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Obstructive & Restrictive Lung Diseases:  The Importance of FEV¹ & FVC test results for Long Term Disability Insurance Claims

If you have a pulmonary disorder, one of the most important tests that you will take is a PFT or Pulmonary Function Test.  This test is somewhat complicated and measures many aspects of lung function.  The most telling sign of lung dysfunction is a reading known as FEV¹.  FEV¹ stands for Forced Expiratory Volume.  This measures the amount of air you can forcefully exhale in a breath.  This indication is very important in Social Security and long-term disability.

An FEV¹ is important because it shows your capability to BREATHE OUT.  People with obstructive lung disease have shortness of breath because they have difficulty exhaling all the air from their lungs.  It is it harder to breathe during increased activity or exertion because there is less time to breathe all the air out of the lungs before the next inhalation.

Some common forms of obstructive lung disease include:

  • COPD (Chronic Obstructive Pulmonary Disease), which includes chronic bronchitis & emphysema
  • Cystic Fibrosis
  • Asthma
  • Bronchiectasis

 

According to the Social Security Administration’s disability listings, the following chart demonstrates FEV¹ standards for disability:

Table I

   Height  without Shoes (centimeters) Height without Shoes (inches) FEV1 Equal to or less than (L,BTPS)
154 or less 60 or less 1.05
155-160 61-63 1.15
161-165 64-65 1.25
166-170 66-67 1.35
171-175 68-69 1.45
176-180 70-71 1.55
181 or more 72 or more 1.65

 

And while the Social Security Administration sees the FEV¹ as an accurate measure for disability, some long-term disability insurers have tried to focus on other findings in a Pulmonary Function Test, rather than the FEV¹.

Another set of pulmonary diseases is known as restrictive lung diseases.  They are measured differently. An FVC (Forced Vital Capacity) test measures the amount of air you can forcefully exhale after inhaling as deeply as possible.  People with restrictive lung disease may have a harder time BREATHING IN and filling their lungs with air, which is measured by Total Lung Capacity (TLC). TLC measures the amount of air in your lungs after you inhale as deeply as possible. These folks have an easier time breathing out, or may have a normal measurement on a FEV¹.

People with restrictive lung disease cannot fully fill their lungs with air. Their lungs are restricted from fully expanding. This can be caused by a condition causing stiffness in the lungs or chest, or from weak muscles, or damaged nerves.

Some conditions that may cause restrictive lung disease include:

  • IPF (Idiopathic Pulmonary Fibrosis)
  •  Sarcoidosis
  • Scoliosis
  • Muscular dystrophy
  • ALS
  • OHS (Obesity hypoventilation Syndrome)

 

According to the Social Security Administration’s disability listings, the following chart demonstrates the FVC standards for disability due to Chronic Restrictive Lung Disease:

Table II

Height without Shoes (centimeters) Height without Shoes (inches) FVC Equal to or less than (L,BTPS)
154 or less 60 or less 1.25
155-160 61-63 1.35
161-165 64-65 1.45
166-170 66-67 1.55
171-175 68-69 1.65
176-180 70-71 1.75
181 or more 72 or more 1.85

 

While long-term disability insurance contracts say nothing about the reading that an individual must obtain on a Pulmonary Function Test, it is clear that these Long Term Disability Insurance Companies will take an offset for any money that is awarded by Social Security (which is based upon these FEV¹ & FVC standards).  Thus, I always argue that the insurer has created an implication that these standards are valid for the operation of long-term disability policies.

Long-term disability policies do not say much about medical standards, but it is illogical to create a construct that embraces two different medical standards. If the long-term disability insurer wanted a specific showing of severity, they could include it as part of the  policy language.

 

Questions about Pulmonary Disorders & your long term disability insurance claim?

 Call (877)-428-9806 and we will be happy to answer your questions or concerns.

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