order to win SSD benefits.
THE SSA’S LISTING 3.04 FOR CYSTIC FIBROSIS
3.04 Cystic fibrosis with A, B, C, D, E, F, or G:
A. FEV1 less than or equal to the value in Table VII-A or VII-B for your age, gender, and height without shoes.
Table VII: FEV1 Criteria for 3.04A
|
Height
without shoes (centimeters) < means
less than |
Height
without shoes (inches) < means
less than |
Table VII-A
|
Table VII-B
|
||
|
Age 18
to attainment of age 20 |
Age 20
or older |
||||
|
Females
FEV1 less than or equal to (L, BTPS) |
Males
FEV1 less than or equal to (L, BTPS) |
Females
FEV1 less than or equal to (L, BTPS) |
Males
FEV1 less than or equal to (L, BTPS) |
||
|
<153.0
|
<60.25
|
1.65
|
1.90
|
1.45
|
1.60
|
|
153.0 to <159.0
|
60.25 to <62.50
|
1.75
|
2.05
|
1.55
|
1.75
|
|
159.0 to <164.0
|
62.50 to <64.50
|
1.85
|
2.15
|
1.65
|
1.90
|
|
164.0 to <169.0
|
64.50 to <66.50
|
1.95
|
2.30
|
1.75
|
2.00
|
|
169.0 to <174.0
|
66.50 to <68.50
|
2.05
|
2.45
|
1.85
|
2.15
|
|
174.0 to <180.0
|
68.50 to <70.75
|
2.20
|
2.60
|
2.00
|
2.30
|
|
180.0 to <185.0
|
70.75 to <72.75
|
2.35
|
2.75
|
2.10
|
2.45
|
|
185.0 or more
|
72.75 or more
|
2.40
|
2.85
|
2.20
|
2.55
|
OR
B. Exacerbations or complications requiring three hospitalizations of any length within a 12 month period and at least 30 days apart (the 12 month period must occur within the period we are considering in connection with your application or continuing disability review).
OR
C. Spontaneous pneumothorax, secondary to CF, requiring chest tube placement.
OR
D. Respiratory failure requiring invasive mechanical ventilation, noninvasive ventilation with BiPAP, or a combination of both treatments, for a continuous period of at least 48 hours, or for a continuous period of at least 72 hours if postoperatively.
OR
E. Pulmonary hemorrhage requiring vascular embolization to control bleeding.
OR
F. SpO2 measured by pulse oximetry either at rest, during a 6MWT, or after a 6MWT, less than or equal to the value in Table VIII, twice within a 12-month period and at least 30 days apart (the 12 month period must occur within the period we are considering in connection with your application or continuing disability review).
Tables VIII: SpO2 Criteria for 3.04F
|
Test site altitude (feet above sea level)
|
SpO2 less than or equal to
|
|
Less than 3,000
|
89 percent
|
|
3,000 through 6,000
|
87 percent
|
|
Over 6,000
|
85 percent
|
OR
G. Two of the following exacerbations or complications (either two of the same or two different) within a 12 month period (the 12 month period must occur within the period we are considering in connection with your application or continuing disability review):
- Pulmonary exacerbation requiring 10 consecutive days of intravenous antibiotic treatment.
- Pulmonary hemorrhage (hemoptysis with more than blood-streaked sputum but not requiring vascular embolization) requiring hospitalization of any length.
- Weight loss requiring daily supplemental enteral nutrition via a gastrostomy for at least 90 consecutive days or parenteral nutrition via a central venous catheter for at least 90 days in a row.
- CFRD requiring daily insulin therapy for at least 90 days in a row.
As you can see the listing is complex. You need to be able to provide the exact test results listed above in order to be found disabled.
SUBMIT YOUR MEDICAL RECORDS TO PROVE YOU CANNOT WORK DUE TO CYSTIC FIBROSIS
The key to proving you meet listing 3.04 is your medical records.
