Autoimmune Disorders and Qualifying for Social Security Disability Benefits

An immune system disorder is the result of abnormally low activity of the immune system or overactivity of the immune system. In cases of overactivity, the body attacks its own tissues; these conditions are called autoimmune diseases.
If you are suffering from the effects of an Immune System Disorder you may qualify for disability benefits.

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The Social Security Administration recognizes autoimmune disorders in their Bluebook under Section 14 so if it has impacted your ability to work you may qualify for disability benefits. Call (512) 454-4000 for help today.

Inflammatory arthritis, lupus, inflammatory bowel disease and Type 1 diabetes mellitus are examples of autoimmune diseases.

Immune deficiency diseases, such as AIDS and Severe Acute Respiratory Syndrome (SARS), decrease the body’s ability to fight toxins and infections. Immune system disorders can cause recurrent infections or dysfunction of the body’s organs and tissues that affect a single organ or two or more organs, resulting in moderate to severe limitations and loss of function. Classic symptoms of immune system disorders include fever, fatigue, musculoskeletal pain, malaise and involuntary weight loss.

Qualifying for Disability with an Autoimmune Disorder

The Social Security Administration lists a diverse group of medical conditions under Section 14.00 Immune System Disorders in its Blue Book. Under this listing Social Security evaluates immune system disorders that cause dysfunction in one or more parts of the immune system.

Social Security organizes these immune system disorders into three categories: autoimmune disorders, immune deficiency disorders (excluding HIV), and HIV.

•    An autoimmune disorder is caused by dysfunctional responses directed against the body’s own tissues resulting in chronic, multisystem impairments that differ in severity and outcome.
•   An immune deficiency disease (that is not HIV) is characterized by unusual or recurrent infections that do not respond well to treatment and are often connected to complications impacting other body organs. An immune deficiency disorder may be primary, existing from birth or inherited, or acquired, meaning the condition is the result of other circumstances. Those circumstances may be medications, treatments, or diseases that have suppressed the immune system or damaged it. Examples include diseases such as chicken pox or treatments like chemotherapy.
•   Human immune deficiency virus (HIV) is a condition marked by increased susceptibility to infections and cancers.

Contact a Social Security disability attorney at 512-454-4000 for a free consultation and see if you can get disability benefits while suffering from an Immune System Disorder. If you have been denied disability don’t give up!

Within these three categories, Social Security lists a number of conditions as immune system disorders that automatically qualify for Social Security Disability Income, provided the applicant meets the specific criteria stated in the impairment listing as well as Social Security’s non-medical requirements.

These conditions include:

•    Systemic lupus erythematosus (14.02)
•   Systemic vasculitis (14.03)
•   Systemic sclerosis or scleroderma (14.04)
•   Polymyositis or dermatomyositis (14.05)
•   Undifferentiated mixed connective tissue disease (14.06)
•   Immune deficiency disorders (excluding (HIV) (14.07)
•    Inflammatory arthritis (14.09)
•   Sjögren’s syndrome (14.10)
•   Human immunodeficiency virus (HIV) infection. (14.11)

Social Security evaluates each disorder differently and requires different documentation as evidence of a disease.

While some requirements are similar or the same for some impairments, each disorder listed under Section 14.00 has specific criteria which must be met to qualify for disability benefits.

Immune Deficiency Disorders (Excluding HIV)

An applicant who has an immune deficiency disorder that is not HIV (14.07) must show evidence of one of the following:

•    Sepsis, meningitis, pneumonia, septic arthritis, endocarditis, or sinusitis that does not respond to treatment or requires hospitalization more than three times per year;
•   Evidence of a recurring immune deficiency disorder and two severe illness symptoms, as well as proof that the condition keeps you from working and performing daily activities; or
•   If undergoing a stem cell transplant, the applicant will qualify for one year after the procedure. After one year, Social Security will reevaluate the case to determine if the treatment was successful and if the applicant is still disabled.

Lupus, Systemic Vasculitis, Sjögren’s Syndrome and Undifferentiated and Mixed Connective Tissue Disease

Applicants with systemic lupus erythematosus, systemic vasculitis, Sjögren’s syndrome, or undifferentiated and mixed connective tissue disease must provide proof of the following:

1.   Involvement of two or more organs/body systems, with:
   
   1.   One of the organs/body systems involved to at least a moderate level of severity; and
   2.    At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).

