WHAT IS LUPUS?
Lupus is a chronic, autoimmune, inflammatory disease caused when the immune system attacks its own tissues. It can damage any part of the body (skin, joints, and/or organs inside the body). Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus. There are many kinds of lupus. The most common type, systemic lupus erythematosus (SLE), affects many parts of the body.
CAN I RECEIVE SOCIAL SECURITY DISABILITY BENEFITS FOR LUPUS?
Lupus health problems, pain, and fatigue can impact your ability to work. Social Security Disability benefits may be available to you.
If you are not engaging in gainful activity due to Lupus, the Social Security Administration must determine if you have an impairment that is “severe.” This is step 2 of the evaluation process. (Visit my prior blog post explaining the steps of Social Security’s Sequential Evaluation Process.)
At step 3 of the Sequential Evaluation Process, the SSA determines if your condition meets a listing. Systemic lupus erythematosus is listed under SSA Medical Listing 14.02, the category of impairments known as the Immune System Disorders – Adult(14.00). To qualify as disabled under this listing, your medical records must show that you meet the following requirements:
A. Involvement of two or more organs/body systems (such as kidneys and brain or heart and lungs), with:
- One of the organs/body systems involved to at least a moderate level of severity
- At least two of the constitutional symptoms or signs (severe fatigue or exhaustion, fever, malaise, or involuntary weight loss)
B. Repeated manifestations of SLE, 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:
- Limitation of activities of daily living.
- Limitation in maintaining social functioning.
- Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.
To determine if an individual has been correctly diagnosed with SLE and that the listing has been “met,” Social Security follows the guidelines set out in the current Criteria for the Classification of Systemic Lupus Erythematosus, by the American College of Rheumatology. An individual must meet four criteria of the established eleven to be diagnosed with lupus. The criteria include:
- Malar Rash
- Discoid rash
- Oral ulcers
- Nonerosive Arthritis
- Pleuritis or Pericarditis
- Renal Disorder
- Neurologic Disorder
- Hematologic disorder
- Immunologic disorder
- Positive Antinuclear Antibody
Medical evidence proving these symptoms may include doctor observations, electrocardiography, and blood tests, but is also dependent on the type of maladies suffered.
If your diagnosis does not equal a listing, the Social Security Administration will next assess your residual functional capacity (RFC) (the work you can still do, despite your lupus), to determine whether you qualify for benefits at steps 4 and 5 of the Sequential Evaluation Process. The lower your RFC, the less the Social Security Administration believes you can do. In determining your RFC, the Social Security Administration adjudicator should consider all of your symptoms in deciding how they may affect your ability to function.
TIPS FOR SSDI APPLICATION FOR LUPUS
- Make sure a lupus diagnosis is in your medical records. We’ve mentioned this before for long-term disability, but it is also true for SSDI, “know your medical records.”
- Make sure your medical records document ALL of your constitutional symptoms and limitations. Let your doctor how often you feel the symptoms, how severe each symptom is and what limitations they cause. Lupus may cause you to have fatigue, chest pain, shortness of breath, vision problems, headaches, and abnormal heart rhythms. These symptoms could make it difficult to stand or walk. Make sure that all your medical problems are adequately documented by your doctor, and that you are receiving the appropriate medical attention for all of your disabling symptoms.
- See a specialist. A lupus diagnosis from a rheumatologist will carry more weight than the same diagnosis from a family physician or internist professional.
- See a mental health professional. If you are suffering from depression or anxiety, see a mental health professional to diagnose, treat, and document these conditions. SLE is often accompanied by or is the cause of mental health conditions. However, it is important that the actual lupus diagnosis comes from a specialist and not your counselor, therapist, or psychiatrist. (see above)
- See your doctor regularly and keep your appointments.
- If you can, provide evidence of a long work history.
- Provide examples of unsuccessful attempts to return to work and/or unsuccessful attempts to work in a decreased capacity.
- Include information from nonmedical sources to support your medical claims. Gather Information from neighbors, friends, relatives, clergy, and/or past employers about your impairments and how they affect your function. Have them document changes that they have seen in your ability over time. These are not given nearly as much weight as testimony from a medical professional, but they don’t hurt.
- Keep a journal. Make regular notes about your impairment, level of function, and treatments.
- If you need assistance, contact an attorney who specializes in Social Security Disability.
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