Guide to Spirometry Under Social Security Disability Programs
The Social Security Administration (SSA) administers two disability programs, Social Security Disability Insurance (SSDI) and the Supplemental Security Income (SSI) program. SSDI is a social insurance program financed through Social Security payroll taxes paid by workers and their employers. Entitlement to these disability benefits is based on an individual's work history, and the amount of the benefit is based on the individual's earnings. SSI payments, financed through general revenues of the U.S. Treasury, are paid only to those aged, blind, or disabled individuals with limited income and resources.
Definition of Disability
For all individuals applying for SSDI benefits, and for adults applying for SSI payments, the definition of disability is the same. The law defines disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
Children (under age 18) applying for SSI payments will be considered disabled if they have a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a continuous period of not less than 12 months.
Proper Documentation: A Need Nationwide
Proper documentation of respiratory impairments for Social Security disability evaluation purposes is critical. In order to ensure that spirometry is performed consistently, particularly for tests that SSA purchases, SSA has published specific guidelines for the performance of spirometry. This pamphlet contains these basic requirements, but a more thorough explanation of the criteria is included in sections 3.00 (Part A for adults) and 103.00 (Part B for children) of the online publication entitled, Disability Evaluation Under Social Security (SSA Publication 64-039).
The following guidelines have been established to promote consistency in the performance and reporting of spirometry results. When performing spirometry purchased by SSA, we require you to adhere to these guidelines. SSA will not purchase spirometry for children who have not attained age 6.
SSA uses the highest FEV1 or FVC value, reported in liters, BTPS (body temperature and ambient pressure, saturated with water vapor), to evaluate a claimant’s respiratory disorder regardless of whether the values are from the same forced expiratory maneuver or different forced expiratory maneuvers.
The claimant must be medically stable at the time of the test. Examples of when SSA would not consider a claimant to be medically stable include when the claimant is: (1) within two weeks of a change in his or her prescribed medication; (2) experiencing, or within 30 days of completion of treatment for, a lower respiratory tract infection; (3) experiencing, or within 30 days of completion of treatment for, an acute exacerbation (temporary worsening) of a chronic respiratory disorders; or (4) hospitalized, or within 30 days of a hospital discharge, for an acute myocardial infarction (heart attack).
If the claimant’s FEV1 is less than 70 percent of his or her predicted normal value, SSA requires repeat spirometry after inhalation of a bronchodilator, unless it is medically contraindicated. If the claimant uses a bronchodilator before arriving for the test and his or her FEV1 is less than 70 percent of his or her predicted normal value, SSA still requires repeat spirometry after inhalation of a bronchodilator unless the supervising physician determines that it is not safe for the claimant to take a bronchodilator again (in which case we may need to reschedule the test). If the claimant does not have post-bronchodilator spirometry, the test report must explain why; for example, the use of bronchodilators is medically contraindicated.
The forced expiratory maneuver must be satisfactory. SSA considers a forced expiratory maneuver to be satisfactory when the claimant exhales with maximum effort following a full inspiration, and when the test tracing has a sharp takeoff and rapid rise to peak flow, has a smooth contour, and either lasts for at least 6 seconds (for adults and children age 10 and older) or for at least 3 seconds (for children who have not attained age 10) or maintains a plateau for at least 1 second.
The spirometry report must include the following information:
The date of the test and the claimant’s name, age or date of birth, gender, and height without shoes. If the claimant’s spine is abnormally curved (for example, he or she has kyphoscoliosis), substitute the longest distance between his or her outstretched fingertips with the arms abducted 90 degrees in place of the height when this measurement is greater than the claimant’s standing height without shoes.
Any factors, if applicable, that can affect the interpretation of the test results (for example, his or her cooperation or effort in doing the test).
Legible tracings of the claimant’s forced expiratory maneuver in a volume-time format showing his or her name and the date of the test for each maneuver.
If you have any questions regarding information presented in this pamphlet or the medical criteria used to evaluate disability under Social Security, please contact the Professional/Medical Relations Officer in your State.
A complete list of Medical/Professional Relations Officers in your State is available.
Publication No. 64-055