When you first apply for benefits, you should include a copy of your medical records with your application. The records will document the fact that you have cystic fibrosis. The burden of proving you deserve SSD benefits is on you. This is true even though DDS, the state agency, collects your medical records.
The reason you should submit your own records is that DDS may not get everything. For example, if you were treated for anxiety in the past, then DDS will probably not collect your old records. However, these records are important to your case. Because they confirm that you have another condition besides cystic fibrosis. They also show how your CF is impacting your mental health. Additionally, older records may contain the medical testing that you need to prove you meet listing 3.04.
If you receive a denial at any stage of the process, you should make sure the SSA has a copy of all of your medical records. You may receive a letter that states your doctor has not sent your records. The letter might only give you 10 days to respond. Instead of worrying about the 10 day time frame, use your time to collect the records and get them into the SSA. If you need more time, then you can ask the SSA to extend the time limit. Additionally, you must update all of your medical records prior to your SSA hearing with a judge. If you hire us, then we will do get your medical evidence for you. Review information about the importance of medical records in your case.
RESIDUAL FUNCTIONAL CAPACITY TEST
If you do not meet specific listing 2.04, then hope is not lost. There are other steps you can take to qualify for SSD benefits. For example, you can always take a “residential functional capacity” (RFC) test. Additionally, you can have your doctor outline your RFC showing that your cystic fibrosis is keeping you from working. A doctor performs tests to see how your cystic fibrosis impacts your ability to do daily tasks.
If the RFC is correct, then it will show that your CF symptoms affect your ability to carry out daily tasks. For example, it may affect your ability to breath and your stamina. Additionally, you might not be able to do long periods of standing, walking, or even sitting. Likewise, you may not be able to lift heavy weights. You can submit these findings to the SSA. They will decide if your RFC keeps you from working. Learn how the RFC applies to your SSD case.
WORK HISTORY
Another part of the filing process for cystic fibrosis benefits is giving the SSA your income for the past 5 years. You will need to submit your work history records. These records should show a decline in your ability to work. Also, the records can help determine if you qualify for SSDI or Supplemental Security Income (SSI). SSI is a needs based program for those with minimal incomes and very few assets.
For instance, if you have worked for the past 10 years and paid Social Security taxes, then you own these benefits. You paid for them. They are there for you if you need to replace your income, now that you can no longer work due to your cystic fibrosis. On the other hand, if you do not have a robust work history, you will not get SSD benefits. However, you may still qualify for SSI benefits.
It is easy to see how giving the SSA the proper financial evidence is vital to winning benefits. That is why you should consider seeking help from an attorney who has experience and is an expert in this area. Also, hiring an attorney with experience gives you three times the chance of winning your SSD benefits. Therefore, this is a dramatic increase in your chances of winning benefits. Hire Cannon Disability Law, because we have over 30 years of legal experience helping clients like you win benefits.
FIND LEGAL HELP TO GET BENEFITS
Now that you understand the steps for filing for SSD benefits for cystic fibrosis, you can get the ball rolling. If you are unclear about any aspect of the process, then the best thing you can do is contact an expert who can help you. The attorneys and staff at our law firm are experts in winning SSD and SSI benefits. Therefore, hiring us will get you the assistance you need and deserve.
At our law firm, we have won more than 20,000 SSD and SSI cases. We also have won more than $100 million in past due and ongoing SSD and SSI benefits for our clients. If you are looking for an Utah SSD attorney, then reach out to us today. Call us. Then you will see how we can help you win your SSD benefits.
We can also help you if you live in Nevada. For example, Dianna Cannon has a license as an attorney in Utah, Nevada and California. If you need an Idaho SSD attorney, then Brett Bunkall has a license to practice law in Idaho. Also, you can learn about our attorneys and staff on our About Us page. You can learn about California SSD benefits.
