An estimated 3.1 million Americans suffer from emphysema, a lung condition that can make it difficult to breathe. Because there is no cure for this condition, those who suffer from it are often left to simply treat the symptoms — and to hope that the progression of the disease can be slowed.
Although many people think of emphysema as an older person’s disease, symptoms of this condition typically appear between the ages of 40 and 60. Some individuals with emphysema may have 20 or more years to work before they can retire. This makes it all the more important that they have options available to provide benefits in the event that they are unable to work.
Long-term disability (LTD) benefits can provide a monthly payment if you cannot perform your job due to a disability — such as emphysema. Understanding how these types of insurance claims work is critical to a successful application. A skilled New Jersey disability benefits attorney can shepherd you through the process, increasing the likelihood of a successful application.
Emphysema is a form of chronic obstructive pulmonary disease (COPD) where the air sacs in the lung, called alveoli, are damaged. Over time, the inner walls of these air sacs weaken and rupture, creating larger air spaces instead of many small air sacs. The total air surface of the lungs is reduced as a result, and so less oxygen reaches the bloodstream.
When a person with emphysema exhales, the damaged air sacs don’t work properly. The stale air becomes trapped, which leaves no room for fresh, oxygen-rich air to enter the lungs. This leads to shortness of breath.
The main symptom of emphysema is shortness of breath; people may also experience confusion due to lack of oxygen or their lips or fingernails turn blue or gray with exertion. This symptom may initially only appear with exertion, but eventually, a person with emphysema will be short of breath even at rest. Many people with emphysema also develop chronic bronchitis (LINK to blog post), another form of COPD.
People who have emphysema are more likely to develop complications. These may include a collapsed lung due to compromised lung function, heart problems because of increased pressure in the arteries that connect the heart and lungs, or large holes in the lunges (which then increase the likelihood of a collapsed lung).
Emphysema is diagnosed through a physical exam and medical history. In addition, a doctor will request a range of diagnostic tests, including imaging tests such as a chest X-ray and a CT scan, lab tests to check how well your blood is carrying oxygen into and removing carbon dioxide from your bloodstream, and lung function tests.
This condition cannot be cured. Treatments can alleviate some symptoms and slow the progress of emphysema. If you have emphysema, your doctor may prescribe medication to relax constricted airways (bronchodilators) to reduce inflammation (inhaled steroids) or to fight infection (antibiotics).
Various types of therapies may also be effective. Pulmonary therapy can help you learn techniques to reduce breathlessness, while nutrition therapy can help you gain or lose weight, and using supplemental oxygen can help you breathe more easily. Surgery, such as lung volume reduction surgery or a lung transplant, may be suggested for severe cases of emphysema.
Eligibility for Long-Term Disability Benefits With an Emphysema Diagnosis
If you have been diagnosed with emphysema and are unable to work as a result you may be eligible for LTD benefits through your group or individual insurance policy. Depending on the terms and conditions policy, you would likely receive a monthly payment of 50 to 60% of your salary. These payments would last anywhere from 24 months to retirement.
However, in order to receive these payments, you must first demonstrate that you meet the definition of disabled under your policy. This is typically done by meeting a two-part standard: demonstrating that you have a disability, and then showing how that disability prevents you from working.
As an initial matter, it is important to note that while emphysema is a distinct condition, it is part of a group of diseases that causes breathing-related problems. COPD includes emphysema and chronic bronchitis. Most individuals with COPD have both conditions, but one is more dominant than the other.
Proving that you have emphysema can be done through the submission of your medical records. Emphysema is diagnosed through a physical exam, laboratory tests, and other diagnostic tests. Records of these tests, along with notes from your treating physician, should be sufficient to prove that you have emphysema.
The next step is connecting your emphysema diagnosis with your inability to work. Here, you will need to demonstrate that the specific symptoms that you experience prevent you from performing your job.
Having emphysema can make it extremely difficult to work. The Centers for Disease Control and Prevention (CDC) released a fact sheet on people COPD in each of the 50 states. In New Jersey, approximately 5.1% of the population reported a diagnosis of COPD (which includes emphysema).
Of those New Jersey residents with COPD, 54.8% of people reported using at least one daily medication. 48.9% stated that they saw a doctor about their symptoms at least once in the past year. 20.9% ent to the hospital or emergency room for COPD symptoms in the previous 12 months.
Most importantly, 50.5% reported that shortness of breath — the main symptom of emphysema — affected their quality of life. According to the CDC, this means that the individuals found it difficult to do the things that they used to do, whether at work or at home. COPD symptoms can lead to decreased quality of life as well as a loss of productivity.
COPD causes a number of complications for its sufferers — including an inability to work. Adults who have been diagnosed with this condition are more likely to be unable to work than those who have not been diagnosed with it (24.3% compared to 5.3%).
To prove your claim, you can ask your doctor to submit a letter detailing your limitations based on your symptoms. For example, your doctor may limit you to working just a few hours per day based on extreme fatigue or may limit the amount of time that you can be on your feet have given your shortness of breath. This type of written opinion, combined with thorough documentation of your medical condition, can help your claim be approved.
Questions? We’re Here to Help
Emphysema can be a devastating disease, particularly when combined with another form of COPD, such as chronic bronchitis. If you have been diagnosed with emphysema, a New Jersey disability benefits attorney can work with you to help you get the long-term disability benefits that you deserve.
Bross & Frankel has more than 20 years of experience helping people with a range of disabilities get the benefits that they need so that they can support themselves and their families when they are unable to work. We advocate aggressively for our clients so that you can focus on what is truly important: your health. To schedule a free disability claim review, contact our office today at 856-795-8880 or reach out online.