OR

2.   Repeated manifestations of the immune system disease, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
   
   1.    Limitation of activities of daily living.
   2.   Limitation in maintaining social functioning.
   3.   Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

Polymyositis and Dermatomyositis

For claimants filing with polymyositis or dermatomyositis the criteria is more extensive:

1.   Pelvic or shoulder muscle weakness and medical documentation of at least one of the following:
   
   1.    A documented medical need for a walker, bilateral canes, or bilateral crutches or a wheeled and seated mobility device involving the use of both hands; or
   2.    An inability to use one upper extremity to independently initiate, sustain, and complete work-related activities involving fine and gross movements, and a documented medical need for a one-handed, hand-held assistive device that requires the use of the other upper extremity or a wheeled and seated mobility device involving the use of one hand; or
   3.    An inability to use both upper extremities to the extent that neither can be used to independently initiate, sustain, and complete work-related activities involving fine and gross movements;

OR

2.    Difficulty swallowing due to muscle weakness that causes aspiration into the lungs.

OR

3.   Breathing difficulties due to a weak diaphragmatic and intercostal muscles.

OR

4.   Calcium deposits that with limit of joint mobility or intestinal function.

OR

5.   Repeated manifestations of polymyositis or dermatomyositis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level:
   1.    Limitation of activities of daily living.
   2.    Limitation in maintaining social functioning.
   3.    Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

Scleroderma, Inflammatory Arthritis and HIV

For Social Security’s specific requirements for scleroderma, inflammatory arthritis or HIV, please see our separate pages on those disorders.

Note that some medical conditions which may be considered autoimmune disorders, such as multiple sclerosis (MS) or Type 1 diabetes mellitus, are not included in Section 14.00, but can be found under different listings in Social Security’s Blue Book.

Though Social Security states that it will make its best effort to obtain medical records, a claimant should provide the following with their application:

•    Compete medical history
•   Report of physical examination;
•   Laboratory results
•   Imaging (angiography, x-rays, CAT, MI, bone scan)
•   Tissue biopsy

If your immune system disorder does not meet the requirements of Social Security’s listing, you may still be eligible for Social Security Disability benefits.

Many individuals with immune system disorders show symptoms of another mental or physical impairment. For example, lupus can impact the heart or kidneys. Social Security must consider how those health issues, combined together, limit an applicant’s ability to hold a job and perform necessary daily tasks. Social Security will conduct a residual functional capacity assessment (RFC) to evaluate your abilities and limitations to determine if you are capable of performing your prior job or any other type of work. Social Security will then consider your medical records and doctors’ statements of how symptoms limit your ability to function, as well as side effects of treatment.

If you have been diagnosed with an immune system disorder and you are unable to work, you may be eligible for Social Security Disability Income.

But filing for disability benefits can easily become frustrating. An experienced Social Security Disability attorney can review your case, gather the medical evidence you need and avoid needless mistakes that may delay the process.

In order to qualify for Social Security Disability, you will need to satisfy a few specific requirements in two categories as determined by the Social Security Administration.

The first category is the Work Requirements which has two tests.

1.   The Duration of Work test.   Whether you have worked long enough to be covered under SSDI.
2.   The Current Work Test.   Whether you worked recently enough for the work to actually count toward coverage.

The second category is the Medical Eligibility Requirement.

1.   Are you working?   Your disability must be “total”.
2.   Is your medical condition severe?    Your disability must be “severe” enough to interfere with your ability to perform basic work-related activities, such as walking, sitting, and remembering.
3.   Is your medical condition on the List of Impairments?   The SSA has a “List of Impairments” that automatically qualify as “severe” disabilities. If your disease is not listed this does not mean you cannot get disability, it means you must prove you cannot maintain employment due to your limitations.
4.   Can you do the work you did before?   SSDI rules look at whether your medical condition prevents you from doing the work you did prior to developing the condition.
5.   Can you do any other type of work?   If you cannot do your prior work, an evaluation is made as to whether you can perform any other kind of work.

More details can be found on our Qualifying for Disability page.