HOW TO GET FREE AND LOW COST HEALTH SERVICES
You can find health resources throughout Utah and the Salt Lake Valley. On the list, we also have clinics from Northern and Southern Utah. Additionally, you will find low or no cost health resources in Nevada and San Francisco/Oakland, California.
All of the listed clinics and health centers state on their website whether they will accept a payment plan. Likewise, some clinics may provide services on a sliding fee scale. Other clinics are free. You should contact the clinics or health resources directly. They can explain their payment options.
If you want to win your Social Security Disability case, then you need evidence. Therefore, you must see a doctor. For example, progress notes, tests, and medical opinions from your doctor are the evidence you need to prove your SSD and SSI case. We also have information on free clinics in Idaho and free and low cost medical services in Colorado.
For many years, the SSA would only accept medical opinions from treating doctors with an M.D. behind their name. Fortunately, the SSA realizes now that most patients get treatment from other types of providers. For example, most doctors employ a P.A. or Physician’s Assistant. That person might take your vitals or discuss your medical history. They may also follow you for CF or do therapy. Likewise, some doctors employ nurses to help them visit with all of their patients. Records from nurses are also important to your benefits case. Because patients receive many different types of medical treatment, the SSA now accepts medical opinions from providers in addition to your doctor.
WHAT WE DO TO HELP YOU WIN SSD BENEFITS FOR CYSTIC FIBROSIS
You do not need to try to win SSD benefits for cystic fibrosis by yourself. We can help file your SSD application. Also, we can help you appeal every SSA denial. That way, you can focus on your health. For example, our attorneys and staff can:
- Send you the paperwork you need to become our client
- Help you file your application for SSD and SSI benefits
- Inform the SSA they should pay your benefits under the Compassionate Allowance Rules
- Request an appeal if you receive an initial denial
- Help you confirm your SSA doctor exam
- Request a Hearing with an Administrative Law Judge
- Prepare you to testify at your ALJ hearing
- Represent you at your hearing and question the expert witnesses
- Read about job expert testimony
- Learn about medical expert testimony
- Request review of a decision with the Appeals Council
- Request review of an Appeals Council denial in Federal Court
If you file your application for benefits on Social Security’s website, then you have 6 months to complete it. However, if you have a medical condition that automatically wins SSD benefits, you should file all of your application as soon as possible. Once you submit your application online, the SSA sends you an application summary in the mail. You must sign the summary and mail it back. Send it in quickly.
Additionally, once you receive an SSA denial, you have 60 days to file an appeal. You must also meet the time limit set by the SSA. If you do not, then you will have to start the process over again. That means you will lose any benefits you could get on a prior application.
WE CAN HELP YOU WIN SSD BENEFITS FOR CYSTIC FIBROSIS
There are many important issues that play a role in whether you receive benefits for cystic fibrosis. One of the most important issues is whether you have a good legal team on your side. Also, you need an attorney who knows the law.
At our law firm, we want to be your legal team. Hire us for our experience. Over the last 30 years, we have won over 20,000 SSDI and SSI claims. For example, we have also won lung cancer cases. It isn’t always easy task to win. But, we have the experience to win your cystic fibrosis case.
Another important factor to consider when hiring an attorney is cost. Cannon Disability is affordable. We do not ask you to pay us any money up front. Because you do not pay an attorney fee until we win your case. If we win, then the attorney fee comes out of your back benefit. If we do not win your case, then there is no attorney fee for you to pay.
Contact us today. Take advantage of our free review of your case. Call and we will answer your questions about your case. For example, you can explain why your cystic fibrosis prevents you from working. Then, we will be able to tell you if you can get benefits. We can tell you because we are experts in SSI and SSD benefits. And, we will do our best to win your cystic fibrosis benefits.
Also, be ready to tell us about your doctors. We also want to know if you are also getting treatment for mental conditions, like anxiety. Find out now if we can help you obtain SSD benefits for cystic fibrosis. Contact us for a free review of your benefits.
