Lupus and qualifying for Social Security Disability Benefits
Author: Attorney Greg Reed
Updated: 7/26/2024
Can I get disability benefits if I am suffering from the effects of Lupus?
To qualify for disability benefits with lupus, one must meet the requirements outlined in Social Security’s Blue Book under Section 14.02. This includes showing that lupus has affected two or more organs or body systems, along with experiencing specific symptoms like severe fatigue, fever, malaise, or weight loss. Alternatively, one can qualify by demonstrating limitations in daily activities, social functioning, or task completion due to lupus symptoms. Detailed medical evidence, including doctor’s observations and test results, is crucial to support a lupus diagnosis. If one’s symptoms do not precisely align with the listing criteria, they may still qualify for SSDI by proving their inability to work due to lupus effects.
Can I get disability benefits if I am suffering from the effects of Lupus?
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
- fatigue
- fever
- 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
- headaches
- 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, to qualify for disability benefits 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
OR
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:
- Malar rash
- Discord rash
- Photosensitivity
- Oral ulcers
- Arthritis
- Serositis
- Renal disorder
- Neurologic disorder
- Hematologic disorder
- Immunologic disorder and/or
- Antinuclear antibody
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.”
The Hartford did not dispute that our Austin client suffered from Systemic Lupus Erythematosus, a significant chronic disease, as well as Fibromyalgia and Polyarticular Inflammatory Arthritis.
According to the record, she suffered near constant oral ulcerations, frequent nasal ulcerations, alopecia (hair loss), fevers, sicca symptoms (dryness of the mouth and eyes), myalgias, Raynaud’s Syndrome, fatigue, and polyarticular inflammatory arthritis. The client’s treating physician stated that the client had been ill since the time she first saw her in April of 2005. The Hartford determined that, since there were no restrictions in the client’s ability to sit, stand, walk, or drive, she was functionally able to perform her job duties. However, her treating physician emphatically stated that she did not have the physical ability to return to her previous job or any similar job.
We helped the client fight her denial and were able to get her benefits reinstated.
The only medical justification referenced in the denial letter for Prudential’s determination that another client’s disability was due to mental illness, and thus limited to 24 months of benefits under her policy, was a Medical Evaluation by a reviewing physician.
This doctor clearly stated that our client was totally disabled but felt she was possibly in a psychotic state on the day of the examination. This doctor also offered that “this may very well be related to lupus or some sort of arthritis.” This, of course is possible. Systemic Lupus Erythematosus is well known to cause Lupus Psychosis. Lupus Psychosis is not, however, a mental illness. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, it is a “psychosis due to a general medical disorder.” Our client suffered from numerous other documented, serious health conditions for which her treating physician had certified her as being totally disabled.
She had also been awarded SSDI benefits. The reviewing physician admitted that our client’s chronic pain alone rendered her disabled, but Prudential chose to deny her benefits. We filed suit on her behalf, and Prudential settled, awarding our client a lump sum.
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Disability Benefits FAQs
Social Security has some basic financial requirements.
Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements. 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.
Basic SSDI Requirements –>
You may also be eligible for Social Security Disability benefits if you have another medical condition.
One disorder alone 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.
Disability for Multiple Impairments –>
If you are 55 or older or have another medical condition you may get approval.
Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job.
Disability for those over 55 –>
You may also be eligible for Social Security Disability benefits if you have another medical condition.
One disorder alone 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.
Disability for Multiple Impairments –>
Should you file a claim?
If you believe that you meet Social Security’s medical and financial requirements, you should apply for benefits. If you are still unsure or would like to talk to someone, please contact us at 512-454-4000. We are always ready to take your call and discuss your options with you free of charge. We are happy to help folks just like you find the best solution for their personal situation.
How do I file for Social Security Disability benefits?
Once you have decided to file a claim, you can take the first step and apply for Social Security Disability benefits in person at your local Social Security Administration office, online, or over the phone.
How to Apply for SSDI –>
Appealing denied benefits
Most who file are denied initially. That doesn’t mean you won’t qualify; you just need to file an appeal.
There are four steps to the Social Security appeal process.
SSDI Appeals Process –>
Do I need a disability attorney for SSDI?
You may certainly file a claim on your own, but evidence shows that your chances for approval are increased significantly if you have legal representation.
Do I need an SSDI attorney–>
What if I don’t qualify for SSDI?
If you haven’t worked long enough to earn enough work credits, or if you earn too much income, 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.
What is Supplemental Security Income or SSI?–>
I have long-term disability insurance – should I file a claim?
Absolutely – you should file a claim as soon as you become disabled.
LTD Disability Appeals Process–>
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 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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