Sleep apnea not just a distressful sleep disorder but it can also lead to temporary or even permanent disability. The effects of this sleep disorder causes severe interference with your daytime functionality and productivity which in turn could make you ineligible to continue with your profession. This type of sleep apnea disability is common in this country.
While job loss is a traumatic experience even to someone who does not suffer from sleep apnea, but for a sleep apnea patient, this also entails loss of critical financial resources at a time when health-wise, you are going through a tremendous crisis. You need finances not just to take care of your home and family, but also to take care of your future health needs.
The first step, understandably, is to seek financial help and disability benefits from Social Security Administration (SSA) or a private insurance provider, if you are covered adequately. However, as we all know there could be many a slip between the cup and the lip when it concerns claiming and finally getting social security benefits. The main reasons for disqualification could be: your sleep apnea disability does not meet the qualifying criteria of the authorities, or, your knowledge about the procedure, etc was inadequate.
Hiring the help of a disability lawyer or advocate is an option to get your application through, but it is possible that your financial resources are not enough to even hire such a professional. Under these circumstances, what does a patient suffering from severe and disabling effects of sleep apnea do?
There are essentially two ways to get benefits if you have disability, the first of which is through private health insurance and second, through the Social Security Administration. If you are insured with any private insurance provider you can get benefits depending on your coverage plan for which you have already paid. However, there are several plans run by the SSA which pay disability benefits, the first is called Social Security disability insurance (SSDI) and the other program is called Supplemental Security Income (SSI), who could pay the benefits if a claimant is not qualified to file claims with SSA.
This article aims to provide useful information on this topic, primarily focusing on getting disability benefits from the Government, or SSA.
For better understanding of the process of managing disability caused by sleep apnea, let us first understand how the authorities interpret ‘disability’ and the general processes followed to file a claim. We would talk more specifically about sleep apnea related disability later in the article.
Be on the same page with SSA when you define disability
The way the authorities view ‘disability’ may not match with yours. The SSA is very clear about what they mean: it is simply your incapability to work. To clarify, this means:
- You are no longer able to continue with the work that you normally would do.
- They are the final authority to decide that your medical condition is preventing you to take up any other kind of alternate work.
- Your condition of not being able to work should be present or likely to be present for at least a year or may cause death.
Additionally, the rules of the program is inclined to think that the patient with disability would have other alternate supportive resources for sustenance during any disability that is expected to last for a short time, like investments, compensation from employers, health insurance, savings, etc.
Criteria for eligibility
One of the first criteria for eligibility to claim SSA benefits is payment of relevant taxes to the authority during your working career. The jobs that you held, prior to disability should have been under the purview of Social Security. Legitimacy of your medical condition is another criterion for eligibility. For this, you need to provide a complete diagnostic report from your physician that confirms your disability and its duration.
The monthly benefits are usually in cash and may continue till such times that you are able once again to resume your official responsibility. On reaching age of retirement, if you are still on such benefits, the same amount will be converted to retirement benefits.
Sleep apnea disability evaluation: Five-Step Sequential Evaluation Process
Though sleep apnea as a disease condition, is considered to have potential to be identified as a disability, the condition should be serious enough to conform to the SSA’s eligibility criteria that clearly mentions that you are not only unable to work right now, but also unable to perform any other alternate duty. To assess whether your condition does indeed belong to the category of ‘disability’, SSA deploys a Five-Step Sequential Evaluation Process that involves a set of five questions, as follows:
2. How serious is your condition
3. Whether your condition is listed under the disabling conditions
4. Whether you are able to perform the work you used to do
5. Whether you are able to do any other kind of work
Working ability and medical history: two prime areas of concern
From the information provided above, it ought to be clear to you that the two areas that define and confirm your eligibility to claim disability benefits are related to a) your ability to handle jobs that earns you a reasonable income; b) your past and present medical history.
While all work-related information can be provided with as much detail and clarity as possible, your medical history may not always carry the kind of information that the authorities are looking for. So, what is it that SSA is looking for in your medical history documents?
Essentially, they are looking for areas where you have confirmed ‘limitations’, which can be either mental or physical in nature. For example, if your disability is caused by spinal arthritis or any back problem, you would not be able to do any job that requires any exertion on the back muscles or the spine. What is important to note here that SSA is not supposed to automatically conclude that a claimant is ‘disabled’ simply because he or she has a specific ailment. Mention of such specific ‘limitations’ should be part of the medical records, as signed and confirmed by the physician. Unfortunately, not many doctors mention such details with such specificity since providing details like this is not really part of any medical documentation.
In the absence of such documented evidence, the authorities are at liberty to conclude and arrive at a decision regarding the degree of disability, which often work against the claimant.
This hurdle is usually overcome if you can provide a statement from your doctor, no matter which specialty, which clearly states the limitations that your present condition has resulted in. This statement is also called Residual Functional Capacity Form or RFC. Broadly speaking, the RFC form declared the types of jobs that you can still perform, despite your disability.
How severe should the condition be to qualify for sleep apnea disability?
Sleep apnea, no matter how serious, does not necessarily make you eligible for claiming benefits. However, there are several consequences of sleep apnea which are serious enough, especially when they happen simultaneously with sleep apnea, which can prevent you from being productive anymore in your work sphere. Therefore if the health condition, when considered in totality (sleep apnea combined with serious health consequence) impairs your ability to be engaged in any gainful employment, there are chances that SSA will consider your case.
Some of the other simultaneous conditions that sleep apnea results in include hypertension, diabetes, major mental deterioration, heart failure, etc. These adverse consequences when combined with sleep apnea should effectively demonstrate to the SSA that the patient does not have any balance (residual) capacity left, to work anymore.
Getting treated for sleep apnea is a must
Claiming that you are not adequately covered by medical insurance or that you do not have enough resources to consult a physician for treating sleep apnea is not likely to cut much ice with SSA. You need to prove to the authorities that you have followed your doctors’ advice to the tee and have even used all the suggested therapies, including CPAP, etc but even then your condition has deteriorated. You also need to prove that various non-surgical treatment options were also tried, including special sleep apnea pillows, dental appliances, weight loss, etc.
In short, to be able to prove your sleep apnea disability, you should prove that your condition is severe and has not responded to any conventional therapeutic options; additionally, you are now saddled with a debilitating consequence of the ailment. The two factors can hopefully convince SSA that you are indeed incapable of doing any productive work anymore.
Some apnea consequences for automatic eligibility
Though it is tough to qualify for disability benefits if you have sleep apnea, there are a few medical complications associated with sleep apnea which can make you qualify more easily. Some of the consequences and their qualifying benchmark, which feature in the SSA list, are as follows:
1. Psychological effects: There are several adverse effects that sleep apnea has on the mental health of the victim. According to SSA, the following mental conditions can cause limitations in your life leading to inability to work:
a. Changes in personality
c. Hallucinations or delusions
d. Instability of the mind
e. I.Q loss of 15 or more.
2. Enlargement of the right ventricle of the heart (medically known as cor pulmonale) due to pulmonary hypertension – a consequence of prolonged duration of sleep apnea. To prove that this is making you incapable of working in any job, you should provide evidence of high blood pressure (more than 40 mmHg) or reduced oxygen levels in blood (lower than what causes chronic pulmonary insufficiency)
Claiming and getting sleep apnea disability benefits is tough, but not impossible, provided you are fully conversant with the rules and limitations laid out by SSA. From the links provided below, you can get more information about how to file your claim and the specific areas where you need to exercise caution. Hopefully, after reading the article and visiting these websites, you can successfully file your claim and start receiving the benefits too.