Lupus and qualifying for Social Security Disability Benefits
Can I get disability benefits if I am suffering from the effects of Lupus?
Author: Attorney Greg Reed
The Lupus Foundation estimates that approximately 1.5 million people in the United States suffer from some form of lupus. Lupus is a chronic autoimmune disease that attacks the body’s tissues and organs, causing inflammation and damage. When lupus occurs the body doesn’t distinguish between invaders and healthy organisms and instead creates autoantibodies that attack its own tissue and organs. Various parts of the body can be affected including the kidneys, lungs, the central nervous system, the heart, and blood vessels. If you are suffering from the effects of Lupus you may qualify for disability benefits.
Every case of lupus is different.
Symptoms of lupus can be mild or severe, temporary or permanent, and appear suddenly or develop gradually over time. Most cases are mild, characterized by episodes called flares when symptoms become worse for a while. The most distinctive sign of lupus is a rash that looks like the wings of a butterfly enfolding across the bridge of the nose and cheeks. Other common symptoms include:
- joint pain, stiffness and swelling
- chest pain
- kidney problems
- shortness of breach
- fingers and toes that turn white or blue when exposed to the cold or when a person is under stress
- vision problems
- dry eyes
- confusion and memory problems
These symptoms can cause you to miss work and jeopardize your ability to maintain employment.
Diagnosis of lupus can be difficult and take months because its symptoms may mimic or overlap those of other diseases.
Doctors will consider a patient’s medical history along with results of a physical exam and laboratory tests. The goal of treatment is to manage symptoms and minimize organ and tissue damage and depends on a patient’s symptoms as well as their age, gender, general health and lifestyle. A variety of drugs such as anti-inflammatories, antimalarials, and corticosteroids may be prescribed to treat fatigue, skin rashes, joint pain, and inflammation of the lungs. Immunosuppressives may also be used to restrain an overactive immune system.
Following your doctor’s treatment plan is an important part of qualifying for disability benefits.
How do I qualify for SSDI if I have Lupus?
A person suffering from lupus may have difficulty maintaining a full-time job or any type of work at all.
The Social Security Administration has created a manual called the Blue Book which lists impairments Social Security considers disabling and may automatically qualify for benefits. Social Security recognizes lupus in its Blue Book under Section 14.02 Systemic lupus erythematosus, but to qualify for disability benefits a person must meet the requirements of the listing or prove that they are unable to work. Specifically, an individual with lupus must show:
- Lupus has affected two or more organs or body systems, such as the kidneys, lungs, heart or brain; AND
- Lupus has resulted in at least two of the following symptoms: severe fatigue resulting in low physical or mental activity, fever, malaise, or involuntary weight loss.
- Activities of daily living
- Maintaining social functioning
- Completing tasks in a timely manner due to problems concentrating, or the inability to work quickly
- Malar rash
- Discord rash
- Oral ulcers
- Renal disorder
- Neurologic disorder
- Hematologic disorder
- Immunologic disorder and/or
- Antinuclear antibody
- File a Request for Reconsideration with the Social Security Administration to completely review the case.
- If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
- If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
The applicant must exhibit at least two of the above symptoms repeatedly, resulting in limitations in the following:
You will need to provide detailed medical evidence to support a diagnosis of lupus, including doctor’s observations, blood tests, imaging tests and the types of maladies suffered.
Social Security follows the guidelines of the American College of Rheumatology to determine that a diagnosis of lupus is accurate. You must exhibit four of the following to be diagnosed with lupus:
If your symptoms don’t exactly match the criteria of Social Security’s listing, you might qualify for SSDI if you are able to prove you are unable to work due to the effects of lupus.
You may have fatigue, chest pain, shortness of breath, headaches or an abnormal heart rhythm that prevents you from walking or standing for long periods of time. You may have difficulty understanding or remembering instructions or dealing with common work pressures. Some people with lupus suffer with anxiety and depression or have difficulty concentrating. Social Security will conduct a Residual Functioning Capacity (RFC) assessment to evaluate the physical, mental and sensory limitations that affect your ability to work, taking into consideration your age, education and whether or not you can drive. If Social Security decides you cannot do your old job or don’t have the skills to perform a new job, you may be approved for a Medical-Vocational Allowance.
Once Social Security determines the limitations caused by your condition, they will employ a vocational expert to assess whether a person with these limitations is employable.
Most vocational experts will find a person to be unemployable if their condition or the treatment rendered for the condition causes the person to regularly be absent two or more days a month or be “off-task” 15% or more of the workday.
If you are 55 or older or have another medical condition you may get approval.
Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.
Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.
You may also be eligible for Social Security Disability benefits if you have another medical condition.
Lupus may develop serious complications including kidney damage, anemia, and increased risk of bleeding, as well as lung and heart problems. One disorder by itself may not meet the criteria of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.
Social Security also has basic financial requirements.
You must satisfy some basic financial requirements before you are eligible for Social Security disability benefits.
You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.
What if I don’t qualify for SSDI?
If you earn too much income or if you haven’t worked long enough to earn enough work credits, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
If you have long-term disability insurance, you should file a claim as soon as you become disabled.
Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. But LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.
How do I file for Social Security Disability benefits?
You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.
If your initial application is denied, don’t be discouraged – most initial applications are – and you will have the opportunity to appeal. Lupus is a chronic disease that becomes progressively worse over time. Though you are initially denied, by the time you appeal and appear before an administrative law judge, your limitations may be so much worse that you qualify. There are four steps to the Social Security appeal process:
Do I need a disability attorney for SSDI?
If you have lupus and cannot work, you may be eligible for Social Security Disability benefits, but qualifying is complicated and applying for SSDI is a long process that can take several months to years.
Your chances for approval are increased significantly if you have legal representation. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.
Do I need a disability attorney for a long-term disability insurance claim?
Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.
The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.
At The Texas Disability law firm Bemis Roach & Reed, our attorneys are committed to helping injured or disabled clients receive the benefits they deserve. Mr. Roach is AV Preeminent and SuperLawyers rated and has become a recognized leader in the field of Long Term Disability law. Mr Bemis focuses his practice on Social Security disability while Mr Reed handles both LTD and SSDI claims. Both are AV Preeminent and SuperLawyers rated and all our attorneys have been successfully helping people fight for their rights against big insurance companies and the government since 1993. If you have applied for benefits and been denied call 512-454-4000 for a free consultation and get help NOW.
Author: Attorney Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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